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Holanda IRM, de Almeida Corrêa Alfredo M, Cassiano DP, Esposito ACC, Lima PB, Bagatin E, Miot HA. Efficacy of oral 5 mg melatonin in the treatment of facial melasma in women: A double-blind, randomized, placebo-controlled clinical trial. J Eur Acad Dermatol Venereol 2024; 38:e607-e609. [PMID: 38226560 DOI: 10.1111/jdv.19784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/19/2023] [Indexed: 01/17/2024]
Affiliation(s)
| | | | | | - Ana Cláudia Cavalcante Esposito
- Department of Dermatology, FMB-UNESP, Botucatu, SP, Brazil
- Universidade do Oeste Paulista (Unoeste), Presidente Prudente, SP, Brazil
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Zhou Y, Li Y, Hamblin MR, Wen X. Comparison of 755-nm picosecond alexandrite laser versus 1064-nm Q-switched Nd:YAG laser for melasma: A randomized, split-face controlled, 2-year follow-up study. Lasers Surg Med 2024; 56:263-269. [PMID: 38282099 DOI: 10.1002/lsm.23763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Pulsed laser treatment of melasma has shown some promising results. To compare the effectiveness and safety of 755-nm picosecond alexandrite laser (PSAL) fitted with diffractive lens array (DLA) versus 1064-nm Q-switched neodynimum:yttrium aluminum garnet laser (QSNYL) for the treatment of melasma. METHODS We conducted a randomized, split face controlled, 2-year follow-up study. Each face was divided into two parts, each side receiving three treatments with either PSAL or QSNYL at 1 month intervals. Modified Melasma Area Severity Index scores (mMASI), pain scores, patient satisfaction and adverse events were recorded. In vivo reflectance confocal microscopy (RCM) images were acquired. RESULTS Twenty subjects were enrolled and three dropped out. At 6 months, mMASI scores were significantly lower than baseline for QSNYL sides (p = 0.022), with no statistically significant difference between PSAL sides before and after treatment, PSAL sides versus QSNYL sides, or patient satisfaction scores. QSNYL treatment was associated with less pain (p = 0.014). No serious adverse events were reported. In the PSAL sides RCM showed a large number of dendritic melanocytes infiltrated in the dermis at 2 weeks and 4 weeks after treatment. Ten patients (58.82%) reported recurrence or exacerbation at 2-year follow-up with no statistically significant difference between the two lasers. CONCLUSIONS QSNYL demonstrated short term clinical efficacy for melasma, but did not provide any additional benefit compared to PSAL with DLA. QSNYL was associated with less pain. There was a high recurrence rate at 2-year follow-up. RCM allowed the detection of cellular changes in melasma lesions.
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Affiliation(s)
- Yanjun Zhou
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa
| | - Xiang Wen
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
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Trisnawaty S, Gunadi JW, Ratnawati H, Lesmana R. Carotenoids in red fruit ( Pandanus conoideus Lam.) have a potential role as an anti‑pigmentation agent (Review). Biomed Rep 2024; 20:54. [PMID: 38357234 PMCID: PMC10865171 DOI: 10.3892/br.2024.1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024] Open
Abstract
Melasma is a persistent condition characterized by excessive melanin production in the skin. The management of melasma necessitates a protracted treatment duration, which is associated with diminished levels of patient satisfaction. One effective strategy for mitigating occurrence of melasma is consumption of nutricosmetics with depigmentation properties. The present review aimed to investigate the potential of red fruit as a depigmentation agent. Carotenoids serve a crucial role in human nutrition as a precursor to vitamin A. Carotenoids serve as scavengers of reactive oxygen species generated by ultraviolet radiation. Carotenoids promote skin health. Red fruit, a fruit originating from Papua (Indonesia) has anti-pigmentation properties associated with its ability to block melanogenesis through various protein pathways such as PKA, ERK, and AKT signaling pathways. The consumption of food rich in carotenoids, such as red fruit, has advantageous properties to reduce hyperpigmentation and skin brightening.
