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Philipp-Dormston WG. Melasma: A Step-by-Step Approach Towards a Multimodal Combination Therapy. Clin Cosmet Investig Dermatol 2024; 17:1203-1216. [PMID: 38800358 PMCID: PMC11128260 DOI: 10.2147/ccid.s372456] [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: 01/12/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024]
Abstract
Melasma is a common challenge in the field of pigmentary skin disorders, exerting a significant emotional and psychosocial burden on patients. The persistent and recurring nature of melasma complicates its management in routine clinical practice. This comprehensive review outlines a stepwise, practical approach encompassing diagnostic, preventive and therapeutic strategies for the management of melasma. A thorough exploration of aggravating and exacerbating factors, including sun exposure, hormonal imbalances, photosensitizing medication and cosmetics, is essential for a holistic assessment of the disease. With an emphasis on consistent and effective photoprotection, initial topical treatment modalities target the melanin production and/or the transfer of melanosomes to keratinocytes. Topical tyrosine inhibitors emerge as the first choice for reducing and preventing hyperpigmentation, with compounds such as thiamidol or tranexamic acid (TXA) being preferred for their safety profile over hydroquinone (HQ), kojic acid and arbutin. Combination with chemical peels can further enhance the therapeutic efficacy, even in cases with resistant melasma. In more severe cases, laser- and light-based interventions may be considered, but with the caveat of the likelihood of recurrence within 3-6 months. Assisted TXA delivery, via either fractional non-ablative laser or microneedling techniques, can further improve clinical outcomes. In conclusion, an optimal melasma management strategy is a multimodal approach, which includes effective photoprotection and a mix of different topical treatments targeting melanin synthesis, the anti-inflammatory environment, senescence and vascularity. Complementary procedures, such as chemical peels, and laser, light-based or microneedling procedures, with or without TXA, can further expedite melanin clearance in more severely affected instances. Individual discussions with patients regarding treatment expectations, recurrence likelihood and potential side effects are paramount to a comprehensive and successful therapeutic journey.
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Affiliation(s)
- Wolfgang G Philipp-Dormston
- Hautzentrum Köln/Cologne Dermatology, Cologne, Germany
- Faculty of Health, University of Witten/Herdecke, Witten, Germany
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Yao H, Shen S, Gao X, Feng J, Song X, Xiang W. Definition of refractory melasma and its treatment: a review. Lasers Med Sci 2024; 39:118. [PMID: 38679674 DOI: 10.1007/s10103-024-04066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
Although patients with refractory melasma have been treated using various methods, there is still no precise definition or summary of the therapies. To define refractory melasma and conduct a review of the treatments, we searched for relevant publications in PubMed, Web of Science, and the Cochrane Library, and a total of 35 references were obtained. Refractory melasma can be roughly defined as an ineffective treatment for melasma, including topical bleaching agents, chemical peels, laser therapy, microdermabrasion for more than six months, or chemical peels treated more than six times. Meanwhile, physicians should be careful when treating patients with darker skin and dermal or mixed types of melasma since these individuals do not respond well to treatment. Lasers combined with other methods, especially different types of lasers or topical agents, are considered more effective than monotherapy. Oral tranexamic acid (TXA) is a prospective cure for refractory melasma. Other methods include a combination of chemical peels, microneedling, or injections with additional therapies. In conclusion, we were able to provide a rough definition of refractory melasma and list the available therapies. According to the literature, the most prevalent treatment is laser combination therapy. However, laser treatment should be considered only after topical agents and chemical peeling have failed. Considering its side effects, efficacy, and safety, oral TXA may be a better option, but more research is needed to make a firm conclusion. Moreover, maintenance therapy is required after treatment.
