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Zheng C, Wen X, Zhang L, Li L, Wen Y, Jiang F, Zeng N, Sun N. Research situation, hot spots, and global trends of melasma therapy: Bibliometric insights and visual analysis from 2000 to 2023. J Cosmet Dermatol 2024. [PMID: 38925583 DOI: 10.1111/jocd.16438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Melasma is a prevalent pigmented disease, yet its pathogenesis remains unclear, posing challenges for effective treatment. Bibliometric analysis, a novel approach to literature research, offers the opportunity to evaluate research trends through qualitative and quantitative methods. This study utilizes bibliometric methods to analyze the existing literature on melasma treatment, examining influential publications, institutions, countries, and authors through statistical analysis. METHODS In order to retrieve manuscripts related to the topic of melasma treatment, we conducted a search using the search formula: (TS = (melasma or Chloasma or "mask of pregnancy")) AND TS = (treatment or therapy). We searched through the Web of Science Core Collection database, covering publications from 2000 to 2023. VOSviewer, CiteSpace and the Bibliometric online site (https://bibliometric.com/app) were used to conduct this bibliometric analysis. Our analysis focused on various factors including publications, authors co-authorship, institutions, countries, citation analysis, keywords co-occurrence, references co-citation and journal co-citation. RESULTS A total of 943 articles and 200 reviews were published between 2000 and 2023, accumulating a total of 8628 citations. The average number of citations per item was 18.85, and the average number of citations per year was 292.69. The most prolific author, Sungeun Chang, contributed a total of 9 articles. Cario University emerged as the top research institution. The United States led in terms of article publications with a count of 276. In the past 5 years, the research trends in this field have primarily focused on tranexamic acid and epidermal melasma, as indicated by the burst analysis of publications and keywords. CONCLUSIONS The United States continues to lead in terms of institutions and research output. The current emphasis is on the meticulous implementation of tranexamic acid and laser therapy. It is crucial to foster enhanced collaboration among countries, institutions, and authors to facilitate improved research.
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Affiliation(s)
- Chenjie Zheng
- Department of Dermatology, Guizhou Province Cosmetic Plastic Surgery Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xue Wen
- Department of Dermatology, Guizhou Province Cosmetic Plastic Surgery Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lanfang Zhang
- Department of Dermatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lin Li
- Department of Dermatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yang Wen
- Department of Dermatology, Guizhou Province Cosmetic Plastic Surgery Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Feng Jiang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ni Zeng
- Department of Dermatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Nana Sun
- Department of Dermatology, Guizhou Province Cosmetic Plastic Surgery Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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2
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Jo JY, Chae SJ, Ryu HJ. Update on Melasma Treatments. Ann Dermatol 2024; 36:125-134. [PMID: 38816973 PMCID: PMC11148313 DOI: 10.5021/ad.23.133] [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: 11/02/2023] [Revised: 02/12/2024] [Accepted: 03/04/2024] [Indexed: 06/01/2024] Open
Abstract
Melasma is a prevalent hyperpigmentation condition known for its challenging treatment due to its resemblance to photoaged skin disorders. Numerous studies have shed light on the intricate nature of melasma, which often bears similarity to photoaging disorders. Various therapeutic approaches, encompassing topical and systemic treatments, chemical peeling, and laser therapy, have exhibited efficacy in managing melasma in previous research. However, melasma often reoccurs despite successful treatment, primarily due to its inherent photoaged properties. Given that melasma shares features with photoaging disorders, including disruptions in the basement membrane, solar elastosis, angiogenesis, and mast cell infiltration in the dermal layer, a comprehensive treatment strategy is imperative. Such an approach might involve addressing epidermal hyperpigmentation while concurrently restoring dermal components. In this article, we provide a comprehensive review of conventional treatment methods frequently employed in clinical practice, as well as innovative treatments currently under development for melasma management. Additionally, we offer an extensive overview of the pathogenesis of melasma.
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Affiliation(s)
- Ju Young Jo
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea
| | - Su Ji Chae
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea
| | - Hwa Jung Ryu
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea.
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3
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Sevilla A, Grichnik J. Therapeutic modulation of KIT ligand in melanocytic disorders with implications for mast cell diseases. Exp Dermatol 2024; 33:e15091. [PMID: 38711220 DOI: 10.1111/exd.15091] [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: 11/20/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/08/2024]
Abstract
KIT ligand and its associated receptor KIT serve as a master regulatory system for both melanocytes and mast cells controlling survival, migration, proliferation and activation. Blockade of this pathway results in cell depletion, while overactivation leads to mastocytosis or melanoma. Expression defects are associated with pigmentary and mast cell disorders. KIT ligand regulation is complex but efficient targeting of this system would be of significant benefit to those suffering from melanocytic or mast cell disorders. Herein, we review the known associations of this pathway with cutaneous diseases and the regulators of this system both in skin and in the more well-studied germ cell system. Exogenous agents modulating this pathway will also be presented. Ultimately, we will review potential therapeutic opportunities to help our patients with melanocytic and mast cell disease processes potentially including vitiligo, hair greying, melasma, urticaria, mastocytosis and melanoma.
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Affiliation(s)
- Alec Sevilla
- Department of Dermatology, New York Medical College, New York, New York, USA
- Department of Internal Medicine, Lakeland Regional Health, Lakeland, Florida, USA
| | - James Grichnik
- Department of Dermatology and Cutaneous Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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4
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Hirobe T. Role of Dermal Factors Involved in Regulating the Melanin and Melanogenesis of Mammalian Melanocytes in Normal and Abnormal Skin. Int J Mol Sci 2024; 25:4560. [PMID: 38674144 PMCID: PMC11049857 DOI: 10.3390/ijms25084560] [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: 03/21/2024] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Mammalian melanin is produced in melanocytes and accumulated in melanosomes. Melanogenesis is supported by many factors derived from the surrounding tissue environment, such as the epidermis, dermis, and subcutaneous tissue, in addition to numerous melanogenesis-related genes. The roles of these genes have been fully investigated and the molecular analysis has been performed. Moreover, the role of paracrine factors derived from epidermis has also been studied. However, the role of dermis has not been fully studied. Thus, in this review, dermis-derived factors including soluble and insoluble components were overviewed and discussed in normal and abnormal circumstances. Dermal factors play an important role in the regulation of melanogenesis in the normal and abnormal mammalian skin.
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Affiliation(s)
- Tomohisa Hirobe
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
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5
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Ghasemiyeh P, Fazlinejad R, Kiafar MR, Rasekh S, Mokhtarzadegan M, Mohammadi-Samani S. Different therapeutic approaches in melasma: advances and limitations. Front Pharmacol 2024; 15:1337282. [PMID: 38628650 PMCID: PMC11019021 DOI: 10.3389/fphar.2024.1337282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Melasma is a chronic hyperpigmentation skin disorder that is more common in the female gender. Although melasma is a multifactorial skin disorder, however, sun-exposure and genetic predisposition are considered as the main etiologic factors in melasma occurrence. Although numerous topical and systemic therapeutic agents and also non-pharmacologic procedural treatments have been considered in melasma management, however, the commonly available therapeutic options have several limitations including the lack of sufficient clinical effectiveness, risk of relapse, and high rate of unwanted adverse drug reactions. Recruitment of nanotechnology for topical drug delivery in melasma management can lead to enhanced skin penetration, targeted drug delivery to the site of action, longer deposition at the targeted area, and limit systemic absorption and therefore systemic availability and adverse drug reactions. In the current review, first of all, the etiology, pathophysiology, and severity classification of melasma have been considered. Then, various pharmacologic and procedural therapeutic options in melasma treatment have been discussed. Afterward, the usage of various types of nanoparticles for the purpose of topical drug delivery for melasma management was considered. In the end, numerous clinical studies and controlled clinical trials on the assessment of the effectiveness of these novel topical formulations in melasma management are summarized.
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Affiliation(s)
- Parisa Ghasemiyeh
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rahil Fazlinejad
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Kiafar
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shiva Rasekh
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Soliman Mohammadi-Samani
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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6
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Hara Y, Shibata T. Characteristics of dermal vascularity in melasma and solar lentigo. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12953. [PMID: 38353352 DOI: 10.1111/phpp.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/10/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND /PURPOSE Melasma and solar lentigo (SL) are major benign hyperpigmented lesions, and both have been shown to involve the dermal vasculature. This review discusses current knowledge regarding the clinical characteristics of dermal vascularity in melasma and SL, as well as the results of relevant molecular biological investigations. METHODS PubMed and Google Scholar were searched in December 2023 to identify articles related to melasma, SL, and the dermal vasculature in these lesions. RESULTS Vascular morphologies in melasma and SL have been detected by histological and non-invasive methods, including modalities such as optical coherence tomography. Biological studies have indicated that factors secreted from vascular endothelial cells, such as stem cell factor and endothelin-1, can promote melanogenesis. With respect to phototherapy, blood vessel-targeting laser treatments are expected to provide long-term suppression of pigmentation, but this regimen is only effective when dilated capillaries are visible. CONCLUSION In both melasma and SL, clinical and experimental investigations are revealing the contributions of dermal vascularity to hyperpigmentation. More effective treatment may require identification of hyperpigmentation subtypes. In the future, knowledge of treatment (including phototherapy) is expected to accumulate through reliable and validated non-invasive measurements.
