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Gan C, Rodrigues M. An Update on New and Existing Treatments for the Management of Melasma. Am J Clin Dermatol 2024:10.1007/s40257-024-00863-2. [PMID: 38896402 DOI: 10.1007/s40257-024-00863-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 06/21/2024]
Abstract
Melasma is a chronic, acquired disorder of focal hypermelanosis that carries significant psychosocial impact and is challenging for both the patient and the treating practitioner to manage in the medium to long term. Multiple treatments have been explored, often in combination given the many aetiological factors involved in its pathogenesis. Therapeutic discoveries to treat melasma are a focal topic in the literature and include a range of modalities, with recent developments including updates on visible light photoprotection, non-hydroquinone depigmenting agents, oral tranexamic acid, chemical peels, and laser and energy-based device therapy for melasma. It is increasingly important yet challenging to remain up-to-date on the arsenal of treatments available for melasma to find an efficacious and well-tolerated option for our patients.
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Affiliation(s)
- Christian Gan
- Department of Dermatology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Michelle Rodrigues
- Department of Dermatology, The Royal Children's Hospital, Melbourne, VIC, Australia.
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
- Chroma Dermatology, Pigment and Skin of Colour Centre, Melbourne, VIC, Australia.
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Sarkar R, Lakhani R. Chemical Peels for Melasma: A Systematic Review. Dermatol Surg 2024:00042728-990000000-00737. [PMID: 38530985 DOI: 10.1097/dss.0000000000004167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Melasma is a common chronic, relapsing pigmentary disorder that causes psychological impact. Chemical peels are a well-known therapeutic modality used for accelerating the treatment of melasma. OBJECTIVE To review the published evidence on the efficacy and safety of chemical peels in the treatment of melasma. METHODS A systematic review was done. A meta-analysis could not be done due to the heterogeneity of data. RESULT The authors conducted a PubMed search and included prospective case series of more than 10 cases and randomized controlled trials (RCTs) that have studied the safety and/or efficacy of chemical peel in melasma. Out of 24 studies, 9 were clinical/comparative trials and 15 were RCTs. The total sample size was 1,075. The duration of the study varied from 8 to 36 weeks. Only 8 studies were split face. All studies used self-assessment, physician global assessment, and Melasma Area and Severity Index (MASI) for quantifying the results. Glycolic acid was found to be the most safe and effective in melasma. CONCLUSION Chemical peels were found to be safe and effective in the management of melasma.
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Affiliation(s)
- Rashmi Sarkar
- All authors are affiliated with the Department of Dermatology and Sexually Transmitted Diseases, Lady Hardinge Medical College and associated Hospitals, Central Delhi, New Delhi, India
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Apt DP, Calderon PD, Kohn BG. Enfrentamiento del paciente con melasma: actualizaciones en tratamiento. REVISTA MÉDICA CLÍNICA LAS CONDES 2023. [DOI: 10.1016/j.rmclc.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Lai D, Zhou S, Cheng S, Liu H, Cui Y. Laser therapy in the treatment of melasma: a systematic review and meta-analysis. Lasers Med Sci 2022; 37:2099-2110. [PMID: 35122202 DOI: 10.1007/s10103-022-03514-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/24/2022] [Indexed: 01/11/2023]
Abstract