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Affiliation(s)
- Huiyi Yao
- Department of Dermatology, Zhejiang Chinese Medical University, Hangzhou Third People's Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Sihao Shen
- Department of Dermatology, Zhejiang Chinese Medical University, Hangzhou Third People's Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Xingyue Gao
- Department of Dermatology, Zhejiang Chinese Medical University, Hangzhou Third People's Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiangfeng Feng
- Department of Dermatology, Zhejiang Chinese Medical University, Hangzhou Third People's Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiuzu Song
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenzhong Xiang
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
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Ding Y, Xu Z, Xiang LF, Zhang C. Unveiling the mystery of Riehl's melanosis: An update from pathogenesis, diagnosis to treatment. Pigment Cell Melanoma Res 2023; 36:455-467. [PMID: 37401632 DOI: 10.1111/pcmr.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
Riehl's melanosis is a hyperpigmentation disorder that has a significant psychological and social impact on individuals. In the past 10 years, new categories have been developed, raising questions about how to classify Riehl's melanosis. The mechanism of this disease remains unclear, although the type IV hypersensitivity response caused by allergic sensitization, as well as genetic, ultraviolet radiation, and autoimmune factors, is to blame. Clinical manifestation, dermoscopy, reflectance confocal microscopy, patch/photopatch testing, histopathology, and a novel multimodality skin imaging system have been used for the diagnosis. A variety of therapies including topical skin-lightening agents, oral tranexamic acid, glycyrrhizin compound, chemical peels, and lasers and light therapies (intense pulsed light, 1064-nm Q-Switched Nd: YAG laser, 755-nm PicoWay laser, nonablative 1927-nm fractional thulium fiber laser, new pulsed-type microneedling radiofrequency), with improved effectiveness. The latest findings on possible biomarkers and their relationship to other autoimmune diseases were also summarized.
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Affiliation(s)
- Yuecen Ding
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhongyi Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Leihong Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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Piętowska Z, Nowicka D, Szepietowski JC. Understanding Melasma-How Can Pharmacology and Cosmetology Procedures and Prevention Help to Achieve Optimal Treatment Results? A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912084. [PMID: 36231404 PMCID: PMC9564742 DOI: 10.3390/ijerph191912084] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 05/06/2023]
Abstract
Melasma is a chronic skin condition that involves the overproduction of melanin in areas exposed to ultraviolet radiation. Melasma treatment is long-term and complicated with recurrence and resistance to treatment. The pathogenesis of melasma is highly complex with multiple pathologies occurring outside of the skin pigment cells. It includes photoaging, excessive melanogenesis, an increased number of mast cells, increased vascularization, and basement membrane damage. In addition, skin lesions related to melasma and their surrounding skin have nearly 300 genes differentially expressed from healthy skin. Traditionally, melasma was treated with topical agents, including hydroquinone, tretinoin, glucocorticosteroids and various formulations; however, the current approach includes the topical application of a variety of substances, chemical peels, laser and light treatments, mesotherapy, microneedling and/or the use of systemic therapy. The treatment plan for patients with melasma begins with the elimination of risk factors, strict protection against ultraviolet radiation, and the topical use of lightening agents. Hyperpigmentation treatment alone can be ineffective unless combined with regenerative methods and photoprotection. In this review, we show that in-depth knowledge associated with proper communication and the establishment of a relationship with the patient help to achieve good adherence and compliance in this long-term, time-consuming and difficult procedure.