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Affiliation(s)
- Sri Trisnawaty
- Master Program of Skin Ageing and Aesthetic Medicine, Faculty of Medicine, Universitas Kristen Maranatha, Bandung, West Java 40164, Indonesia
| | - Julia Windi Gunadi
- Department of Physiology, Faculty of Medicine, Universitas Kristen Maranatha, Bandung, West Java 40164, Indonesia
- Maranatha Biomedical Research Laboratory, Faculty of Medicine, Universitas Kristen Maranatha, Bandung, West Java 40164, Indonesia
| | - Hana Ratnawati
- Department of Histology, Faculty of Medicine, Universitas Kristen Maranatha, Bandung, West Java 40164, Indonesia
| | - Ronny Lesmana
- Physiology Division, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java 45363, Indonesia
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Zhao S, Wang M, Lai X, Yan Y. Efficacy and Safety of Ablative Fractional Laser in Melasma: A Meta-analysis and Systematic Review. Lasers Med Sci 2024; 39:71. [PMID: 38379033 DOI: 10.1007/s10103-024-03972-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/31/2023] [Indexed: 02/22/2024]
Abstract
Melasma is a common acquired skin pigmentation disorder. The treatment is urgent but challenging. Ablative fractional laser (AFL) can improve pigmentation, but the efficacy and potential side effects are still debatable. This study aimed to evaluate the efficacy and safety of ablative fractional lasers in the treatment of melasma. A comprehensive systematic search of literature published before June 20, 2023, was conducted on online databases, including PubMed, Embase, Cochrane Library, and Web of Science. The data obtained were analyzed using Review Manager 5.4 software. Fourteen randomized controlled trials, comprising 527 patients, were included. Compared to the drug alone, the combination of AFL and the drug showed improved therapeutic efficacy in the melasma area and severity index (MASI) (MD = 1.54, 95% CI [0.16, 2.92], P = 0.03) and physician global assessment (RR = 1.61, 95% CI [1.08, 2.41], P = 0.02). However, no statistically significant results were found in patient self-assessment (RR = 1.56, 95% CI [0.88, 2.76], P = 0.12). As an individual therapy, AFL is not superior to any other lasers in terms of MASI (MD = 2.66, 95% CI [-1.32, 6.64], P = 0.19) or melanin index (MD = -7.06, 95% CI [-45.09, 30.97], P = 0.72). Common adverse events included transient erythema, burning, edema, and superficial crusting. Only a few patients experienced reversible post-inflammatory hyperpigmentation, herpes labialis, and acne breakouts. These results support the application of AFL as a viable treatment option for melasma, particularly in refractory and severe cases. Rational parameterization or combination therapy may lead to significant clinical improvement with fewer complications.
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Affiliation(s)
- Shasha Zhao
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33 Badachu Shijingshan District, Beijing, 100144, China
| | - Meng Wang
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33 Badachu Shijingshan District, Beijing, 100144, China
| | - Xiaodong Lai
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33 Badachu Shijingshan District, Beijing, 100144, China
| | - Yan Yan
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33 Badachu Shijingshan District, Beijing, 100144, China.
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5
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Desai SR, Alexis AF, Elbuluk N, Grimes PE, Weiss J, Hamzavi IH, Taylor SC. Best practices in the treatment of melasma with a focus on patients with skin of color. J Am Acad Dermatol 2024; 90:269-279. [PMID: 37748556 DOI: 10.1016/j.jaad.2023.07.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/16/2023] [Accepted: 07/22/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Melasma is a chronic hypermelanosis of the skin that affects approximately 1% of the global population, predominantly affects women, and is more prevalent in skin of color. Melasma is a common driver for patients with skin of color to seek out a dermatologist for treatment, and ensuring the right approach for these patients is important because some treatments may be associated with adverse side effects. Because of the chronicity of the disease and established psychosocial and emotional impacts, there is a large need to ensure care follows the best available evidence on the treatment of patients with melasma. OBJECTIVE Here, we summarized current available topical treatments for melasma with considerations dermatologists should have for their patients with skin of color. METHODS Steering committee consensus on clinical best practices. RESULTS We describe a flexible and focused treatment algorithm that reflects both treatment and maintenance periods that is a consensus of our extensive clinical experience. LIMITATIONS Use of real-world evidence and potential for individual practice bias. CONCLUSION Melasma can be challenging to treat, particularly in patients with skin of color, and our recommendations for best practices for patients in the United States are an important step toward standardizing care.