Melasma is a highly prevalent and cosmetically disfiguring pigmented skin disease. The post-treatment results are often unsatisfactory. A large number of clinical trials have tried to prove the effectiveness of the combination therapy involving laser therapy, but the results have been indeterminate. This study aimed to evaluate the effectiveness of laser treatment for melasma via a systematic review and meta-analysis. We respectively searched 4 databases and clinicaltrials.gov as of June 8, 2021. Two researchers independently searched for literature and extracted data. Study outcomes were computed by weighted mean differences (WMD). All statistical analyses were performed by the Review Manager version 5.3, STATA version 14 software at 95% confidence interval. We obtained 22 eligible studies which involved a total of 694 patients. After the heterogeneity test and sensitivity analysis, we took a subgroup meta-analysis on the before and after treatment of different laser types. We found that most lasers and laser-based combinations were associated with reduced melasma area and severity index (MASI), such as low-fluence Q-switch 1,064-nm Nd: YAG laser (QSNYL) (WMD: - 2.76; 95% CI: - 3.53 to - 1.99), fractional ablative CO2 laser (WMD: - 9.36; 95% CI: - 12.51 to - 6.21), and fractional ablative 2940-nm Er: YAG laser (WMD: - 2,72; 95% CI: - 3.94 to - 1.49). Significant decrease was seen in neither MASI score of non-ablative 1550-nm fractional laser (WMD: - 1.29; 95% CI: - 2.80 to 0.21) and picosecond laser (WMD: - 0.58; 95% CI: - 1.43 to 0.27), nor melanin index (MI) of low-fluence QSNYL treatment (WMD: 10.17; 95% CI: - 4.11 to 24.46). When using laser to treat melasma, various adverse reactions may occur, most of which will resolve quickly without subsequent treatment, such as edema, erythema, scaling, and burning sensation after treatment. However, for patients with darker skin, there are risks of postinflammatory hyperpigmentation and hypopigmentation. The laser and laser-based combination treatment for melasma could significantly reduce the MASI score, which was showed by our systematic review and meta-analysis.
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Affiliation(s)
- Dihui Lai
- Department of Dermatology, Beijing ChuiYangLiu Hospital, Beijing, China
| | - Shaona Zhou
- Department of Dermatology, Beijing ChuiYangLiu Hospital, Beijing, China
| | - Shaowei Cheng
- Department of Dermatology, Beijing ChuiYangLiu Hospital, Beijing, China
| | - Hongmei Liu
- Department of Dermatology, MEIYAN Aesthetic Plastic Medical Clinic, Beijing, China
| | - Yong Cui
- Department of Dermatology, China-Japan Friendship Hospital, NO.2 Yinghua East Road, Chaoyang District, Beijing, China.
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Nautiyal A, Wairkar S. Management of hyperpigmentation: Current treatments and emerging therapies. Pigment Cell Melanoma Res 2021; 34:1000-1014. [PMID: 33998768 DOI: 10.1111/pcmr.12986] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/16/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022]
Abstract
Hyperpigmentation of the skin refers to a dermatological condition which alters the color of the skin, making it discolored or darkened. The treatments for hyperpigmentation disorders often take very long to show results and have poor patient compliance. The first-line treatment for hyperpigmentation involves topical formulations of conventional agents such as hydroquinone, kojic acid, and glycolic acid followed by oral formulations of therapeutic agents such as tranexamic acid, melatonin, and cysteamine hydrochloride. The second-line approaches include chemical peels and laser therapy given under the observation of expert professionals. However, these therapies pose certain limitations and adverse effects such as erythema, skin peeling, and drying and require long treatment duration to show visible effects. These shortcomings of the conventional treatments provided scope for further research on newer alternatives for managing hyperpigmentation. Some of these therapies include novel formulations such as solid lipid nanocarriers, liposomes, phytochemicals, platelet-rich plasma, microneedling. This review focuses on elaborating on several hyperpigmentation disorders and their mechanisms, the current, novel and emerging treatment options for management of hyperpigmentation.
