On which of the following areas a nurse would expect Chloasma?

WCL Staff Nurse - 2019

Obstetrics & Gynecology

Easy

Appeared in: WCL Staff Nurse - 2019

Explanation

Chloasma, also known as melasma gravidarum or the "mask of pregnancy," is a common form of hyperpigmentation that occurs during pregnancy.
It is characterized by symmetric, irregular brownish patches on sun-exposed areas of the body.
The most frequent locations for chloasma are on the face, specifically the cheeks, forehead, and the bridge of the nose, as depicted in the provided image.
This condition is triggered by hormonal changes, primarily increased estrogen, which stimulates melanocytes to produce more pigment.

Option A: This option describes areolar hyperpigmentation. While the breasts, areola, and nipples do darken during pregnancy due to hormonal changes, this specific change is not referred to as chloasma.
Option B: These areas are not the primary or typical sites for chloasma. While some minor skin pigmentation changes can occur on the neck, chloasma is characteristically a facial condition.
Option C: This option lists the common locations for striae gravidarum (stretch marks), which are another type of skin change in pregnancy. Striae are caused by the stretching of the skin, not hyperpigmentation.

Clinical Relevance

Nursing practice connection: Knowing Physiological Skin Changes in Pregnancy: Chloasma helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A key nursing role is to provide reassurance and education. Patients may be distressed by the appearance of chloasma, and it's important to inform them that it is a normal, temporary change that usually resolves after childbirth.
Nurses should emphasize the importance of sun protection. Sun exposure can significantly darken the patches, so advising the use of broad-spectrum sunscreen and protective clothing is a crucial part of patient care.
What if? If a patient reports that the pigmented patches are painful, itchy, bleeding, or rapidly changing in size or shape, this is not characteristic of chloasma. The nurse should advise the patient to see a healthcare provider or dermatologist to rule out other skin conditions, including malignancy.

How to Approach the Question

First, identify the key term in the question: "Chloasma."
Recall the common name for chloasma, which is the "mask of pregnancy." This name itself provides a strong clue about its location.
Analyze the provided image, which clearly shows hyperpigmentation on a woman's face, confirming the facial location.
Evaluate the given options based on this knowledge. Option D, "Cheeks, Forehead, Nose," directly aligns with the facial areas affected by the "mask of pregnancy."
Systematically eliminate the other options by associating them with different, distinct skin changes that occur during pregnancy: Option A (areolar darkening), Option C (striae gravidarum).

Concept Tested & Keywords

Concept Tested: Physiological Skin Changes in Pregnancy: Chloasma
Stem keywords: Chloasma, nurse, area
Lead-in keywords: On which
Clinical cues: The image provided shows a woman with hyperpigmentation on her cheeks and forehead, which is a classic visual cue for chloasma.

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E6 Obstetrics Williams p. 40-59

E6 Medicine Harrison 22e Part 1 pp. 419-421, 440-442