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Affiliation(s)
- Seemal R Desai
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Innovative Dermatology, Plano, Texas.
| | - Andrew F Alexis
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine Dermatology, University of South California, Los Angeles, California
| | - Pearl E Grimes
- Division of Dermatology, Vitiligo & Pigmentation Institute of Southern California, David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Hospital; Hamzavi Dermatology/Dermatology Specialists, Detroit, Michigan
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Goh CL, Kang HY, Morita A, Zhang C, Wu Y, Prakoeswa CRS, Sau NH, Kerob D, Flament F, Wei L. Awareness of sun exposure risks and photoprotection for preventing pigmentary disorders in Asian populations: Survey results from three Asian countries and expert panel recommendations. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12932. [PMID: 38059515 DOI: 10.1111/phpp.12932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND In this article, we review and discuss the photoprotection behavior of Asians based on the literature, along with a subanalysis of an original online survey, and make recommendations to optimize photoprotection for Asian populations to prevent photoaging and pigmentary disorders. METHODS An international panel of eight dermatologists from Asia (China, Korea, Japan, Singapore, Indonesia, and Vietnam) met to discuss sunscreen photoprotection for Asian patients. Additionally, a subanalysis of an online survey by 3000 respondents from three Asian countries (China, Indonesia, and Japan) investigated general public awareness and attitudes to sun exposure. RESULTS A pre-meeting survey of the eight experts from Asia showed key concerns of Asian patients consulting dermatologists are pigmentary disorders, especially actinic/senile lentigo, post-inflammatory hyperpigmentation, melasma, vitiligo, and Hori's nevus. The survey subanalysis of participants from China, Indonesia, and Japan with predominantly Fitzpatrick skin types (FST) II to IV revealed that they are particularly concerned about sun exposure causing photoaging and pigmentary disorders. Most of the respondents indicated they have limited knowledge on sunlight radiation and appropriate sunscreen protection factors. Only 22%, 13%, and 3% for China, Indonesia, and Japan, respectively, systematically use multiple protective measures (using sunscreen, avoiding midday sun, staying in the shade, wearing a hat, protective clothing, and sunglasses) when exposed to the sun. CONCLUSIONS Further education is needed for Asian populations on the importance of comprehensive daily photoprotection, including broad-spectrum sunscreen, with high UVA and visible light protection, to reduce and prevent photoaging and pigmentary disorders.
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Affiliation(s)
| | - Hee Young Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Wu
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - Cita Rosita Sigit Prakoeswa
- Department of Dermatology and Venerology, Faculty of Medicine, Universitas Airlangga - Dr Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Nguyen Huu Sau
- Hanoi Medical University and National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Delphine Kerob
- Laboratoire Dermatologique La Roche-Posay, Levallois-Perret, France
| | | | - Liu Wei
- Department of Dermatology, The General Hospital of Air Force PLA, Beijing, China
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Sarkar R, Katoch S. Chemical Peels in Treatment of Melasma. Dermatol Clin 2024; 42:21-32. [PMID: 37977681 DOI: 10.1016/j.det.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Superficial chemical peels are one of the most popular skin resurfacing procedures in a dermatologists' clinic today due to quick application process, fast recovery, good patient acceptance, and excellent cosmetic results. The role of various peeling agents like glycolic acid, salicylic acid, trichloroacetic acid, Jessner's solution, retinoic acid, and lactic acid in the management of melasma has been established as that of an additional or maintenance therapy. This article details the current evidence and recommendations for the use of chemical peels in the treatment of melasma, a chronic and recurrent hyperpigmentary disorder.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and SSK and KSC Hospital, New Delhi 110001, India.