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Affiliation(s)
- Avni Nautiyal
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, Mumbai, India
| | - Sarika Wairkar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, Mumbai, India
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Abstract
BACKGROUND Melasma is an acquired, chronic pigmentary disorder predominantly affecting women. It may significantly affect quality of life and self-esteem due to its disfiguring appearance. Multiple treatments for melasma are available, with mixed results. OBJECTIVE The aim of this article was to conduct an evidence-based review of all available interventions for melasma. METHODS A systematic literature search of the PubMed electronic database was performed using the keywords 'melasma' and/or 'chloasma' in the title, through October 2018. The search was then limited to 'randomized controlled trial' and 'controlled clinical trial' in English-language journals. The Cochrane database was also searched for systematic reviews. RESULTS The electronic search yielded a total of 212 citations. Overall, 113 studies met the inclusion criteria and were included in this review, with a total of 6897 participants. Interventions included topical agents, chemical peels, laser- and light-based devices, and oral agents. Triple combination cream (hydroquinone, tretinoin, and corticosteroid) remains the most effective treatment for melasma, as well as hydroquinone alone. Chemical peels and laser- and light-based devices have mixed results. Oral tranexamic acid is a promising new treatment for moderate and severe recurrent melasma. Adverse events from all treatments tend to be mild, and mainly consist of skin irritation, dryness, burning, erythema, and post-inflammatory hyperpigmentation. CONCLUSIONS Hydroquinone monotherapy and triple combination cream are the most effective and well-studied treatments for melasma, whereas chemical peels and laser- and light-based therapies are equal or inferior to topicals, but offer a higher risk of adverse effects. Oral tranexamic acid may be a safe, systemic adjunctive treatment for melasma, but more studies are needed to determine its long-term safety and efficacy. Limitations of the current evidence are heterogeneity of study design, small sample size, and lack of long-term follow-up, highlighting the need for larger, more rigorous studies in the treatment of this recalcitrant disorder.
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Affiliation(s)
- Jacqueline McKesey
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9190, USA
| | | | - Amit G Pandya
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9190, USA.
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Zhang Y, Zheng X, Chen Z, Lu L. Laser and laser compound therapy for melasma: a meta-analysis. J DERMATOL TREAT 2019; 31:77-83. [PMID: 30702958 DOI: 10.1080/09546634.2019.1577544] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Treatment of melasma is challenging because its pathogenesis is unclear and it is prone to recurrence. We performed a meta-analysis to evaluate the efficacy and safety of laser and laser compound therapy for melasma.Methods: We searched the Cochrane, Embase, and Medline databases for all relevant studies published from inception to July 2018. All randomized controlled trials of melasma describing treatment with lasers or laser compound therapy were included.Results: A total of 346 patients were enrolled in nine RCT studies. Laser therapy and laser compound therapy had better PGA (MD: 1.96 (95% CI: 0.17, 3.75); I2 = 0%) and mMASI scores (MD: -1.57 (95% CI: -3.08, -0.05); I2 = 19%) than drug and laser therapy, respectively. Four studies were assessed to be of low risk of bias. Subgroup analysis was consistent with the results of the meta-analysis, reflecting the reliability of our results.Linking evidence to action: The results of this meta-analysis provide evidence that laser and laser compound therapy can improve the area and severity of melasma. Further high-quality clinical studies should be carried out in the future to confirm this conclusion. Abbreviations: MASI: Melasma Area and Severity Index; mMASI: modified Melasma Area and Severity Index; PGA: patient global assessment; MI: melasma index.