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Affiliation(s)
- Yusuke Hara
- MIRAI Technology Institute, Shiseido Co., Ltd., Yokohama, Japan
| | - Takako Shibata
- MIRAI Technology Institute, Shiseido Co., Ltd., Yokohama, Japan
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7
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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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8
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Zhang J, Jiang C, Wang Z, Fang B, He J, Li M. Investigation of the pathogenesis of ADAR1 gene in dyschromatosis symmetrica hereditaria. Exp Dermatol 2024; 33:e15031. [PMID: 38375898 DOI: 10.1111/exd.15031] [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: 11/26/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/21/2024]
Abstract
The pathogenesis of dyschromatosis symmetrica hereditaria (DSH) has not been well defined. In this study, we sought to investigate the influence of the ADAR1 gene on DSH both in vitro and in vivo. Morpholino knockdown of adar1 in zebrafish produced phenotypes characterized by polarity changes, and abnormal migration and distribution of melanocytes. Differential expression of C-KIT and distinct patterns of apoptosis between hyperpigmented and hypopigmented areas in DSH patient were detected by means of immunohistochemical methods and TUNEL assays, respectively. This study revealed that adar1 knockdown in a zebrafish model resulted in abnormal migration and changes in the cell polarity of melanocytes, and provided novel insight into the mechanism of DSH pathogenesis.
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Affiliation(s)
- Jia Zhang
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chengyi Jiang
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhen Wang
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Biqing Fang
- Department of Dermatology, QuanZhou Women's and Children's Hospital, Quanzhou, China
| | - Jin He
- Department of Pediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Li
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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9
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Shiu J, Lentsch G, Polleys CM, Mobasher P, Ericson M, Georgakoudi I, Ganesan AK, Balu M. Non-invasive Imaging Techniques for Monitoring Cellular Response to Treatment in Stable Vitiligo. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.15.553419. [PMID: 37645823 PMCID: PMC10462045 DOI: 10.1101/2023.08.15.553419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Punch grafting procedures, where small pieces of normal skin are transplanted into stable vitiligo patches, results in repigmentation in only half of patients treated, yet the factors that determine whether a patient responds to treatment or not are still unknown. Reflectance confocal microscopy (RCM) is adept at visualizing melanocyte migration and epidermal changes over large areas while multiphoton microscopy (MPM) can capture metabolic changes in keratinocytes. With the overall goal of identifying optical biomarkers for early treatment response, we followed 12 vitiligo lesions undergoing punch grafting. Dendritic melanocytes adjacent to the graft site were observed before clinical evidence of repigmentation in treatment responsive patients but not in treatment non-responsive patients, suggesting that the early visualization of melanocytes is indicative of a therapeutic response. Keratinocyte metabolic changes in vitiligo skin adjacent to the graft site also correlated with treatment response, indicating that a keratinocyte microenvironment that more closely resembles normal skin is more hospitable for migrating melanocytes. Taken together, these studies suggest that successful melanocyte transplantation requires both the introduction of new melanocytes and modulation of the local tissue microenvironment.
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Affiliation(s)
- Jessica Shiu
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | - Griffin Lentsch
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, USA
| | | | - Pezhman Mobasher
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | - Marissa Ericson
- Biostatistics, Epidemiology and Research Design, University of California, Irvine, Irvine, CA, USA
| | - Irene Georgakoudi
- Department of Biological Chemistry, University of California, Irvine, Irvine, CA, USA
| | - Anand K Ganesan
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
- Department of Biological Chemistry, University of California, Irvine, Irvine, CA, USA
- Skin Biology Resource Center, University of California, Irvine, Irvine, CA, USA
| | - Mihaela Balu
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, USA
- Skin Biology Resource Center, University of California, Irvine, Irvine, CA, USA
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10
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Mechanism of Action of Topical Tranexamic Acid in the Treatment of Melasma and Sun-Induced Skin Hyperpigmentation. COSMETICS 2022. [DOI: 10.3390/cosmetics9050108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tranexamic acid (TXA) has anti-plasmin activity and has been shown when administered orally to be effective against melasma, for which it is considered first-line pharmacotherapy. Several studies have shown that topically applied TXA is also effective against melasma and skin hyperpigmentation caused by sunburn and inflammation. The TXA concentration in the epidermis and dermis/vasculature has been estimated from its distribution in the skin after closed application, and topically applied TXA has thus been shown to act on neutrophils and mast cells in the dermis and on the vascular system. It is unlikely that topically applied TXA acts on dermal neutrophils or mast cells or on the vascular system to form thrombi. As discussed in the present review, studies on the effects of topical TXA on the hyperpigmentation process indicate that the resulting skin-lightening mechanism involves the suppression of cytokine/chemical mediator production, which stimulates melanin production via the keratinocyte-derived urokinase-type plasminogen activator and plasminogen derived from dermal vascular in the basal layer of the epidermis, thereby suppressing the production of excessive melanin to prevent hyperpigmentation.
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11
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Skin-Aging Pigmentation: Who Is the Real Enemy? Cells 2022; 11:cells11162541. [PMID: 36010618 PMCID: PMC9406699 DOI: 10.3390/cells11162541] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 12/21/2022] Open
Abstract
Skin aging is induced and sustained by chronological aging and photoaging. Aging skin pigmentation such as mottled pigmentation (senile lentigo) and melasma are typical signs of photoaging. The skin, like other human organs, undergoes cellular senescence, and senescent cells in the skin increase with age. The crosstalk between melanocytes as pigmentary cells and other adjacent types of aged skin cells such as senescent fibroblasts play a role in skin-aging pigmentation. In this review, we provide an overview of cellular senescence during the skin-aging process. The discussion also includes cellular senescence related to skin-aging pigmentation and the therapeutic potential of regulating the senescence process.
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12
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Abstract
Melasma is a multifactorial dyschromia that results from exposure to external factors (such as solar radiation) and hormonal factors (such as sex hormones and pregnancy), as well as skin inflammation (such as contact dermatitis and esthetic procedures), in genetically predisposed individuals. Beyond hyperfunctional melanocytes, skin with melasma exhibits a series of structural and functional alterations in the epidermis, basement membrane, and upper dermis that interact to elicit and sustain a focal hypermelanogenic phenotype. Evolution in the knowledge of the genetic basis of melasma and the cutaneous response to solar radiation, as well as the roles of endocrine factors, antioxidant system, endothelium proliferation, fibroblast senescence, mast cell degranulation, autophagy deficits of the melanocyte, and the paracrine regulation of melanogenesis, will lead to the development of new treatments and preventive strategies. This review presents current knowledge on these aspects of the pathogenesis of melasma and discusses the effects of specific treatments and future research on these issues.
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13
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Fibroblast morphology, growth rate and gene expression in facial melasma. An Bras Dermatol 2022; 97:575-582. [PMID: 35840442 PMCID: PMC9453522 DOI: 10.1016/j.abd.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background In addition to melanocytic hyperfunction, changes are observed in the upper dermis of melasma, and fibroblasts play a central role in collagen synthesis and pigmentation induction. Objective To explore the morphology, growth rate, and gene expression profile of fibroblasts from the skin with melasma in comparison to fibroblasts from the adjacent healthy skin. Methods Ten women with facial melasma were biopsied (lesion and adjacent healthy skin), and the fragments were processed for fibroblast culture. Samples from five participants were seeded to evaluate growth (days 2, 5 and 8) and senescence (SA-β-gal) curves. The samples from the other participants were submitted to real-time PCR to comparatively evaluation of the expression of 39 genes. Results Cultured fibroblasts from melasma skin were morphologically less fusiform in appearance and on average a 34% (95% CI 4%‒63%) greater proportion of cells labeled with SA-β-gal than the fibroblasts from the adjacent skin. The cell growth rate was lower for the melasma samples after eight days (p < 0.01). TheWNT3A, EDN3, ESR2, PTG2, MMP1, and SOD2 genes were up-regulated, whereas the COL4A1, CSF2, DKK3, COL7A1, TIMP4, CCL2, and CDH11 genes were down-regulated in melasma skin fibroblasts when compared to the ones from adjacent healthy skin. Study limitations Small sample size; absence of functional tests. Conclusions Fibroblasts from the skin with melasma showed a lower growth rate, less fusiform morphology and greater accumulation of SA-β-gal than those from adjacent photo exposed skin. Moreover, their gene expression profile comprised factors that may contribute to upper dermis damage and sustained melanogenesis.
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14
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Flori E, Mastrofrancesco A, Mosca S, Ottaviani M, Briganti S, Cardinali G, Filoni A, Cameli N, Zaccarini M, Zouboulis CC, Picardo M. Sebocytes contribute to melasma onset. iScience 2022; 25:103871. [PMID: 35252805 PMCID: PMC8891974 DOI: 10.1016/j.isci.2022.103871] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/14/2021] [Accepted: 01/28/2022] [Indexed: 12/30/2022] Open
Abstract
Melasma is a hyperpigmentary disorder with photoaging features, whose manifestations appear on specific face areas, rich in sebaceous glands (SGs). To explore the SGs possible contribution to the onset, the expression of pro-melanogenic and inflammatory factors from the SZ95 SG cell line exposed to single or repetitive ultraviolet (UVA) radiation was evaluated. UVA up-modulated the long-lasting production of α-MSH, EDN1, b-FGF, SCF, inflammatory cytokines and mediators. Irradiated SZ95 sebocyte conditioned media increased pigmentation in melanocytes and the expression of senescence markers, pro-inflammatory cytokines, and growth factors regulating melanogenesis in fibroblasts cultures. Cocultures experiments with skin explants confirmed the role of sebocytes on melanogenesis promotion. The analysis on sebum collected from melasma patients demonstrated that in vivo sebocytes from lesional areas express the UVA-activated pathways markers observed in vitro. Our results indicate sebocytes as one of the actors in melasma pathogenesis, inducing prolonged skin cell stimulation, contributing to localized dermal aging and hyperpigmentation.
