Natural options for management of melasma, a review

Promoting public skin health through a national continuing medical education project on cosmetic and dermatologic sciences: a 15-year experience

Background

The developments in cosmetic sciences and technologies have generated a gap between the cosmetics and their users. Users including regular customers, clinicians, industry personnel, researchers, testing agencies, beauty salon workers, and mass media hardly possess the ability to distinguish truth from falsehood. The gap remained as one major reason for inappropriate cosmetics usage, insufficient efficacy, and even cosmetics adverse reactions (CARs).

Methods

Aiming at enhancing the relevant practitioners' cosmetic and dermatologic sciences, we launched a cosmetic and dermatologic sciences continuing medical education (CME) since 2008. The objective of the current study was to evaluate the effectiveness of the CME. We summarized and analyzed the project for the last 15 years. Meanwhile, an online survey consisted of three parts was performed to evaluate the CME and to collect the trainees' comments.

Results

A total of 3,923 trainees have participated in the CME project from 2008 to 2022. The trainees included clinicians, industry staffs, biomedical researchers, third-party cosmetics testing staffs, beauty salon staffs, students, and media staffs. The trainees had theory courses on cosmetic and dermatologic sciences, cosmetics DIY practice & video watching, and an optional guided tour during the 4.5-day CME. Eight hundred and twenty-three trainees and 586 control subjects responded to the online survey. The comprehensive test in the second part of the survey demonstrated that compared with the control group, the CME project significantly enhanced the trainees' perception and knowledge regarding the cosmetics formula sciences, basic dermatologic sciences, cosmetics usage, noninvasive measurements, new advances, CARs, and laws (p = 0.000). Trainees of all occupations ranked "basic dermatologic sciences and skin diseases" as the most significant sections. Trainees of all occupations believed the CME has contributed most in "understand the function & efficacy of cosmetics." We noticed the occupational variances. Over 97% of trainees were willing to recommend the CME to the others.

Conclusion

The CME project significantly enhanced the trainees' cosmetic and dermatologic sciences, which bridged the gap between cosmetics and public skin health. This multidisciplinary CME also contributed to establishing an interdisciplinary interaction and cooperation platform for the multiple occupations involved in the public skin health maintenance and promotion.

Design and development of tranexamic acid loaded film-forming gel to alleviate melasma

BACKGROUND

Melasma is a skin condition that causes increased epidermal pigmentation, enlarged melanocytes, increased melanosomes, solar elastosis, dermal blood vessels, and, occasionally, perivascular lymph histiocytic infiltrates.

OBJECTIVE

To develop the film-forming gel to alleviate melasma. Tranexamic acid was used as a model drug to evaluate the suitability of formulation to prevent symmetric hyperpigmentation.

METHODS

FFG is a hydrophilic polymeric cross-linked system loaded with an active moiety. Nine different formulations of 2% TXA were formulated using polyvinyl alcohol and hydroxypropyl methylcellulose 50 cP as film-forming polymers. Sodium carboxymethylcellulose, methylcellulose, and carbopol were used as gelling agents.

RESULTS

F7, F8, and F9 showed shorter DT, that is, 11, 8, and 12 min, respectively. The folding endurance of F7, F8, and F9 was >100 folds, and the pH of F7, F8, and F9 was >6. Among three formulations, F8 was further analyzed for in vitro drug diffusion, which showed >95% drug diffusion within 48 h. In vivo, the skin irritation potential of F8 was estimated using BAL/C mice, which confirmed the absence of skin irritation.

CONCLUSION

From the obtained results, we conclude that the FFG can be a strategic attempt to deliver the cosmeceutical drugs like TXA to alleviate Melasma with improved sustainability of the drug.

Thiamidol containing treatment regimens in facial hyperpigmentation: An international multi-centre approach consisting of a double-blind, controlled, split-face study and of an open-label, real-world study

Objective

Tyrosinase is the rate‐limiting enzyme in melanogenesis. Thiamidol is the most potent inhibitor of human tyrosinase out of 50 000 tested compounds. In clinical studies, it was shown to improve facial hyperpigmentation, post‐inflammatory hyperpigmentation and age spots significantly. To identify the optimal number of daily Thiamidol applications, we conducted a split‐face study comparing the efficacy and tolerability of four‐times with two‐times daily application. Subsequently, we evaluated the efficacy and tolerability of a typical face care regimen containing Thiamidol in a real‐world study.

Methods

The split‐face study was double‐blind, randomized, controlled, including two Thiamidol containing products (serum and day care SPF 30). The serum was applied twice daily on one half of the face and the day care SPF30 twice‐daily on the whole face. The real‐world study was open‐label, observational, including three Thiamidol containing products (day care SPF 30 in the morning, serum and night care in the evening). In both studies, subjects with mild‐to‐moderate facial hyperpigmentation applied the products over 12 weeks. Assessments included clinical and subjective grading of hyperpigmentation, skin condition, hemi‐/modified MASI, chromameter and clinical photography.

Results

In the split‐face study (n = 34), hyperpigmentation, skin roughness and hMASI improved all significantly (P < 0.001) versus baseline, with first visible results after two weeks of twice‐daily application. The four‐times daily application led to significant improvement versus the two‐times daily application. In the real‐world study (n = 83), all evaluated parameters, including skin condition and chromametry (n = 30), improved significantly (P < 0.001) in comparison with baseline and the corresponding preceding visits. The subjects judged the cosmetic properties of the products positively. In both studies, the products were well tolerated.

Conclusion

Four‐times daily Thiamidol improves facial hyperpigmentation significantly more than two‐times daily and is well tolerated by the subjects. The real‐world study with a typical face care regimen containing Thiamidol shows improvement of facial hyperpigmentation and confirms tolerability. Furthermore, the data provide evidence for the suitability of this three‐product Thiamidol regimen for day‐to‐day life.

Evaluation of Modified Melasma Area and Severity Index in Hyperthyroid Patients Receiving Anti-thyroid Drugs

BACKGROUND: Melasma is a common hyperpigmentation disorder, which causes brownish discoloration of the face. Despite unclear mechanisms, thyroid hormones were thought to play a role in melasma. AIM: This study aims to determine and compare the clinical improvement of melasma in hyperthyroid patients receiving anti-thyroid drugs. METHODS: An interventional study with a quasi-experimental design (pre-post-intervention study) was conducted at the Internal Medicine Outpatient Clinic and Dermatology and Venereology Outpatient Clinic, Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from July 2019 to March 2020. A comparative analysis was done to compare the modified melasma area and severity index (mMASI) in hyperthyroid patients before and after 12 weeks of anti-thyroid drugs. All subjects did not receive any additional topical therapies for their melasma. The clinical features were evaluated objectively at baseline and 12th-week visit, by mMASI score on different areas of the face (forehead, left-right malar, and chin) and Wood’s lamp examination. RESULTS: All areas showed a decline in mMASI score components (e.g., involvement areas and darkness degree) after 12 weeks of treatment. However, only the malar area showed a significant decline (p < 0.05). Wood’s lamp examination at baseline revealed dermal type melasma on 17 subjects, mixed type on six subjects, and epidermal type on one subject. All types remained unchanged after 12 weeks of treatment. CONCLUSIONS: Our study demonstrated that mMASI score in malar area improved significantly, this might be because malar area included this study were comprised of epidermal, dermal, and mixed type. On the other hand, based on Wood’s lamp examination, all types of melasma remained unchanged after 12 weeks of treatment.