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Affiliation(s)
- Yanan Zhang
- Second Clinical Medical School, Zhejiang Chinese Medical University, Zhejiang, PR China
| | - Xiaoyan Zheng
- Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, PR China
| | - Zhiwei Chen
- Dermatology, Wenzhou Hospital of Integrated Chinese and Western Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine, Zhejiang, PR China
| | - Liming Lu
- Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, PR China
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The Safety and Efficacy of Treatment With a 1,927-nm Diode Laser With and Without Topical Hydroquinone for Facial Hyperpigmentation and Melasma in Darker Skin Types. Dermatol Surg 2018; 44:1304-1310. [PMID: 29659405 DOI: 10.1097/dss.0000000000001521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The nonablative, fractional, 1,927-nm diode laser is theoretically a safe and effective treatment for hyperpigmentation and melasma in darker skin and may potentiate topical cosmeceutical delivery. OBJECTIVE To evaluate the use of a nonablative, fractional, 1,927-nm diode laser with and without topical 2% hydroquinone (HQ) cream for moderate-to-severe facial hyperpigmentation in Fitzpatrick skin Types III-V. METHODS Forty adults underwent 4 laser treatments at 2-week intervals and were randomized to daily application of 2% HQ cream or moisturizer. Follow-ups were conducted 4 and 12 weeks after the final laser treatment. RESULTS Hydroquinone and moisturizer groups demonstrated Mottled Pigmentation Area and Severity Index improvements of approximately 50% at post-treatment Weeks 4 and 12. Blinded investigator-assessed hyperpigmentation and photodamage improved significantly for both the groups at post-treatment Weeks 4 and 12. Subject satisfaction improved significantly in both the groups by post-treatment Week 4. Although investigator-rated Global Aesthetic Improvement Scale scores were significantly better in the HQ group at post-treatment Week 12, satisfaction was higher among those using moisturizer. No adverse events were noted. CONCLUSION The nonablative, fractional, 1,927-nm diode laser produced significant improvement in hyperpigmentation in Fitzpatrick skin Types III-V by 4 weeks, with maintenance of results at 12 weeks after treatment even without HQ.
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Chan IL, Cohen S, da Cunha MG, Maluf LC. Characteristics and management of Asian skin. Int J Dermatol 2018; 58:131-143. [DOI: 10.1111/ijd.14153] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- I. Lym Chan
- Faculdade de Medicina do ABC; Santo André São Paulo Brazil
| | - Simão Cohen
- Faculdade de Medicina do ABC; Santo André São Paulo Brazil
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Mansouri P, Azizian Z, Hejazi S, Chalangari R, Chalangari KM. Evaluation the efficacy of trichloroacetic acid (TCA) 33% in treatment of oral retinoid-induced cheilitis compared with placebo (Vaseline): a randomized pilot study. J DERMATOL TREAT 2018; 29:694-697. [PMID: 29464980 DOI: 10.1080/09546634.2018.1441489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Oral Isotretinoin (13-cis-retinoic acid) is a gold standardtreatment for severe forms of acne with cheilitis as a most frequent complication. We designed this novel study to investigate the therapeutic effect of trichloroacetic acid (TCA) 33% as compared with placebo to treat cheilitis. METHODS In this pilot study, 90 acne vulgaris patients between 18 and 50 years, who referred dermatologic clinic with cheilitis, were assigned to either case (TCA) or control (Vaseline) group using permuted-block randomization from 2013 to 2015 with data analysis in 2016. Patients had follow-up visits after 2 and 6 weeks, at which their lesions were photographed. Two blinded expert dermatologists recorded physician International global score for each image. RESULTS Ninety eligible patients were randomly allocated into two groups. This included 45 patients in each group. At the end of follow-up, 44 patients in the intervention group and 37 patients in control group completed the final assessment. Compared to the control group, the TCA group had a greater reduction in the mean ICGS value from baseline to Week 6 (mean difference 2.59 points, p < .0001). CONCLUSIONS TCA can be considered as a good strategy in improvement of cheilitis to isotretinoin therapy.
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Affiliation(s)
- Parvin Mansouri
- a Skin and Stem Cell Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Zahra Azizian
- a Skin and Stem Cell Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Somayeh Hejazi
- a Skin and Stem Cell Research Center, Tehran University of Medical Sciences , Tehran , Iran
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LaRosa C, Chiaravalloti A, Jinna S, Berger W, Finch J. Laser treatment of medical skin disease in women. Int J Womens Dermatol 2017; 3:131-139. [PMID: 28831422 PMCID: PMC5555278 DOI: 10.1016/j.ijwd.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/01/2023] Open
Abstract
Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the body of literature that exists for the laser treatment of women with these medical conditions.