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Affiliation(s)
- Enrica Flori
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Arianna Mastrofrancesco
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Sarah Mosca
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Monica Ottaviani
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Stefania Briganti
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Giorgia Cardinali
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Angela Filoni
- Dermatology Department, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Norma Cameli
- Dermatology Department, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Marco Zaccarini
- Genetic Research, Molecular Biology and Dermatopathology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodore Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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15
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Park BJ, Jung YJ, Ro YS, Chang SE, Kim JE. Therapeutic Effects of New Pulsed-Type Microneedling Radiofrequency for Refractory Facial Pigmentary Disorders. Dermatol Surg 2022; 48:327-333. [PMID: 34999602 DOI: 10.1097/dss.0000000000003367] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous treatments for pigmentary disorders have been used with variable outcomes. Recently, a new radiofrequency (RF) device with minimal pulse duration has been introduced. OBJECTIVE The aim of this study was to evaluate the efficacy and safety of a pulsed-type microneedling RF device for treatment of facial pigmentary disorders. METHODS Forty-four patients diagnosed with facial melasma or Riehl melanosis received 5 treatments with RF at 2-week intervals, and evaluation was performed at each visits, including 4 and 8 weeks after the last treatment. Treatment outcomes were evaluated by investigator global assessment, patient global assessment score, and skin biophysical parameters of erythema index, melanin index (MI), and transepidermal water loss. Gene array and immunohistochemical staining including melan-A, Fontana silver, CD44, basic fibroblast growth factor (bFGF), and periodic acid-Schiff were performed. RESULTS Most of the patients showed clinical improvement. Erythema index, MI, and transepidermal water loss decreased after the first treatment. Histopathologic examination showed decrease of melanin pigment, melanophages, and blood vessel proliferation but thickened basement membrane after treatment. Expression of CD44 and b-FGF was decreased after treatment. There were no serious adverse events reported during the study. CONCLUSION Pulsed-type microneedling RF could be a treatment option for facial pigmentary disorders.
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Affiliation(s)
- Byeong Jin Park
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - You Jin Jung
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
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16
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Phansuk K, Vachiramon V, Jurairattanaporn N, Chanprapaph K, Rattananukrom T. Dermal Pathology in Melasma: An Update Review. Clin Cosmet Investig Dermatol 2022; 15:11-19. [PMID: 35023942 PMCID: PMC8747646 DOI: 10.2147/ccid.s343332] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Melasma is a complex and multipathophysiological condition that is challenging to treat. The roles of each element in the dermis were highlighted in this recent year due to targeting it with emerging therapies. Although some studies have demonstrated abnormal findings in the dermis of melasma lesions, there are no integrated data regarding these findings. PURPOSE This article aims to discuss each finding in the dermis of melasma lesions and to provide some ideas about treatment options. METHODS An Internet search was completed using the MEDLINE, Embase, Scopus, and Google Scholar databases for relevant literature through June 2021 and reference lists of respective articles. Only the articles published in English language were included. RESULTS Several studies have focused on the dermal changes in melasma. Common findings included basement membrane disruption, pendulous melanocytes, marked solar elastosis, increased melanophages, increased mast cells, and neovascularization. In addition, each of them had the specified mechanism that may relate with the others. CONCLUSION Several changes in the dermis of melasma lesion may be connected with pathological changes in the epidermis. This may serve as a potential target treatment for melasma, which requires a multimodal approach.
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Affiliation(s)
- Kachanat Phansuk
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vasanop Vachiramon
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Natthachat Jurairattanaporn
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Rattananukrom
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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17
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Kwon SH, Na JI, Huh CH, Park KC. A Clinical and Biochemical Evaluation of a Temperature-Controlled Continuous Non-Invasive Radiofrequency Device for the Treatment of Melasma. Ann Dermatol 2021; 33:522-530. [PMID: 34858003 PMCID: PMC8577901 DOI: 10.5021/ad.2021.33.6.522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 01/09/2023] Open
Abstract
Background Melasma shows characteristic histological features of photoaged skin. Objective We evaluated the effect of dermal rejuvenation using a temperature-controlled continuous non-invasive radiofrequency (RF) device on melasma. Methods Continuous skin heating at the temperature of 43°C for 20 minutes was performed in ten subjects with melasma who underwent 3 tri-weekly RF sessions. Pigmentation was evaluated with Mexameter® and investigator’s global assessment (IGA). Immunohistochemical staining and image analysis was performed to evaluate biopsies from melasma skin before and after the treatment. Results The lesional melanin index was decreased by 13.7% at week 9. IGA score was improved from 3.50 at baseline to 2.95 at week 9. No significant adverse event was reported. Histologic analysis revealed reduced melanin and increased collagen density and thickness. The expression of procollagen-1 and type IV collagen was increased after the treatment. The number of p16INK4A-positive senescent fibroblasts was reduced after the treatment, while the expression of heat shock protein 70 and 90 was increased. Stromal derived factor-1, a senescence-associated anti-melanogenic factor secreted from the fibroblasts, was up-regulated after the treatment, while the level of c-kit was not changed. Conclusion Thermal skin stimulation by the temperature-controlled continuous RF device improved melasma through dermal rejuvenation.
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Affiliation(s)
- Soon-Hyo Kwon
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung-Im Na
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chang-Hun Huh
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyoung-Chan Park
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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18
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Dias JAF, Lima PB, Cassiano DP, Espósito ACC, Bagatin E, Miot LDB, Miot HA. Oral ketotifen associated with famotidine for the treatment of facial melasma: a randomized, double-blind, placebo-controlled trial. J Eur Acad Dermatol Venereol 2021; 36:e123-e125. [PMID: 34553413 DOI: 10.1111/jdv.17692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J A F Dias
- Departamento de Dermatologia, UNESP, Botucatu, Brazil
| | - P B Lima
- Departamento de Dermatologia, UNESP, Botucatu, Brazil
| | - D P Cassiano
- Departamento de Dermatologia, UNIFESP, São Paulo, Brazil
| | | | - E Bagatin
- Departamento de Dermatologia, UNIFESP, São Paulo, Brazil
| | - L D B Miot
- Departamento de Dermatologia, UNESP, Botucatu, Brazil
| | - H A Miot
- Departamento de Dermatologia, UNESP, Botucatu, Brazil
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19
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Kang HY, Lee JW, Papaccio F, Bellei B, Picardo M. Alterations of the pigmentation system in the aging process. Pigment Cell Melanoma Res 2021; 34:800-813. [PMID: 34048137 DOI: 10.1111/pcmr.12994] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 01/10/2023]
Abstract
Human skin aging is a natural phenomenon that results from continuous exposure to intrinsic (time, genetic factors, hormones) as well as extrinsic factors (UV exposure, pollution, tobacco). In areas that are frequently exposed to the sun, photoaging blends with the process of intrinsic aging, resulting in an increased senescent cells number and consequently accelerating the aging process. The severity of photodamage depends on constitutional factors, including skin phototype (skin color, tanning capacity), intensity, and duration of sunlight/UV exposure. Aging affects nearly every aspect of cutaneous biology, including pigmentation. Clinically, the phenotype of age pigmented skin has a mottled, uneven color, primarily due to age spots, with or without hypopigmentation. Uneven pigmentation might be attributed to the hyperactivation of melanocytes, altered distribution of pigment, and turnover. In addition to direct damage to pigment-producing cells, photodamage alters the physiological crosstalk between keratinocytes, fibroblasts, endothelial cells, and melanocytes responsible for natural pigmentation homeostasis. Interestingly, age-independent diffuse expression of senescence-associated markers in the dermal and epidermal compartment is also associated with vitiligo, suggesting that premature senescence plays an important role in the pathology.
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Affiliation(s)
- Hee Young Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Jin Wook Lee
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea.,Department of Dermatology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Federica Papaccio
- Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Barbara Bellei
- Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Mauro Picardo
- Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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20
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Upadhyay PR, Ho T, Abdel-Malek ZA. Participation of keratinocyte- and fibroblast-derived factors in melanocyte homeostasis, the response to UV, and pigmentary disorders. Pigment Cell Melanoma Res 2021; 34:762-776. [PMID: 33973367 DOI: 10.1111/pcmr.12985] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/19/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
Human epidermal melanocytes play a central role in sensing the environment and protecting the skin from the drastic effects of solar ultraviolet radiation and other environmental toxins or inflammatory agents. Melanocytes survive in the epidermis for decades, which subjects them to chronic environmental insults. Melanocytes have a poor self-renewal capacity; therefore, it is critical to ensure their survival with genomic stability. The function and survival of melanocytes is regulated by an elaborate network of paracrine factors synthesized mainly by epidermal keratinocytes and dermal fibroblasts. A symbiotic relationship exists between epidermal melanocytes and keratinocytes on the one hand, and between melanocytes and dermal fibroblasts on the other hand. Melanocytes protect epidermal keratinocytes and dermal fibroblasts from the damaging effects of solar radiation, and the latter cells synthesize biochemical mediators that maintain the homeostasis, and regulate the stress response of melanocytes. Disruption of the paracrine network results in pigmentary disorders, due to abnormal regulation of melanin synthesis, and compromise of melanocyte survival or genomic stability. This review provides an update of the current knowledge of keratinocyte- and fibroblast-derived paracrine factors and their contribution to melanocyte physiology, and how their abnormal production is involved in the pathogenesis of common pigmentary disorders.
