Shelemba E. Optimization of management tactics for patients with facial hyperpigmentation with different skin phototypes

In the dissertation, the new method of management of patients with facial hyperpigmentation with different skin phototypes was suggested: author has studied the clinic-epidemiological features of melasma and post-inflammatory hyperpigmentation depending on skin phototype and patient’s sex; the biochemical, hormonal and vitamin D-status of patients with different types of hyperpigmentation and different skin phototypes; the depth of pigment deposition using Wood’s lamp and dermatoscopic features in different types of hypermelanoses and different skin phototypes were evaluated; gender-related and biophysical features of affected skin areas in patients with facial hypermelanoses depending on skin phototypes were determined. The aim of study was optimization of treatment effectiveness of facial hypermelanoses in patients with different skin phototypes based on the study of role of vitamin D deficiency and insufficiency, biophysical skin changes in the pathogenesis of dermatosis and complex personified treatment method based on the administration of vitamin D3 and topical azelaic acid. During the initial stage of study, clinic-epidemiological signs of melasma and post inflammatory hyperpigmentation depending on the skin phototype and patients’ gender were studied. In the gender analysis of patients’ distribution depending of skin phototype it was noticed that the number of patients with dark skin phototypes (IV-VI) was greater than the number of patients with light skin phototypes. In 48 % of patients minimum one close relative also had facial hypermelanosis. In analysis of the duration of the disease it was established, that most patients have been suffering from facial hypermelanoses from 1 to 5 years. During the next stage of study, the biochemical, hormonal and D status of patients with different hypermelanoses and skin phototypes was established. The clinic-hormonal and biochemical studies were performed in patients with different types of facial hypermelanoses (in 64 patients with melasma and in 51 patients with post inflammatory hyperpigmentation) and in 25 healthy persons (16 females and 9 males), who were in the control group. The mentioned analyses were done before the administration of treatment. Patients with all types with facial hypermelanoses (both males and females) had significant biochemical disturbances; 61,7 % of patients with facial hypermelanoses had the disturbances of sex hormones, deficiency and insufficiency of vitamin D levels, which should be taken into consideration in management, treatment and rehabilitation of such patients. Author has developed the comprehensive and personalized treatment method for patients with facial hypermelanoses depending on the deficiency or insufficiency of vitamin D level in blood serum, type of hypermelanosis and skin phototype, which is based on the integrated usage of vitamin D3 and azelaic acid. The implementation of the developed treatment method has enabled significant improvement in 25 (64,1 %) patients with melasma, who were treated according to the developed method, and only in 1 (7,1 %) of patients, who received the traditional therapy; among patients with post-inflammatory hyperpigmentation – in 22 (61,1 %) and 4 (26,6 %) accordingly. The positive dynamics of skin process in all types of facial hypermelanoses was accompanied by the elevation of vitamin D levels, life quality indexes, which were higher in patients treated by the developed method.