彭鹰 刘毅

[摘要]黄褐斑是一种常见于育龄期妇女光暴露皮肤部位的对称性色素沉着性疾病。其病因及机制尚未完全阐明，已知相关因素有遗传易感性、紫外线照射及性激素等，成纤维细胞、角质形成细胞及其分泌因子参与黄褐斑的发生过程，近年来其发病机制在基因水平也有一定研究。随着对黄褐斑的逐步认识，其诊断工具也有所发展，除传统的非侵入性成像工具Woods灯外，皮肤镜、共聚焦显微镜及多光子显微镜也逐渐用于黄褐斑。由于黄褐斑的难治性及复发性，黄褐斑的有效治疗始终是一项重大挑战。尽管黄褐斑临床治疗方案繁多，但目前仍以药物治疗为主。更多作用于抑制黑色素合成、减少血管生成、抗炎症及抗氧化等各种途径的新型药物将为未来黄褐斑的治疗提供新思路。

[关键词]黄褐斑;发病机制;治療;新药;色素沉着

[中图分类号]R758.4+2    [文献标志码]A    [文章编号]1008-6455（2020）03-0162-04

Abstract： Melasma is a symmetrical pigmentation disorder mainly involving the sun-exposed areas of women in their reproductive time. Its etiology and mechanisms have not been fully elucidated. Related factors include genetic predisposition， ultraviolet radiation and sex hormones. Fibroblasts， keratinocytes and their secretory factors are involved in the process of melasma. In recent years， there is also a certain understanding about its gene expression. Diagnostic tools have also been developed with the update of its pathogenesis. Non-invasive imaging tools include Wood's lamps， dermoscopy， confocal and multiphoton microscopes. Due to its refractory and recurrent characteristics， effective treatments have always been a major challenge. Although there are a variety of therapeutic options， drugs are the mainstay. Novel treatments have been constantly discovered which target  inhibiting melanin formation， angiogenesis， inflammation， oxidative stress and other underlying etiology. And these will provide some new strategies for better treatment of melasma in the future.

Key words： melasma; pathogenesis; treatment; new drugs; hyperpigmentation

黄褐斑是一种获得性皮肤色素沉着增加性疾病，常见于女性及较深肤色人群。黄褐斑在影响美观的同时，还对患者心理造成一定伤害，生活质量研究显示黄褐斑对情绪状态、正常社交及日常生活均有严重负面影响[1]。目前，其相关因素包括遗传因素、紫外线暴露、性激素、甲状腺疾病、微量元素缺乏及服用抗抑郁药等[2-6]。近年来，对黄褐斑的发病机制有进一步的认识，黄褐斑形成除主要涉及黑色素相关信号分子及通路外，炎症反应、屏障功能受损和氧化应激也可能参与其发病过程，这为新的药物研究提供了方向。……