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Affiliation(s)
- Parth R Upadhyay
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pharmaceutical Sciences, College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Tina Ho
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Zalfa A Abdel-Malek
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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21
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Mizutani Y, Yamashita M, Hashimoto R, Atsugi T, Ryu A, Hayashi A, Rikimaru-Nishi Y, Ohta K. Three-dimensional structure analysis of melanocytes and keratinocytes in senile lentigo. Microscopy (Oxf) 2021; 70:224-231. [PMID: 32991711 DOI: 10.1093/jmicro/dfaa054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 08/01/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022] Open
Abstract
Senile lentigo or age spots are hyperpigmented macules of skin that commonly develop following long-term exposure to ultraviolet radiation. This condition is caused by accumulation of large numbers of melanosomes (melanin granules) produced by melanocytes within neighboring keratinocytes. However, there is still no consensus regarding the melanosome transfer mechanism in senile lentigo. To date, most pathohistological studies of skin have been two-dimensional and do not provide detailed data on the complex interactions of the melanocyte-keratinocyte network involved in melanosome transfer. We performed a three-dimensional reconstruction of the epidermal microstructure in senile lentigo using three different microscopic modalities to visualize the topological melanocyte-keratinocyte relationship and melanosome distribution. Confocal laser microscopy images showed that melanocyte dendritic processes are more frequently branched and elongated in senile lentigo skin than in normal skin. Serial transmission electron micrographs showed that dendritic processes extend into intercellular spaces between keratinocytes. Focused ion beam-scanning electron micrographs showed that dendritic processes in senile lentigo encircle adjacent keratinocytes and accumulate large numbers of melanosomes. Moreover, melanosomes transferred to keratinocytes are present not only in the supranuclear area but throughout the perinuclear area except on the basal side. The use of these different microscopic methods helped to elucidate the three-dimensional morphology and topology of melanocytes and keratinocytes in senile lentigo. We show that the localization of melanosomes in dendritic processes to the region encircling recipient keratinocytes contributes to efficient melanosome transfer in senile lentigo.
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Affiliation(s)
- Yuki Mizutani
- Research Laboratories, KOSÉ Corporation, 48-18 Sakae-cho, Kita-ku, Tokyo, 114-0005 Japan
| | - Mika Yamashita
- Research Laboratories, KOSÉ Corporation, 48-18 Sakae-cho, Kita-ku, Tokyo, 114-0005 Japan
| | - Rie Hashimoto
- Research Laboratories, KOSÉ Corporation, 48-18 Sakae-cho, Kita-ku, Tokyo, 114-0005 Japan
| | - Toru Atsugi
- Research Laboratories, KOSÉ Corporation, 48-18 Sakae-cho, Kita-ku, Tokyo, 114-0005 Japan
| | - Akemi Ryu
- Research Laboratories, KOSÉ Corporation, 48-18 Sakae-cho, Kita-ku, Tokyo, 114-0005 Japan
| | - Akinobu Hayashi
- Research Laboratories, KOSÉ Corporation, 48-18 Sakae-cho, Kita-ku, Tokyo, 114-0005 Japan
| | - Yukiko Rikimaru-Nishi
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011 Japan.,Department of Plastic and Reconstructive Surgery, and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Keisuke Ohta
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011 Japan
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22
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Lueangarun S, Namboonlue C, Tempark T. Postinflammatory and rebound hyperpigmentation as a complication after treatment efficacy of telangiectatic melasma with 585 nanometers Q-switched Nd: YAG laser and 4% hydroquinone cream in skin phototypes III-V. J Cosmet Dermatol 2020; 20:1700-1708. [PMID: 33002283 DOI: 10.1111/jocd.13756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/30/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The potential efficacy of vascular component-targeted laser has been evaluated for the treatment of melasma, which commonly found with the co-existence of telangiectasia. AIMS To evaluate the treatment efficacy and safety of 585-nm QSNYL and 4% HQ cream combination vs 4% HQ cream alone for telangiectatic melasma in the skin phototypes III-V. PATIENTS/METHODS Twenty-one Thai female patients with telangiectatic melasma and Fitzpatrick skin phototypes (FPTs) III-V were randomly treated with the 585-nm QSNYL on one side of the face for five sessions at 2-week intervals. All patients were assigned to apply HQ cream daily at night on both sides of the face for 10 weeks and a broad-spectrum sunscreen regularly throughout the study. The treatment efficacy and safety were evaluated using the Modified Melasma Area and Severity Index (mMASI), biometric evaluation, patient assessment, and adverse effects. RESULTS The combination-treated side yielded more significant improvement of mMASI than the topical-treated side at weeks 2, 4, and 8, respectively. However, 19% of the patients developed postinflammatory hyperpigmentation (PIH) on the laser-treated side, especially in FPTs IV-V and rebound hyperpigmentation. There was a significant improvement of hemoglobin and melanin index, but without statistical difference between the two treatment groups. CONCLUSIONS The combination of 585-nm QSNYL and HQ treatment yields treatment efficacy and skin rejuvenation effects for telangiectatic melasma. Nonetheless, a high incidence of PIH and rebound hyperpigmentation is adversely developed in dark FPT. Thus, this laser treatment should be cautiously applied in those with dark FPTs IV-V to avoid laser-induced pigment alteration.
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Affiliation(s)
- Suparuj Lueangarun
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Chutimon Namboonlue
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Therdpong Tempark
- Department of Pediatrics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
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23
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Kapoor R, Dhatwalia S, Kumar R, Rani S, Parsad D. Emerging role of dermal compartment in skin pigmentation: comprehensive review. J Eur Acad Dermatol Venereol 2020; 34:2757-2765. [DOI: 10.1111/jdv.16404] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/03/2020] [Indexed: 12/16/2022]
Affiliation(s)
- R. Kapoor
- Department of Zoology Panjab University Chandigarh Chandigarh India
| | - S.K. Dhatwalia
- Department of Zoology Panjab University Chandigarh Chandigarh India
| | - R. Kumar
- Department of Zoology Panjab University Chandigarh Chandigarh India
| | - S. Rani
- Department of Zoology Panjab University Chandigarh Chandigarh India
| | - D. Parsad
- Department of Dermatology PGIMER Chandigarh India
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24
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Kutlubay Z, Cesur SK, Aşkın Ö, Tüzün Y. The color of skin: brown diseases of the skin, nails, and mucosa. Clin Dermatol 2020; 37:487-506. [PMID: 31896404 DOI: 10.1016/j.clindermatol.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Brown diseases comprise disorders leading to hyperpigmentation in skin and nails. Melasma is an acquired skin disorder that is characterized by brownish macules that typically occur on the face. Schamberg disease, also known as progressive pigmented purpura, is characterized by brown pigmentation with pepper spots on their edges. We summarize the epidemiology, pathogenesis, histologic features, and treatment choices for additional brown diseases, including melasma, pigmented purpuric dermatoses, postinflammatory hyperpigmentation, drug-induced hyperpigmentation, and pigmentations due to systemic or physiologic conditions.
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Affiliation(s)
- Zekayi Kutlubay
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | | | - Özge Aşkın
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yalçın Tüzün
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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25
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Bellei B, Picardo M. Premature cell senescence in human skin: Dual face in chronic acquired pigmentary disorders. Ageing Res Rev 2020; 57:100981. [PMID: 31733332 DOI: 10.1016/j.arr.2019.100981] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/16/2019] [Accepted: 11/07/2019] [Indexed: 01/10/2023]
Abstract
Although senescence was originally described as an in vitro acquired cellular characteristic, it was recently recognized that senescence is physiologically and pathologically involved in aging and age-related diseases in vivo. The definition of cellular senescence has expanded to include the growth arrest caused by various cellular stresses, including DNA damage, inadequate mitochondria function, activated oncogene or tumor suppressor genes and oxidative stress. While senescence in normal aging involves various tissues over time and contributes to a decline in tissue function even with healthy aging, disease-induced premature senescence may be restricted to one or a few organs triggering a prolonged and more intense rate of accumulation of senescent cells than in normal aging. Organ-specific high senescence rate could lead to chronic diseases, especially in post-mitotic rich tissue. Recently, two opposite acquired pathological conditions related to skin pigmentation were described to be associated with premature senescence: vitiligo and melasma. In both cases, it was demonstrated that pathological dysfunctions are not restricted to melanocytes, the cell type responsible for melanin production and transport to surrounding keratinocytes. Similar to physiological melanogenesis, dermal and epidermal cells contribute directly and indirectly to deregulate skin pigmentation as a result of complex intercellular communication. Thus, despite senescence usually being reported as a uniform phenotype sharing the expression of characteristic markers, skin senescence involving mainly the dermal compartment and its paracrine function could be associated with the disappearance of melanocytes in vitiligo lesions and with the exacerbated activity of melanocytes in the hyperpigmentation spots of melasma. This suggests that the difference may arise in melanocyte intrinsic differences and/or in highly defined microenvironment peculiarities poorly explored at the current state of the art. A similar dualistic phenotype has been attributed to intratumoral stromal cells as cancer-associated fibroblasts presenting a senescent-like phenotype which influence the behavior of neoplastic cells in either a tumor-promoting or tumor-inhibiting manner. Here, we present a framework dissecting senescent-related molecular alterations shared by vitiligo and melasma patients and we also discuss disease-specific differences representing new challenges for treatment.