| | - Saloni Katoch
- Dr. KN Barua Institute of Dermatological Sciences, Guwahati, Assam, India
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8
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Galache TR, Sena MM, Tassinary JAF, Pavani C. Photobiomodulation for melasma treatment: Integrative review and state of the art. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12935. [PMID: 38018017 DOI: 10.1111/phpp.12935] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/06/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE Photobiomodulation therapy (PBM) is a versatile technique for treating skin diseases. Melasma, a chronic hyperpigmentation condition, has recently been associated with vascular features and dermal photoaging and poses significant management challenges. We review the recent literature on melasma etiology and the evidence supporting PBM as a therapeutic modality for melasma treatment. METHODS We conducted a comprehensive literature search in three different databases from May to August 2023, focusing on studies published in the past 10 years. The inclusion criteria comprised full-text studies investigating low-power lasers and/or light-emitting diodes (LEDs) in in vitro or in vivo models, as well as clinical trials. We excluded studies discussing alternative melasma therapies or lacking experimental data. We identified additional studies by searching the reference lists of the selected articles. RESULTS We identified nine relevant studies. Clinical studies, in agreement with in vitro experiments and animal models, suggest that PBM effectively reduces melasma-associated hyperpigmentation. Specific wavelengths (red: 630 nm; amber: 585 and 590 nm; infrared: 830 and 850 nm) at radiant exposures between 1 and 20 J/cm2 exert modulatory effects on tyrosinase activity, gene expression, and protein synthesis of melanocytic pathway components, and thus significantly reduce the melanin content. Additionally, PBM is effective in improving the dermal structure and reducing erythema and neovascularization, features recently identified as pathological components of melasma. CONCLUSION PBM emerges as a promising, contemporary, and non-invasive procedure for treating melasma. Beyond its role in inhibiting melanogenesis, PBM shows potential in reducing erythema and vascularization and improving dermal conditions. However, robust and well-designed clinical trials are needed to determine optimal light parameters and to evaluate the effects of PBM on melasma thoroughly.
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Affiliation(s)
- Thais Rodrigues Galache
- Postgraduate Program in Biophotonics Medicine, Universidade Nove de Julho, UNINOVE, São Paulo, SP, Brazil
| | - Michelle Mota Sena
- Postgraduate Program in Biophotonics Medicine, Universidade Nove de Julho, UNINOVE, São Paulo, SP, Brazil
| | | | - Christiane Pavani
- Postgraduate Program in Biophotonics Medicine, Universidade Nove de Julho, UNINOVE, São Paulo, SP, Brazil
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Mongkhon P, Ruengorn C, Awiphan R, Phosuya C, Ruanta Y, Thavorn K, Jamjanya S, Chuamanochan M, Nochaiwong S. Efficacy and safety of metformin for melasma treatment: a systematic review and meta-analysis. Front Pharmacol 2023; 14:1281050. [PMID: 38192412 PMCID: PMC10773746 DOI: 10.3389/fphar.2023.1281050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
