Les taches pigmentaires

Zitouni Imounachen 14/02/2024 197

DE QUOI S’AGIT-IL?
Appelées aussi taches de soleil, ou lentigos, les taches brunes sont des altérations pigmentaires qui se présentent sous forme de macules et de plaques irrégulières, allant du brun clair au gris brun. Elles atteignent essentiellement les zones cutanées exposées au soleil comme le visage, le cou, les épaules et les bras. Les taches brunes sont liées à la production excessive et la répartition inégale de la mélanine.

Il existe différents types de taches brunes:
– Mélasma ou chloasma : communément appelé « masque de grossesse » ; est une affection bénigne de la peau qui survient principalement chez les femmes enceintes ou sous un traitement hormonale.
– Lentigos actiniques (hypermelanioses épidermiques) : ce sont des pigmentations en motte ; elles sont localisées aux niveau des zones les plus exposées aux radiations UV.
– Lentigos séniles, lentigines ou taches de sénescence : ce sont des troubles bénins de la pigmentation cutanée, caractérisés par des petites taches chamoisées, planes, de couleur uniforme liées en grande partie à la vieillesse, mais aussi, aux radiations UV.
– Les taches post inflammatoires: ce sont souvent des cicatrices d’acné, brûlure, frottement, etc.

Les altérations pigmentaires, en général, s’amorcent à la trentaine, avec plus de 30% des 30-39 ans concernés. Cette proportion augmente avec l’âge : à 60 ans prés de 60% des femmes sont concernées.
La taille des lentigos varie de quelques millimètres à quelques centimètres. Les manifestations du photo-vieillissement sont plus ou moins présentes en fonction du groupe ethnique.
Tout âge confondu, le vécu des taches est plus stigmatisant que celui des rides. Par ailleurs, il existe une différence entre les taches brunes et les grains de beauté, les kératoses séborrhéiques et le mélanome.


CAUSES :
Les facteurs étiologiques dans la pathogenèse des lentigos comprennent les influences génétiques, l’exposition aux rayons UV, la grossesse, les traitements hormonaux, les cosmétiques et les médicaments phototoxiques ou photosensibilisants.
Radiations UV :
Les UVA et UVB entrainent une production excessive d’espèces réactives de l’oxygène (ERO) dans les cellules
cutanées et au niveau de la matrice extracellulaire. Les capacités de défense antioxydante vont être dépassés par la surproduction du (ERO), ce qui va entraîner l’apparition du stress oxydant. Celui-ci, induit notamment par les UVA, va être à l’origine des dégâts conduisant à l’héliodermie (photo-vieillissement).
Âge :
Le lentigo sénile, apparaît vers la cinquantaine sur les zones découvertes de la peau, plus particulièrement sur le visage, et le dos des mains. Elles peuvent être à l’origine d’un processus sénile prolifératif débutant.
Hormones:
• Grossesse :
Pendant la grossesse, les modifications hormonales peuvent être à l’origine de l’apparition des dermatoses hyperchromiques. C’est le cas du chloasma, hypermelanoses ou masque de grossesse. Les femmes brunes de phototype IV sont les plus touchées. Les contours des taches sont irréguliers, avec une disposition symétrique sur le front, les joues, les tempes et la lèvre supérieure. Cette hyperpigmentation disparaît régressivement après l’accouchement. Une pigmentation résiduelle peut, cependant, subsister des mois voire des années plus tard.
• Pilule :
Lors des traitements oestro-progestatifs, 5 à 30% des femmes utilisant des contraceptifs oraux présentent une hyperpigmentation cutanée à contours irréguliers avec une disposition symétrique semblable aux taches de grossesse. L’hyperpigmentation est intensifiée par les radiations UV.
D’autres hormones, souvent synthétisées par l’hypophyse (comme l’ACTH) peuvent aussi causer certaines hyperpigmentations liées à des maladies endocriniennes.
• Les médicaments photosensibilisants :
Certains médicaments induisent des hyperpigmentations cutanées comme :
L’imipramine qui cause un cas rare de pigmentation faciale bleu gris.
La monocycline, dérivé semi synthétique de la tétracycline, qui peut induire des troubles pigmentaires. Trois types distincts de pigmentation cutanée ont été décrits.
Type I, pigmentation bleu-noir confinée aux sites de cicatrices ou d’inflammation du visage;
Type II, pigmentation circonscrite bleu-gris de la peau normale du bas des jambes et des avant-bras;
Type III, pigmentation brune boueuse de peau normale accentuée dans les zones exposées au soleil.

 

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