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Affiliation(s)
- Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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26
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Atef A, El-Rashidy MA, Azeem AA, Kabel AM. The Role of Stem Cell Factor in Hyperpigmented Skin Lesions. Asian Pac J Cancer Prev 2019; 20:3723-3728. [PMID: 31870114 PMCID: PMC7173358 DOI: 10.31557/apjcp.2019.20.12.3723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/18/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Skin hyperpigmentation usually results from an increased number, or activity, of melanocytes. The degree of pigmentation of skin depends on the amount and type of melanin, degree of skin vascularity, presence of carotene, and thickness of the stratum corneum. Common causes of hyperpigmentation include post-inflammatory hyperpigmentation, melasma, solar lentigines, ephelides (freckles), and café-au-lait macules. Some skin tumors can be hyperpigmented as basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma (MM). Stem cell factor (SCF) is a growth factor and its interaction with its receptor, c-kit, is well known to be critical to the survival of melanocytes. METHODS This study was carried out on 60 patients complaining of hyperpigmented skin lesions (20 melasma, 20 solar lentigines, and 20 freckles) and 36 patients with skin tumors (14 BCC, 12 SCC, and 10 MM). Punch skin biopsies were taken from the previous lesions. Immunohistochemical staining of these samples was done using the stem cell factor (SCF). RESULTS There was positive expression of SCF in all cases of melasma, solar lentigines and freckles with significant increase in the intensity of expression in the lesional areas than the non-lesional ones (P=0.004). There was also a statistically significant increase in the expression of SCF in BCC and melanoma tumor cells. CONCLUSION SCF has a great role in skin hyperpigmented disorders and this can be used as a target for the developing of new antipigmentary lines of treatment by inhibiting SCF. SCF can also be involved in the emergence of some skin tumors.
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Affiliation(s)
| | | | | | - Ahmed M Kabel
- Department of Pharmacology, Faculty of Medicine, Tanta University, Tanta, Egypt,
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia.
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27
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Colferai MMT, Miquelin GM, Steiner D. Evaluation of oral tranexamic acid in the treatment of melasma. J Cosmet Dermatol 2019; 18:1495-1501. [PMID: 30536592 DOI: 10.1111/jocd.12830] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Melasma is an acquired, chronic, recurrent hypermelanosis that occurs exclusively in areas exposed to the sun. Its treatment can be very challenging. Tranexamic acid (TA) is an inhibitor of plasmin, and it is a synthetic derivative of the amino acid lysine that reversibly blocks binding sites on the plasminogen molecule, inhibiting the plasminogen activator from converting plasminogen to plasmin. AIMS This study evaluated the efficacy of oral TA in the treatment of melasma in patients from a philanthropic dermatological clinic. PATIENTS/METHODS This was a monocentric, randomized, double-blind, controlled clinical trial. Patients with facial melasma were randomly divided into the following two groups: A (TA 250 mg orally twice daily) or B (oral placebo twice daily). Evaluations were performed before and after 12 weeks of treatment with photographs, colorimetry, MELASQoL, and MASI. All patients were instructed to use tinted sunscreen (SPF 50). RESULTS Of the 47 patients selected, 37 completed the study, with 20 in group A and 17 in group B; the patients consisted of one male and 36 females, and the mean age was 43.97 years old. Based on the four methods of evaluation, the melasma in 50% of patients in group A improved versus only 5.9% of patients in group B (P < 0.005). There was an improvement according to all evaluation methods in the treatment group. No patient had severe side effects. CONCLUSIONS We conclude that tranexamic acid was effective in 50% of patients according to four methods of evaluation when compared to the placebo.
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Affiliation(s)
| | | | - Denise Steiner
- Universidade de Mogi das Cruzes, Dermatology, Mogi das Cruzes, Brazil
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28
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Frumento G, Zuo J, Verma K, Croft W, Ramagiri P, Chen FE, Moss P. CD117 (c-Kit) Is Expressed During CD8 + T Cell Priming and Stratifies Sensitivity to Apoptosis According to Strength of TCR Engagement. Front Immunol 2019; 10:468. [PMID: 30930902 PMCID: PMC6428734 DOI: 10.3389/fimmu.2019.00468] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 02/21/2019] [Indexed: 01/04/2023] Open
Abstract
CD117 (cKit) is the receptor for stem cell factor (SCF) and plays an important role in early haemopoiesis. We show that CD117 is also expressed following priming of mature human CD8+ T cells in vitro and is detectable following primary infection in vivo. CD117 expression is mediated through an intrinsic pathway and is suppressed by IL-12. Importantly, the extent of CD117 expression is inversely related to the strength of the activating stimulus and subsequent engagement with cell-bound SCF markedly increases susceptibility to apoptosis. CD117 is therefore likely to shape the pattern of CD8+ T cell immunodominance during a primary immune response by rendering cells with low avidity for antigen more prone to apoptosis. Furthermore, CD117+ T cells are highly sensitive to apoptosis mediated by galectin-1, a molecule commonly expressed within the tumor microenvironment, and CD117 expression may therefore represent a novel and potentially targetable mechanism of tumor immune evasion.
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Affiliation(s)
- Guido Frumento
- Institute of Immunology and Immunotherapy, University of Birmingham Birmingham, United Kingdom.,NHS Blood and Transplant, Birmingham, United Kingdom
| | - Jianmin Zuo
- Institute of Immunology and Immunotherapy, University of Birmingham Birmingham, United Kingdom
| | - Kriti Verma
- Institute of Immunology and Immunotherapy, University of Birmingham Birmingham, United Kingdom
| | - Wayne Croft
- Institute of Immunology and Immunotherapy, University of Birmingham Birmingham, United Kingdom.,Centre for Computational Biology, University of Birmingham Birmingham, United Kingdom
| | - Pradeep Ramagiri
- Institute of Immunology and Immunotherapy, University of Birmingham Birmingham, United Kingdom
| | - Frederick E Chen
- Institute of Immunology and Immunotherapy, University of Birmingham Birmingham, United Kingdom.,NHS Blood and Transplant, Birmingham, United Kingdom.,Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust Birmingham, United Kingdom.,Royal London Hospital, Barts Health NHS Trust London, United Kingdom
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham Birmingham, United Kingdom.,Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust Birmingham, United Kingdom
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Grimes P, Ijaz S, Nashawati R, Kwak D. New oral and topical approaches for the treatment of melasma. Int J Womens Dermatol 2019; 5:30-36. [PMID: 30809577 PMCID: PMC6374710 DOI: 10.1016/j.ijwd.2018.09.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/30/2018] [Accepted: 09/30/2018] [Indexed: 12/23/2022] Open
Abstract
Melasma is a common, therapeutically challenging, and universally relapsing disorder of hyperpigmentation that is most often observed in women and individuals with Fitzpatrick Skin Types III through VI. The pathogenesis of melasma is complex and protean. Contributing factors that are often implicated in the etiopathogenesis of this condition include a genetic predisposition, intense ultraviolet radiation exposure, and hormonal influences. Therapeutic interventions for melasma include a multimodality approach incorporating photoprotection agents, topical and oral skin lighteners, and resurfacing procedures. Given our expanding knowledge of the pathogenesis of melasma, new and effective treatments are expanding our therapeutic armamentarium. This article reviews new and emerging oral and topical treatments for melasma.
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Affiliation(s)
- P.E. Grimes
- Vitiligo & Pigmentation Institute of Southern California, Los Angeles, California
- Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - S. Ijaz
- Vitiligo & Pigmentation Institute of Southern California, Los Angeles, California
| | - R. Nashawati
- Vitiligo & Pigmentation Institute of Southern California, Los Angeles, California
| | - D. Kwak
- Vitiligo & Pigmentation Institute of Southern California, Los Angeles, California
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30
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Kwon SH, Na JI, Choi JY, Park KC. Melasma: Updates and perspectives. Exp Dermatol 2018; 28:704-708. [PMID: 30422338 DOI: 10.1111/exd.13844] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
Abstract
Management of melasma is highly challenging due to inconsistent treatment results and frequent relapses. However, recent studies revealed that melasma may not only be a disease of melanocytes, but also a photoaging skin disorder. Herein, we attempt to validate that melasma is indeed a photoaging disorder by presenting the histopathologic findings of melasma: solar elastosis, altered basement membrane, increased vascularization and increased mast cell count. We also provide some therapeutic implications based on these findings and a discussion on the latest updates and perspectives regarding treatment.