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Affiliation(s)
- Zuzanna Piętowska
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, 50-368 Wrocław, Poland
| | - Danuta Nowicka
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, 50-368 Wrocław, Poland
- Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wrocław, Poland
- Correspondence:
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, 50-368 Wrocław, Poland
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Wu X, Zhang Z, Zhu J, Lu S, Chen C, Wu X, Wang X, Zhao Z. Can Microneedle Fractional Radiofrequency System Treatment Impair the Skin Barrier Function in Chinese Patients? A Prospective Clinical Trial. Dermatol Ther (Heidelb) 2022; 12:2371-2382. [PMID: 36129670 PMCID: PMC9515261 DOI: 10.1007/s13555-022-00807-w] [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: 07/08/2022] [Accepted: 09/01/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Facial cosmetic conditions can manifest as post-inflammatory erythema, scars, pigmentation, enlarged pores, skin laxity, and photoaging. The microneedle fractional radiofrequency system (MFRS) is a new device that combines radiofrequency and microneedles and has been widely used for skin rejuvenation. Since MFRS is an invasive technique, this study aimed to evaluate whether the skin barrier functions might be impaired by this treatment, revealed by skin sensitivity and exacerbation of melasma. Methods Twenty patients with Fitzpatrick grades III–IV facial conditions (skin laxity with melasma, n = 9; post-inflammatory erythema and scars, n = 5; and enlarged pores, n = 6) and treated with MFRS were enrolled. Transepidermal water loss (TEWL, using Ultrascan UC22), skin sensitivity (ten-item Sensitive Scale, SS-10), melanin index (MI), melasma area and severity index (MASI), red areas (VISIA), and thickness and density of the epidermis and dermis on ultrasonography were compared between baseline and 6 months after all treatment sessions. Results Twenty patients completed a 6-month follow-up after two MFRS treatments. During days 1–3 post-treatment, the TEWL values gradually increased to the peak and decreased to baseline levels (BD) on day 7. There was no significant difference in TEWL compared with baseline in month (M) 1, M3, and M6. There were no significant changes in the thickness and density of the epidermis. Although the thickness and density of the dermis increased, there was no significant difference compared to baseline. There was no significant difference in the MI, MASI, and SS-10 score before and after MFRS treatment. After treatment with MFRS, the red area and scarring reduced significantly (p < .01), and no significant difference was observed in other patients. Conclusions MFRS is a safe and effective treatment for facial cosmetic conditions. The skin barrier function is not impaired by MFRS treatment, since it does not cause skin sensitivity or melasma exacerbation. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00807-w.
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Affiliation(s)
- Xiujuan Wu
- Department of Dermatology, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, No. 966, Huaihai Middale Road, Xuhui District, Shanghai, 200031, China
| | - Zhen Zhang
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, China
| | - Jian Zhu
- Department of Dermatology, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, No. 966, Huaihai Middale Road, Xuhui District, Shanghai, 200031, China
| | - Sheng Lu
- Department of Dermatology, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, No. 966, Huaihai Middale Road, Xuhui District, Shanghai, 200031, China
| | - Chen Chen
- Department of Dermatology, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, No. 966, Huaihai Middale Road, Xuhui District, Shanghai, 200031, China
| | - Xianglei Wu
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
| | - Xue Wang
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, China.
| | - Zongfeng Zhao
- Department of Scientific Research, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, No. 966, Huaihai Middle Road, Shanghai, 200031, China.
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Cassiano DP, Espósito ACC, da Silva CN, Lima PB, Dias JAF, Hassun K, Miot LDB, Miot HA, Bagatin E. Update on Melasma-Part II: Treatment. Dermatol Ther (Heidelb) 2022; 12:1989-2012. [PMID: 35906506 PMCID: PMC9464276 DOI: 10.1007/s13555-022-00780-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/13/2022] [Indexed: 01/10/2023] Open
Abstract
Melasma is a prevalent chronic relapsing pigmentary disorder that affects photoexposed areas, especially in women of childbearing age. Although there is currently no curative treatment available for melasma, this manuscript critically reviews the knowledge regarding photoprotection, topical and oral therapies, and procedures such as peelings, laser, and microneedling that represent the main strategies for control and prevention of this disease. As the pathogenesis of melasma is not entirely understood, there are prospects for the development of new therapeutic strategies that might act on the pathways that promote sustained pigmentation rather than merely decreasing melanin synthesis and removing melanin from the epidermis.
