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A new study addresses the gaps in what new pathogenic factors can be linked to melasma, in particular with diet, living environments and other lifestyle factors.1 Interestingly, alcohol consumption has proven to be a potential trigger for melasma. These results and others differ from pre -established causes such as sun exposure, hormonal changes and genetic history.2
The Cas-Tesimo study took place at the Chinese Medicine Hospital in the Jiangsu province from April to October 2023. The average age of the 150 patients was 39.98 with 96% of them. Almost half of the participants had a type of fitzpatrick skin of III with the rest of the patients classified like II or IV. About 30% had family history of Mélasma, especially among parents in the first degree. After analyzing the facial lesions, the severity index of the median melasma area (MASI) was 7.5. Zygomatic and the cheeks were the most affected parts with an unequal centro-factory topographic preference of 54.67%.
A witness group of 142 healthy volunteers without melasma was also included in the study. This group had no statistically significant difference in sex, age and body mass index compared to the cohort of the case. In both groups, researchers have analyzed demographic and clinical characteristics as well as risk and protection factors.
Univariate and multivariate analyzes have also confirmed that sunburn or exposure before the sun ≥ 2 hours / day (gold: 19.43, 95%CI: 4.72–79.99), as well as an irregular menstrual cycle (gold: 4.32, 95%CI: 1.28–14.50), may be key risk factors. This has already been found in previous studies.
However, this research is the first to identify a strong positive relationship between the supply of alcohol and the melasma (gold: 20.05, 95%CI: 1.17–343.17). This could be due to the dysfunction of the liver associated with the consumption of alcoholic beverages, but more research is necessary to confirm the underlying mechanisms.
The study revealed a new additional trigger in breast cystic hyperplasia, which is more frequent in women (gold: 15.98, 95%CI: 4.28–59.72). This condition is associated with stress, levels of abnormal hormones and genetic history, which are existing factors of the occurrence of melasma.3
Several other characteristics have been identified as potential discounts for the risk of melasma, including the change of residence (gold: 0.03, 95%CI: 0.00–0.30), renovation of the house (gold: 0.13, 95%CI: 0.03–0.58) and intake in gas drinks (gold: 0.04, 95%CI 0.00-0.83). Reinstallation and renovation in cities with healthier and less polluted areas could be the reason for this. In addition, soft drinks can contain vitamin C, which has proven to manage pigment disorders such as melasma.
Other interesting results include the use of oral contraceptives (gold: 1.73, 95%CI: 1.00–2.98), the habit of rubbing the face (gold: 1.70, 95%CI: 1.00–2.90), and insomnia (gold: 1.88, 95%CI: 1.18–2.99), as potential trigments Mélasma.
The study has several limits, including the lack of diversified population and detailed analyzes of the subclass. Retrospective design can also create contradictory results. According to the authors, larger and multicenter studies with a more in -depth analysis “would help to determine whether our results are true in different demographic and geographic contexts”.
Before that, there have been very few epidemiological cases-testimonies that explored how these factors can lead to the start of melasma, especially in the under-represented Chinese population.
“These results collectively underline the multifactorial nature of melasma and the importance of systemic, environmental and lifestyle factors in its development,” concluded the authors. “The fight against these factors can lead to an improvement in preventive and therapeutic strategies for this condition.”
References
1. Shi y, Guo S, Tan C. Food and living environment as new etiological factors for melasma: the results form a case-testing study of 150 Chinese patients. J Cosmet Dermatol. 2025; 24 (2): E70038. DOI: 10.1111 / JOCD.70038
2. Handel AC, Miot LD, Miot ha. Mélasma: a clinical and epidemiological review. A media dermatol. 2014; 89 (5): 771-782. DOI: 10.1590 / ABD1806-4841.20143063
3. Espósito MCC, Espósito ACC, Jorge MFS, from Elia MPB, Miot Ha. Depression, anxiety and self -esteem in women with facial melasma: an internet survey in Brazil. Int j dermatol. 2021; 60 (9): E346-E347. DOI: 10.1111 / IJD.15490