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Affiliation(s)
- Soon-Hyo Kwon
- College of Medicine, Seoul National University Bundang Hospital, Seoul National University, Gyeonggi, Korea
| | - Jung-Im Na
- College of Medicine, Seoul National University Bundang Hospital, Seoul National University, Gyeonggi, Korea
| | - Ji-Young Choi
- College of Medicine, Seoul National University Bundang Hospital, Seoul National University, Gyeonggi, Korea
| | - Kyoung-Chan Park
- College of Medicine, Seoul National University Bundang Hospital, Seoul National University, Gyeonggi, Korea
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31
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Imokawa G. The Xanthophyll Carotenoid Astaxanthin has Distinct Biological Effects to Prevent the Photoaging of the Skin Even by its Postirradiation Treatment. Photochem Photobiol 2018; 95:490-500. [DOI: 10.1111/php.13039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/02/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Genji Imokawa
- Center for Bioscience Research & Education Utsunomiya University Utsunomiya Japan
- Research Institute for Biological Functions Chubu University Kasugai Japan
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32
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Kwon HH, Choi SC, Jung JY, Park GH. Combined treatment of melasma involving low-fluence Q-switched Nd:YAG laser and fractional microneedling radiofrequency. J DERMATOL TREAT 2018; 30:352-356. [PMID: 30160539 DOI: 10.1080/09546634.2018.1516858] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: While low fluence Q-switched Nd:YAG laser (QSNY) demonstrates moderate efficacy in the melasma treatment for darker skin types, this single regimen still remains challenges. Fractional microneedling radiofrequency (FMR) is known to enhance dermal microenvironment, possibly offsetting pathogenic factors of melasma aggravation. Objectives: To compare the effectiveness and safety of combination therapy using low-fluence QSNY and FRM with QSNY monotherapy in Asian melasma patients Methods: A retrospective study was undertaken for melasma patients to compare clinical data between 56 patients receiving combination regimen and 58 patients with QSNY only. For the 10 sessions at 1-week intervals, combination group was consecutively treated with QSNY and FRM, while QS toning group with QSNY alone. Two blinded dermatologists evaluated the efficacy based on modified Melasma Area and Severity Index (mMASI) and the physician's global assessment (PGA) at baseline and 3 months after the final treatment. Treatment-related side effects and disease course was recorded in detail. Results: Combination group demonstrated better efficacy compared with QS toning only group. Both median degrees of mMASI decrease (2.9 vs. 1.8) and proportions of PGA achieving better than 'good' grades (68% vs. 54%) showed superior efficacies of combination group. No significant difference was observed for treatment-related side effects between two groups, while the prevalence of mottle hypopigmentation and rebound hyperpigmentation was higher in QSNY only group. Conclusion: A novel dual mode of low-fluence QSNY and FRM represents a safe and effective treatment for melasma in Asian melasma patients.
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Affiliation(s)
| | | | | | - Gyeong-Hun Park
- b Department of Dermatology , Dongtan Sacred Heart Hospital, Hallym University College of Medicine , Hwaseong , Korea
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The Effects of Acupuncture Combined with Auricular Acupressure in the Treatment of Chloasma. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:6438458. [PMID: 29849716 PMCID: PMC5937619 DOI: 10.1155/2018/6438458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/07/2018] [Accepted: 03/11/2018] [Indexed: 11/28/2022]
Abstract
Objective To investigate the effectiveness of acupuncture combined with auricular acupressure in chloasma treatment. Methods A prospective, randomized controlled assessor-blind clinical trial was performed and 135 patients were assigned into acupuncture combined with auricular acupressure (A), acupuncture (B), and control (C) groups, each with 45 patients. For groups A and B, body and facial acupuncture were applied for 2 months. For group A, auricular acupressure was applied concomitantly. For group C, vitamins C and E were prescribed for 3 months. Primary outcome measure was the therapeutic effects while secondary outcome measure was safety evaluation. Results The total effective rate was 95.6%, 91.1%, and 75.6% for groups A, B, and C (P < 0.01 between groups A and C; P < 0.05 between groups B and C). The posttreatment estradiol (E2) levels in groups A and B were significantly decreased while the progesterone (P4) levels were significantly increased compared to pretreatment (P < 0.01 and P < 0.05, resp.). The differences were significant compared to group C (P < 0.01 and P < 0.05, resp.). No adverse events occurred. Conclusion Acupuncture combined with auricular acupressure could significantly increase the therapeutic effect of chloasma treatment and could be better than vitamins C and E.
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34
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Kim M, Shibata T, Kwon S, Park TJ, Kang HY. Ultraviolet-irradiated endothelial cells secrete stem cell factor and induce epidermal pigmentation. Sci Rep 2018. [PMID: 29523807 PMCID: PMC5844989 DOI: 10.1038/s41598-018-22608-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Ultraviolet (UV)-associated hyperpigmented skins are characterized with increased vasculature underlying pigmentation, suggestive of the possible biological role of endothelial cells in the regulation of skin pigmentation during UV irradiation. In this study, we showed that UV-irradiated endothelial cells significantly increased the pigmentation of melanocytes through epithelial-mesenchymal crosstalk. The stimulatory effect of endothelial cells was further demonstrated using ex vivo human skin. RNA sequence analysis and enzyme-linked immunosorbent assay showed that endothelial cells secrete more stem cell factor (SCF) upon UV irradiation than non-irradiated cells. The increased pigmentation elicited by endothelial cells was abrogated following inhibition of SCF/c-KIT signaling. Together these results suggest that endothelial cells are activated upon UV exposure to release melanogenic factors such as SCF, which contributes to the development of skin hyperpigmentation during chronic sun exposure.
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Affiliation(s)
- Misun Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | | | - Soohyun Kwon
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Tae Jun Park
- Department of Biochemistry and Molecular Biology, Ajou University School of Medicine, Suwon, Korea. .,Chronic Inflammatory Disease Research Center, Ajou University School of Medicine, Suwon, Korea. .,Department of Biomedical Science, The Graduate School, Ajou University, Suwon, Korea.
| | - Hee Young Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea. .,Department of Biomedical Science, The Graduate School, Ajou University, Suwon, Korea.
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35
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Del Rosario E, Florez-Pollack S, Zapata L, Hernandez K, Tovar-Garza A, Rodrigues M, Hynan LS, Pandya AG. Randomized, placebo-controlled, double-blind study of oral tranexamic acid in the treatment of moderate-to-severe melasma. J Am Acad Dermatol 2017; 78:363-369. [PMID: 28987494 DOI: 10.1016/j.jaad.2017.09.053] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 09/17/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Melasma is a common pigmentary disorder that is often difficult to treat. Tranexamic acid (TA) has emerged as a promising treatment for melasma; however, few controlled studies exist. OBJECTIVE To determine the efficacy of oral TA in patients with moderate-to-severe melasma. METHODS Patients with moderate-to-severe melasma were treated with 250 mg of TA or placebo capsules twice daily for 3 months and sunscreen followed by 3 months of treatment with sunscreen only. The primary outcome measure was the modified Melasma Area and Severity Index (mMASI) score. RESULTS A total of 44 patients were enrolled and 39 completed the study. At 3 months, there was a 49% reduction in mMASI score in the TA group versus 18% in the control group. Patients with severe melasma improved more than those with moderate melasma. Three months after treatment was stopped, there was a 26% reduction in mMASI score in the TA group compared with the baseline visit versus a 19% reduction in the placebo arm. No serious adverse events were noted in either group. LIMITATIONS Single-center study enrolling predominantly Hispanic women. CONCLUSIONS Oral TA appears to be an effective treatment for moderate-to-severe melasma with minimal side effects.
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Affiliation(s)
- Eunice Del Rosario
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Lucio Zapata
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katia Hernandez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrea Tovar-Garza
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michelle Rodrigues
- Department of Dermatology, St. Vincent's Hospital, Melbourne, Victoria, Australia; The Skin and Cancer Foundation Inc, Melbourne, Victoria, Australia; The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Linda S Hynan
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amit G Pandya
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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36
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Ogbechie-Godec OA, Elbuluk N. Melasma: an Up-to-Date Comprehensive Review. Dermatol Ther (Heidelb) 2017; 7:305-318. [PMID: 28726212 PMCID: PMC5574745 DOI: 10.1007/s13555-017-0194-1] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 01/12/2023] Open
Abstract
Melasma is a common acquired condition of symmetric hyperpigmentation, typically occurring on the face, with higher prevalence in females and darker skin types. Multiple etiologies, including light exposure, hormonal influences, and family history, have been implicated in the pathogenesis of this disorder. Overall prevalence ranges widely at 1-50%, since values are typically calculated within a specific ethnic population within a geographic region. Histologically, melasma can display increased epidermal and/or dermal pigmentation, enlarged melanocytes, increased melanosomes, solar elastosis, dermal blood vessels, and, occasionally, perivascular lymphohistiocytic infiltrates. Various topical, oral, and procedural therapies have been successfully used to treat melasma. Traditional topical therapies including hydroquinone, tretinoin, corticosteroids, and triple combination creams; however, other synthetic and natural topical compounds have also shown varying efficacies. Promising oral therapies for melasma include tranexamic acid, Polypodium leucotomos, and glutathione. Procedures, including chemical peels, microneedling, radiofrequency, and lasers, are also often used as primary or adjunctive treatments for melasma. Notably, combination therapies within or across treatment modalities generally result in better efficacies than monotherapies. This review serves as a comprehensive update on the current understanding of the epidemiology, pathogenesis, clinical and histologic features of melasma, as well as treatments for this common, yet therapeutically challenging, condition.
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Affiliation(s)
| | - Nada Elbuluk
- Ronald O. Perelman Department of Dermatology, New York University, New York, NY, USA.