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Affiliation(s)
| | - Ana Cláudia C. Espósito
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Campus de Rubião Jr., Botucatu, SP Brazil
| | - Carolina N. da Silva
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Campus de Rubião Jr., Botucatu, SP Brazil
| | - Paula B. Lima
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Campus de Rubião Jr., Botucatu, SP Brazil
| | - Joana A. F. Dias
- Departamento de Dermatologia, UNIFESP, São Paulo, SP Brazil
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Campus de Rubião Jr., Botucatu, SP Brazil
| | - Karime Hassun
- Departamento de Dermatologia, UNIFESP, São Paulo, SP Brazil
| | - Luciane D. B. Miot
- Departamento de Dermatologia, UNIFESP, São Paulo, SP Brazil
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Campus de Rubião Jr., Botucatu, SP Brazil
| | - Hélio A. Miot
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Campus de Rubião Jr., Botucatu, SP Brazil
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Gulfan MCB, Wanitphakdeedecha R, Wongdama S, Jantanapornchai N, Yan C, Rakchart S. Efficacy and Safety of Using Noninsulated Microneedle Radiofrequency Alone Versus in Combination with Polynucleotides for the Treatment of Melasma: A Pilot Study. Dermatol Ther (Heidelb) 2022; 12:1325-1336. [PMID: 35538360 PMCID: PMC9209614 DOI: 10.1007/s13555-022-00728-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction This split-face, double-blind, randomized controlled study investigated the efficacy and safety of using a microneedling radiofrequency (RF) device with polynucleotides (PN) versus RF alone for the treatment of melasma. Methods Thirty adult participants with melasma (Fitzpatrick skin types III–V) received three treatments with an invasive, bipolar, pulsed-type microneedling RF device on both sides of the face. The treatment sessions occurred once every 2 weeks. The hemifaces of each participant were designated for treatment and control with PN and normal saline solution (NSS), applied after treatment with RF. Measurements were made of melanin index (MI), erythema index (EI), skin roughness (by the Antera 3D system), modified melasma area severity index (mMASI) for each hemiface, and patients’ self-assessed improvement. These occurred at baseline and again following the final treatment (2 weeks and 1, 2, 3, and 6 months after). Mean values were obtained for MI, EI, skin roughness, and mMASI. A generalized estimating equation (GEE) was used to compare the obtained values for the outcome measures across all assessment points. Results All patients were women (mean age, 43.2 ± 7.0 years). Mixed melasma predominated (61.5%; n = 16), and the mean duration of melasma was 8.9 ± 6.5 years. Twenty-six participants were followed up to the 6-month assessment point. Significant improvements were observed from baseline in MI, skin roughness, and mMASI scores for both the PN and control sides at 6 months, with no statistically significant differences between sides. Patients’ self-assessed improvement scores also showed a positive trend. Melasma recurrence was observed in three patients at 2, 3, and 4 months after the last treatment session (10% recurrence rate). Conclusions The combination of an invasive, bipolar, pulsed-type microneedling RF with PN is not superior compared with microneedling RF alone in the treatment of melasma. Microneedling RF may be considered as safe and efficacious for the improvement of skin roughness, and as an adjunctive treatment option for melasma. Clinical Trial Registration This study was registered on ClinicalTrials.gov and assigned NCT number TCTR20210804002.
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Affiliation(s)
- Ma Christina B Gulfan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Supisara Wongdama
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuttagarn Jantanapornchai
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chadakan Yan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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WANG B, AN X, QU L, WANG F. Review on oral plant extracts in Skin Whitening. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.83922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Bo WANG
- Shanghai Jiyan Bio-pharmaceutical Co., China; Yunnan Botanee Bio-technology Group Co., China
| | - Xiaohong AN
- Shanghai Jiyan Bio-pharmaceutical Co., China; Yunnan Botanee Bio-technology Group Co., China
| | - Liping QU
- Shanghai Jiyan Bio-pharmaceutical Co., China; Yunnan Botanee Bio-technology Group Co., China; Botaneen Research Institute, China
| | - Feifei WANG
- Shanghai Jiyan Bio-pharmaceutical Co., China; Yunnan Botanee Bio-technology Group Co., China; Botaneen Research Institute, China
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