Objective: Metformin has recently been demonstrated to have an anti-melanogenic activity. Nevertheless, clinical evidence of the effectiveness of metformin in melasma is lacking. The objective of this study was to assess the efficacy and safety of metformin in the treatment of melasma. Methods: MEDLINE, Embase, PubMed, Cochrane Library (CENTRAL), Scopus, CINAHL, and grey literature databases were searched to 4 October 2022 and updated on 26 February 2023. Randomized controlled trials (RCTs), quasi-RCTs, observational studies, case series, and case reports investigating the efficacy and safety of metformin for melasma were included. The Melasma Area Severity Index (MASI) scores that changed from baseline were pooled using fixed-effects model and expressed as standardized mean differences (SMDs) and 95% confidence intervals (CIs). Results: Three RCTs including 140 patients with melasma were included. The results demonstrated that after 8 weeks, 15% topical metformin significantly reduced the Melasma Area Severity Index (MASI) score compared to placebo (1 trial; n = 60; MD, -0.56; 95% CI, -1.07 to -0.04; p = 0.034). Furthermore, when compared to triple combination cream (TCC), 30% topical metformin demonstrated similar efficacy in reducing the MASI score after 8 weeks (2 trials; n = 80; MD, 0.19, 95% CI, -0.25 to 0.63; p = 0.390). Patients using 30% topical metformin had fewer adverse events compared to TCC users, although no statistical difference was found. Conclusion: Topical metformin was as effective as triple combination cream (TCC) in decreasing changes in the MASI score in patients with melasma, with minimum adverse events. Further studies with larger sample sizes, longer follow-up times, and well-designed trials are required. Systematic Review Registration: Identifier PROSPERO (CRD42022351966).
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Affiliation(s)
- Pajaree Mongkhon
- Pharmacoepidemiology, Social and Administrative Pharmacy (PSAP) Research Unit, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Chidchanok Ruengorn
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Ratanaporn Awiphan
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Chabaphai Phosuya
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Yongyuth Ruanta
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Kednapa Thavorn
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Mati Chuamanochan
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Surapon Nochaiwong
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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Rodríguez-Luna A, Zamarrón A, Juarranz Á, González S. Clinical Applications of Polypodium leucotomos (Fernblock ®): An Update. Life (Basel) 2023; 13:1513. [PMID: 37511888 PMCID: PMC10381169 DOI: 10.3390/life13071513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Exposure to sun radiation leads to higher risk of sunburn, pigmentation, immunosuppression, photoaging and skin cancer. In addition to ultraviolet radiation (UVR), recent research indicates that infrared radiation (IR) and visible light (VIS) can play an important role in the pathogenesis of some of these processes. Detrimental effects associated with sun exposure are well known, but new studies have shown that DNA damage continues to occur long after exposure to solar radiation has ended. Regarding photoprotection strategies, natural substances are emerging for topical and oral photoprotection. In this sense, Fernblock®, a standardized aqueous extract of the fern Polypodium Leucotomos (PLE), has been widely administered both topically and orally with a strong safety profile. Thus, this extract has been used extensively in clinical practice, including as a complement to photodynamic therapy (PDT) for treating actinic keratoses (AKs) and field cancerization. It has also been used to treat skin diseases such as photodermatoses, photoaggravated inflammatory conditions and pigmentary disorders. This review examines the most recent developments in the clinical application of Fernblock® and assesses how newly investigated action mechanisms may influence its clinical use.