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37
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Precise role of dermal fibroblasts on melanocyte pigmentation. J Dermatol Sci 2017; 88:159-166. [PMID: 28711237 DOI: 10.1016/j.jdermsci.2017.06.018] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/26/2017] [Accepted: 06/26/2017] [Indexed: 12/22/2022]
Abstract
Dermal fibroblasts are traditionally recognized as synthesizing, remodeling and depositing collagen and extracellular matrix, the structural framework for tissues, helping to bring thickness and firmness to the skin. However, the role of fibroblasts on skin pigmentation arouses concern recently. More is known about the interactions between epidermal melanocytes and keratinocytes. This review highlights the importance of fibroblast-derived melanogenic paracrine mediators in the regulation of melanocyte activities. Fibroblasts act on melanocytes directly and indirectly through neighboring cells by secreting a large number of cytokines (SCF), proteins (DKK1, sFRP, Sema7a, CCN, FAP-α) and growth factors (KGF, HGF, bFGF, NT-3, NRG-1, TGF-β) which bind to receptors and modulate intracellular signaling cascades (MAPK/ERK, cAMP/PKA, Wnt/β-catenin, PI3K/Akt) related to melanocyte functions. These factors influence the growth, the pigmentation of melanocytes via the expression of melanin-producing enzymes and melanosome transfer, as well as their dendricity, mobility and adhesive properties. Thus, fibroblasts are implicated in both skin physiological and pathological pigmentation. In order to investigate their contribution, various in vitro models have been developed, based on cellular senescence. UV exposure, a major factor implicated in pigmentary disorders, may affect the secretory crosstalk between dermal and epithelial cells. Therefore, identification of the interactions between fibroblasts and melanocytes could provide novel insights not only for the development of melanogenic agents in the clinical and cosmetic fields, but also for a better understanding of the melanocyte biology and melanogenesis regulation.
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38
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Moon HR, Kim YJ, Jung JM, Won CH, Lee MW, Choi JH, Chang SE. Acquired bilateral telangiectasia macularis eruptiva perstans: A unique clinical feature of photodamaging rather than a subtype of cutaneous mastocytosis. J Dermatol 2017. [PMID: 28646532 DOI: 10.1111/1346-8138.13928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Telangiectasia macularis eruptiva perstans (TMEP) is a rare subtype of cutaneous mastocytosis, characterized by telangiectatic tan to brown macules on the trunk and extremities. Although TMEP has been descried as an uncommon disease in the literature, we often encounter patients with TMEP lesions in the outpatient clinic. We aimed to assess the clinical and histopathological characteristics of acquired bilateral TMEP, and the pathophysiological mechanism of acquired bilateral TMEP among these patients. We retrospectively reviewed 30 patients (28 men and 2 women) with acquired bilateral TMEP; multiple telangiectatic dark red to brown macules that were symmetrically distributed. The clinical characteristics and general histopathological findings of lesional skin were investigated. The number of mast cells was evaluated using immunohistochemical analysis with an antibody directed against c-kit (CD117). Acquired bilateral TMEP was predominantly localized on the sun-exposed area: the upper arm in 30 patients (100%), forearm in 19 patients (63.3%) and anterior chest in 15 patients (50%). A total of 16 patients (53.3%) showed at least one aggravating factor, including UV irradiation, alcohol use and heat exposure. Compared with the mast cell numbers in 19 age- and biopsy site-matched healthy controls (91 ± 29.0/mm2 ), the number of mast cells in the papillary dermal skin of acquired bilateral TMEP patients was significantly increased (159 ± 37.2/mm2 , P < 0.01). In addition, a significant difference in vessel numbers in the papillary dermis was observed between acquired bilateral TMEP patients and healthy controls (10.5 ± 1.9 vs 5.4 ± 1.0/mm2 , P < 0.01). Acquired bilateral TMEP is a relatively common disorder in middle-aged Asian men. An increased number of mast cells and dilated vessels might be a photoaging-related reactive process of chronic sun-exposure, which consequently leads to the formation of characteristic telangiectatic hyperpigmentary macules through certain melanogenic mediators.
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Affiliation(s)
- Hye-Rim Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Jae Kim
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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39
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Demirkan S, Gündüz Ö, Sayan CD. Retrospective Analysis of Endemic Melasma Patients. Dermatol Reports 2017; 9:7027. [PMID: 28652905 PMCID: PMC5475413 DOI: 10.4081/dr.2017.7027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 05/02/2017] [Indexed: 11/23/2022] Open
Abstract
Melasma is an acquired diffuse hypermelanosis characterized by localized, symmetrical, irregular, light-to-dark brown maculae occurring in sun-exposed areas of skin. The aim of this retrospective study was to determine demographics of patients, analysis of etiologic factors, clinical features, efficacy and side effects of available topical treatments due to high incidence of melasma patients. In this study melasma patients in Birecik State Hospital were investigated retrospectively. Between January 2014 and October 2015, 1008 patients had diagnosis of melasma in 49,809 applications of 24,603 different patients who admitted to Dermatology Outpatient Clinics. Of the 1008 patients, 263 had completed 3-month treatment period. These patients did not receive treatment in June, July, August and September. All melasma patients were rural and dealing with agriculture. There was no significant difference between female and male patients in terms of age. Of the 253 female melasma patients, only 2 of them had not child and none of them were using hormone drug. Of the 263 patients with melasma, Fitzpatrick skin type was 3 in 79 (30%) patients, 4 in 184 (70%) patients. Şanliurfa city showed higher fertility rate, sun exposure, and skin type than Turkey as a whole. These predisposing factors may explain higher melasma occurrence in Şanliurfa. Patient information about preventive measures and treatment play important role in treatment of cosmetic condition. The most important measure seems to advise patients about sun-protection especially during pregnancy.
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40
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Hasegawa K, Fujiwara R, Sato K, Park JY, Kim SJ, Kim M, Kang HY. Increased blood flow and vasculature in solar lentigo. J Dermatol 2016; 43:1209-1213. [DOI: 10.1111/1346-8138.13458] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/05/2016] [Indexed: 01/23/2023]
Affiliation(s)
| | | | - Kiyoshi Sato
- Shiseido Global Innovation Center; Yokohama Japan
| | - Ji-Youn Park
- Department of Dermatology; Ajou University School of Medicine; Suwon Korea
| | - Sang Jin Kim
- Department of Dermatology; Ajou University School of Medicine; Suwon Korea
| | - Misun Kim
- Department of Dermatology; Ajou University School of Medicine; Suwon Korea
- Department of Biomedical Sciences; Graduate School of Ajou University; Suwon Korea
| | - Hee Young Kang
- Department of Dermatology; Ajou University School of Medicine; Suwon Korea
- Department of Biomedical Sciences; Graduate School of Ajou University; Suwon Korea
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41
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Nouveau S, Agrawal D, Kohli M, Bernerd F, Misra N, Nayak CS. Skin Hyperpigmentation in Indian Population: Insights and Best Practice. Indian J Dermatol 2016; 61:487-95. [PMID: 27688436 PMCID: PMC5029232 DOI: 10.4103/0019-5154.190103] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Skin pigmentation is one of the most strikingly variable phenotypes in humans, therefore making cutaneous pigmentation disorders frequent symptoms manifesting in a multitude of forms. The most common among them include lentigines, postinflammatory hyperpigmentation, dark eye circles, and melasma. Variability of skin tones throughout the world is well-documented, some skin tones being reported as more susceptible to pigmentation disorders than others, especially in Asia and India. Furthermore, exposure to ultraviolet radiation is known to trigger or exacerbate pigmentation disorders. Preventive strategies for photoprotection and treatment modalities including topical and other medical approaches have been adopted by dermatologists to mitigate these disorders. This review article outlines the current knowledge on pigmentation disorders including pathophysiology, molecular profiling, and therapeutic options with a special focus on the Indian population.
