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Type O with Melasma


I'm type O. My dermatologist tells me I have melasma, dark spots on my face. Is there anything that you can recommend?


Melasma is a common acquired increase of pigmentation that occurs exclusively in sun-exposed areas. Brownish in color, it is exacerbated by sun exposure, pregnancy, oral contraceptives, and certain anti-epilepsy drugs. Melasma is reasonably common, especially in women of child-bearing age. However, up to 10% of cases have been reported in males. While all races are affected, there is a prominence among Latinos and Asians. Melasma is more apparent during and after periods of sun exposure and less obvious in winter months, when sun exposure is lacking. Melasma presents itself in one of the three usually symmetrical facial patterns. The most common is a centrofacial pattern involving the cheeks, forehead, upper lip, nose, and chin. Less common are the malar pattern, involving the cheeks and nose, and the mandibular pattern, involving the ramus of the mandible (the side of the cheeks and jawline). Melasma also occurs on the forearms, but this is rare.

Melasma has been considered to arise from pregnancy, oral contraceptives, endocrine dysfunction, genetic factors, medications, nutritional deficiency, hepatic dysfunction, and other factors. The majority of cases appear related to pregnancy or oral contraceptives.

There is a syndrome named Congenital Generalized Lipodystrophy (CGL) characterzied by marked insulin resistance, high blood triglycerides and melasma -which interestingly enough has the gene for its origin at 9q34, exactly the same site as the gene for ABO blood type. (1)

There is some thought that nutrient deficiencies may give rise to melasma, so from a supplement standpoint, a good multivitamin, with sizeable levels of the B complex is probably a pretty good idea. Since insulin resistance is linked to melasma (2) it is great that you will be following the low-lectin type O diet

Most of the time melasma will slowly resolve following childbirth or upon discontinued use of oral contraceptives. If not, bleaching agents (mandelic acid is one), retinoic acid (Retin A) and religious use of sun block will often help.

1. Garg A, Wilson R, Barnes R, Arioglu E, Zaidi Z, Gurakan F, Kocak N, O'Rahilly S, Taylor SI, Patel SB, Bowcock AM. A gene for congenital generalized lipodystrophy maps to human chromosome 9q34. J Clin Endocrinol Metab 1999 Sep;84(9):3390-4

2. Jaffiol C, Rouard M, Macari F, Lautier C, Ait el Mkadem S, Mechaly I, Brun JF, Renard E, Cros G, Bringer J, Grigorescu F. [Insulin resistance: from clinical diagnosis to molecular genetics. Implications in diabetes mellitus]. Bull Acad Natl Med. 1999;183(9):1761-75; discussion 1775-7.

The Ask Dr. D'Adamo internet advice column ran from 1996 to 2009, at which time Dr. D'Adamo's teaching and programming responsibilities no longer allowed him to devote time and resources to directly answering visitor questions. However we've recently reorganized this treasure-trove of material and made it again available to his readership. He occasionally posts new entries. These are marked with a NEW tag.

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