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Affiliation(s)
- Azahara Rodríguez-Luna
- Department of Basic Health Sciences, Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), 28933 Alcorcón, Spain
- Department of Pharmacology, Faculty of Pharmacy, University of Seville, 41012 Seville, Spain
| | - Alicia Zamarrón
- Department of Biology, Faculty of Sciences, Autónoma University of Madrid (UAM), 28049 Madrid, Spain
| | - Ángeles Juarranz
- Department of Biology, Faculty of Sciences, Autónoma University of Madrid (UAM), 28049 Madrid, Spain
| | - Salvador González
- Department of Medicine and Medical Specialties, Alcalá de Henares University, 28805 Madrid, Spain
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Liang S, Shang S, Zhang W, Tan A, Zhou B, Mei X, Li L. Comparison of the efficacy and safety of picosecond Nd:YAG laser (1,064 nm), picosecond alexandrite laser (755 nm) and 2% hydroquinone cream in the treatment of melasma: A randomized, controlled, assessor-blinded trial. Front Med (Lausanne) 2023; 10:1132823. [PMID: 37056729 PMCID: PMC10086227 DOI: 10.3389/fmed.2023.1132823] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundIncreasing numbers of studies demonstrated that picosecond lasers (Picos) were effective and safe for melasma. However, A limited number of randomized controlled trials (RCTs) regarding Picos contribute to a modest level of evidence. Topical hydroquinone (HQ) remains to be the first-line therapy.ObjectiveTo compare the efficacy and safety of non-fractional picosecond Nd:YAG laser (PSNYL), non-fractional picosecond alexandrite laser (PSAL), and 2% HQ cream in the treatment of melasma.MethodSixty melasma patients with Fitzpatrick skin types (FST) III-IV were randomly assigned to the PSNY, PSAL, and HQ groups at a 1:1:1 ratio. Patients in PSNYL and PSAL groups received 3 laser sessions at 4-week intervals. The 2% HQ cream was applied twice daily for 12 weeks in patients of the HQ group. The primary outcome, the melasma area and severity index (MASI) score, was evaluated at weeks 0, 4, 8, 12, 16, 20, and 24. The patient assessment score by quartile rating scale was rated at weeks 12, 16, 20, and 24.ResultsFifty-nine (98.3%) subjects were included in the analysis. Each group showed significant change from baseline in MASI scores from week 4 to week 24. The MASI score in the PSNYL group showed the greatest reduction compared to the PSAL group (p = 0.016) and HQ group (p = 0.018). The PSAL group demonstrated comparable MASI improvement as the HQ group (p = 0.998). The PSNYL group had the highest patient assessment score, followed by the PSAL group and then the HQ group, although only the differences between PSNYL and HQ groups at weeks 12 and 16 were significant. Four patients (6.8%) experienced recurrence. Other unanticipated events were transient and subsided after 1 week to 6 months.ConclusionThe efficacy of non-fractional PSNYL was superior to that of non-fractional PSAL, which was not inferior to 2% HQ, thus non-fractional Picos providing an alternative for melasma patients with FSTs III-IV. The safety profiles of PSNYL, PSAL, and 2% HQ cream were similar.Clinical Trial Registrationhttps://www.chictr.org.cn/showprojen.aspx?proj=130994, ChiCTR2100050089.
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Decrypting the Potential of Nanotechnology-Based Approaches as Cutting-Edge for Management of Hyperpigmentation Disorder. MOLECULES (BASEL, SWITZERLAND) 2022; 28:molecules28010220. [PMID: 36615414 PMCID: PMC9822493 DOI: 10.3390/molecules28010220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
The abundant synthesis and accretion of melanin inside skin can be caused by activation of melanogenic enzymes or increase in number of melanocytes. Melasma is defined as hyperpigmented bright or dark brown spots which are symmetrically distributed and have serrated and irregular borders. The three general categories of pigmentation pattern include centro facial pattern, malar pattern, and mandibular pattern. Exposure to UV rays, heat, use of cosmetics and photosensitizing drugs, female sex hormonal therapies, aberrant production of melanocyte stimulating hormone, and increasing aesthetic demands are factors which cause the development of melasma disease. This review gives a brief overview regarding the Fitzpatrick skin phototype classification system, life cycle of melanin, mechanism of action of anti-hyperpigmenting drugs, and existing pharmacotherapy strategies for the treatment of melasma. The objectives of this review are focused on role of cutting-edge nanotechnology-based strategies, such as lipid-based nanocarriers, i.e., lipid nanoparticles, microemulsions, nanoemulsions, liposomes, ethosomes, niosomes, transfersomes, aspasomes, invasomes penetration-enhancing vesicles; inorganic nanocarriers, i.e., gold nanoparticles and fullerenes; and polymer-based nanocarriers i.e., polymeric nanoparticles, polymerosomes, and polymeric micelles for the management of hyperpigmentation.
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