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Affiliation(s)
- Stephanie Nouveau
- Department of Advanced Research, L'Oreal Research and Innovation, France
| | - Divya Agrawal
- Department of Advanced Research, L'Oreal India Pvt. Limited, Mumbai, Maharashtra, India
| | - Malavika Kohli
- Department of Dermatology, Jaslok Hospital and Breach Candy Hospital Trust, Mumbai, Maharashtra, India
| | - Francoise Bernerd
- Department of Advanced Research, L'Oreal Research and Innovation, France
| | - Namita Misra
- Department of Advanced Research, L'Oreal India Pvt. Limited, Mumbai, Maharashtra, India
| | - Chitra Shivanand Nayak
- Department of Dermatology, Leprology and Venereology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
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42
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Byun JW, Park IS, Choi GS, Shin J. Role of fibroblast-derived factors in the pathogenesis of melasma. Clin Exp Dermatol 2016; 41:601-9. [DOI: 10.1111/ced.12874] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/30/2022]
Affiliation(s)
- J. W. Byun
- Department of Dermatology; Inha Hospital; INHA University School of Medicine; Incheon Korea
| | - I. S. Park
- Department of Pathology; INHA University School of Medicine; Incheon Korea
| | - G. S. Choi
- Department of Dermatology; Inha Hospital; INHA University School of Medicine; Incheon Korea
| | - J. Shin
- Department of Dermatology; Inha Hospital; INHA University School of Medicine; Incheon Korea
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43
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Shin J, Kang HY, Kim KH, Park CJ, Oh SH, Lee SC, Lee S, Choi GS, Hann SK. Involvement of T cells in early evolving segmental vitiligo. Clin Exp Dermatol 2016; 41:671-4. [DOI: 10.1111/ced.12852] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2015] [Indexed: 10/21/2022]
Affiliation(s)
- J. Shin
- Department of Dermatology; Inha University Hospital; Graduate School of Medical Science; Incheon Korea
| | - H. Y. Kang
- Department of Dermatology; Ajou University School of Medicine; Suwon Korea
| | - K. H. Kim
- Department of Dermatology; Dong-A University College of Medicine; Busan Korea
| | - C. J. Park
- Department of Dermatology; Bucheon St. Mary's Hospital; College of Medicine; Catholic University of Korea; Bucheon Korea
| | - S. H. Oh
- Department of Dermatology; Severance Hospital; Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - S. C. Lee
- Department of Dermatology; Chonnam National University Medical School; Gwangju Korea
| | - S. Lee
- Department of Dermatology; Soonchunhyang University College of Medicine; Bucheon Korea
| | - G. S. Choi
- Department of Dermatology; Inha University Hospital; Graduate School of Medical Science; Incheon Korea
| | - S. K. Hann
- Korea Institute of Vitiligo Research and Drs Woo and Hann's Skin Center; Seoul Korea
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44
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Heterogeneous Pathology of Melasma and Its Clinical Implications. Int J Mol Sci 2016; 17:ijms17060824. [PMID: 27240341 PMCID: PMC4926358 DOI: 10.3390/ijms17060824] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/14/2016] [Accepted: 05/23/2016] [Indexed: 11/22/2022] Open
Abstract
Melasma is a commonly acquired hypermelanosis that affects sun-exposed areas of the skin, with frequent facial involvement. Its histologic manifestations are evident in the epidermis, extracellular matrix, and dermis. In addition to epidermal pigmentation, pathologic findings of melasma include extracellular matrix abnormality, especially solar elastosis. The disrupted basement membrane has been described in melasma with variable incidences. In the dermis, an increase in vascularity and an increase in the number of mast cells were observed, indicating that dermal factors have critical roles in the pathogenesis of melasma, despite the fact that melasma is characterized by epidermal hyperpigmentation. This review discusses such histologic characteristics of melasma, with consideration to their implications for melasma treatment.
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45
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Bastonini E, Kovacs D, Picardo M. Skin Pigmentation and Pigmentary Disorders: Focus on Epidermal/Dermal Cross-Talk. Ann Dermatol 2016; 28:279-89. [PMID: 27274625 PMCID: PMC4884703 DOI: 10.5021/ad.2016.28.3.279] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 01/18/2023] Open
Abstract
Variation in human skin and hair color is the most notable aspect of human variability and several studies in evolution, genetics and developmental biology contributed to explain the mechanisms underlying human skin pigmentation, which is responsible for differences in skin color across the world's populations. Despite skin pigmentation is primarily related to melanocytes functionality, the surrounding keratinocytes and extracellular matrix proteins and fibroblasts in the underlying dermal compartment actively contribute to cutaneous homeostasis. Many autocrine/paracrine secreted factors and cell adhesion mechanisms involving both epidermal and dermal constituents determine constitutive skin pigmentation and, whenever deregulated, the occurrence of pigmentary disorders. In particular, an increased expression of such mediators and their specific receptors frequently lead to hyperpigmentary conditions, such as in melasma and in solar lentigo, whereas a defect in their expression/release is related to hypopigmented disorders, as seen in vitiligo. All these interactions underline the relevant role of pigmentation on human evolution and biology.
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Affiliation(s)
- Emanuela Bastonini
- Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Daniela Kovacs
- Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Mauro Picardo
- Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
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46
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Kim M, Han JH, Kim JH, Park TJ, Kang HY. Secreted Frizzled-Related Protein 2 (sFRP2) Functions as a Melanogenic Stimulator; the Role of sFRP2 in UV-Induced Hyperpigmentary Disorders. J Invest Dermatol 2016; 136:236-44. [PMID: 26763443 DOI: 10.1038/jid.2015.365] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 07/16/2015] [Accepted: 07/23/2015] [Indexed: 12/19/2022]
Abstract
In this study, we found that secreted frizzled-related protein 2 (sFRP2) is overexpressed in the hyperpigmentary skin of melasma and solar lentigo and in acutely UV-irradiated skin. To investigate the effect of sFRP2 on melanogenesis, normal human melanocytes were infected with sFRP2-lentivirus or sh-sFRP2. It was found that sFRP2 stimulates melanogenesis through microphthalmia-associated transcription factor and/or tyrosinase upregulation via β-catenin signaling. The stimulatory action of sFRP2 in pigmentation was further confirmed in melanocytes cocultured with fibroblasts and in ex vivo cultured skin. The findings suggest that sFRP2 functions as a melanogenic stimulator and that it plays a role in the development of UV-induced hyperpigmentary disorders.
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Affiliation(s)
- Misun Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea; Chronic Inflammatory Disease Research Center, Ajou University School of Medicine, Suwon, Korea; Department of Biomedical Science, Ajou University School of Medicine, Suwon, Korea
| | - Jae Ho Han
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Jang-Hee Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Tae Jun Park
- Chronic Inflammatory Disease Research Center, Ajou University School of Medicine, Suwon, Korea; Department of Biomedical Science, Ajou University School of Medicine, Suwon, Korea; Department of Biochemistry, Ajou University School of Medicine, Suwon, Korea.
| | - Hee Young Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea; Chronic Inflammatory Disease Research Center, Ajou University School of Medicine, Suwon, Korea; Department of Biomedical Science, Ajou University School of Medicine, Suwon, Korea.
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47
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Kim SJ, Park JY, Shibata T, Fujiwara R, Kang HY. Efficacy and possible mechanisms of topical tranexamic acid in melasma. Clin Exp Dermatol 2016; 41:480-5. [DOI: 10.1111/ced.12835] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S. J. Kim
- Department of Dermatology; Ajou University School of Medicine; Suwon Korea
| | - J.-Y. Park
- Department of Dermatology; Ajou University School of Medicine; Suwon Korea
| | - T. Shibata
- Shiseido Research Center; Yokohama Japan
| | | | - H. Y. Kang
- Department of Dermatology; Ajou University School of Medicine; Suwon Korea
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48
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Lee AY. Recent progress in melasma pathogenesis. Pigment Cell Melanoma Res 2015; 28:648-60. [PMID: 26230865 DOI: 10.1111/pcmr.12404] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/27/2015] [Indexed: 12/19/2022]
Abstract
Melasma is a common skin pigmentation condition. Given therapeutic difficulty as one of the biggest concerns, understanding of the etiology and pathogenesis of melasma becomes essential. UV irradiation, female sex hormones, and inflammatory processes are addressed as triggering factors with genetic predisposition. The mechanism of UV-induced melanogenesis has been extensively investigated as a model system to study melasma pathogenesis. Hitherto, treatment modalities for melasma are similar to other hyperpigmentation disorders. However, individual triggering factors induce a separate pigmentation disease, whose pathogenic mechanisms and clinical phenotypes are different from the ones encountered in melasma. Fortunately, there have been ongoing updates on melasma pathogenesis with regard to major triggering factors. Presence of certain factors working independently of UV exposure and role of dermal factors and microRNAs are being identified as novel discoveries about melasma pathogenesis. In this review, the melasma pathogenesis is reviewed in association with updated and new findings.
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Affiliation(s)
- Ai-Young Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, Ilsandong-gu, Goyang-si, Gyeonggi-do, South Korea
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49
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Ma C, Sivamani RK. Acupuncture as a Treatment Modality in Dermatology: A Systematic Review. J Altern Complement Med 2015; 21:520-9. [DOI: 10.1089/acm.2014.0274] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Chelsea Ma
- Department of Dermatology, University of California, Davis, Sacramento, CA
| | - Raja K. Sivamani
- Department of Dermatology, University of California, Davis, Sacramento, CA
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50
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Moncada B, Castillo-Martínez C, Arenas E, León-Bejarano F, Ramírez-Elías MG, González FJ. Raman spectroscopy analysis of the skin of patients with melasma before standard treatment with topical corticosteroids, retinoic acid, and hydroquinone mixture. Skin Res Technol 2015; 22:170-3. [DOI: 10.1111/srt.12245] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 11/27/2022]
Affiliation(s)
- B. Moncada
- Dermatology Department; Hospital Central ‘Dr. Ignacio Morones Prieto’; Autonomous University of San Luis Potosí; San Luis Potosí México
| | - C. Castillo-Martínez
- Dermatology Department; Hospital Central ‘Dr. Ignacio Morones Prieto’; Autonomous University of San Luis Potosí; San Luis Potosí México
| | - E. Arenas
- Dermatology Department; Hospital Central ‘Dr. Ignacio Morones Prieto’; Autonomous University of San Luis Potosí; San Luis Potosí México
| | - F. León-Bejarano
- Engineering Division; University of Guanajuato; Guanajuato México
| | - M. G. Ramírez-Elías
- School of Sciences; Autonomous University of San Luis Potosí; San Luis Potosí México
| | - F. J. González
- Coordination for the Innovation and the Application of Science and Technology; Autonomous University of San Luis Potosí; San Luis Potosí México
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