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Affiliation(s)
- C. LaRosa
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - A. Chiaravalloti
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - S. Jinna
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - W. Berger
- Frank H. Netter MD School of Medicine, Quinnipiac University, North, Haven, CT
| | - J. Finch
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
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Affiliation(s)
- Christopher J. Britt
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Benjamin Marcus
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison
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Jang HW, Chun SH, Park HC, Ryu HJ, Kim IH. Comparative study of dual-pulsed 1064 nm Q-switched Nd:YAG laser and single-pulsed 1064 nm Q-switched Nd:YAG laser by using zebrafish model and prospective split-face analysis of facial melasma. J COSMET LASER THER 2016; 19:114-123. [PMID: 27911108 DOI: 10.1080/14764172.2016.1262958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recently dual-pulsed low-fluence 1064-nm Q-switched Nd:YAG (QSNY) laser has been developed for reducing complication during melasma treatment. OBJECTIVE Comparison of the efficacy and safety between dual-pulsed mode and single-pulsed mode for the treatment of melasma. MATERIALS AND METHODS In preclinical study, adult zebrafish were irradiated with dual-pulsed and single-pulsed mode. Changes of melanophore and cell death were assessed. In split-face clinical study, dual-pulsed and single-pulsed mode were irradiated on the left and right side of the face, respectively. L* value, clinical digital photos, modified Melasma Area and Severity Index (MASI) scores, and side effects were measured. RESULTS As compared to single-pulsed mode and dual-pulsed mode with longer intervals, zebrafish melanophore was cleared quickly at dual-pulsed mode with 80-μsec interval and 0.3 J/cm2 fluence. Dual-pulsed mode showed the least regeneration of melanophore at 4 weeks after irradiation and no cell death was observed with 80-μsec interval. Both pulse modes improved melasma significantly but modified MASI score and L* value were not significantly different between each other. Lesser pain and shorter duration of post-laser erythema were observed with dual-pulsed mode. CONCLUSION Dual-pulsed mode was as effective as single-pulsed mode for the treatment of melasma and revealed less side effects.
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Affiliation(s)
- Hee Won Jang
- a Department of Dermatology , Arumdaun Nara Dermatologic Clinic , Seoul , Korea
| | - Seung Hyun Chun
- b Department of Dermatology, College of Medicine , Korea University Ansan Hospital , Ansan , Korea
| | - Hae Chul Park
- c Laboratory of Neurodevelopmental Genetics, Graduate School of Medicine , Korea University , Ansan , Korea
| | - Hwa Jung Ryu
- b Department of Dermatology, College of Medicine , Korea University Ansan Hospital , Ansan , Korea
| | - Il-Hwan Kim
- b Department of Dermatology, College of Medicine , Korea University Ansan Hospital , Ansan , Korea
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Wat H, Wu DC, Chan HHL. Fractional resurfacing in the Asian patient: Current state of the art. Lasers Surg Med 2016; 49:45-59. [PMID: 27605303 DOI: 10.1002/lsm.22579] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Fractionated photothermolysis (FP) has revolutionized modern laser technology. By creating selective columns of microthermal damage, fractionated devices allows for greater treatment depths to be achieved without the prolonged downtime and risk of complications seen in traditional fully ablative laser resurfacing. Fractional resurfacing is a proven method to treat a variety of cutaneous conditions. In the Caucasian patient, a wide range of devices and treatment settings can be utilized safely and effectively. However, ethnic skin requires special consideration due to its unique pigmentary characteristics and clinical presentations. In this review article, we detail the current indications and strategies to optimize results and mitigate complications when utilizing fractional resurfacing for the Asian patient. METHODS A review of the MEDLINE English literature was conducted on fractionated laser devices studied in the Asian population. Articles included describe non-ablative devices including fractionated erbium glass, thulium fiber, diode, and radiofrequency devices; and ablative devices including fractionated carbon dioxide (CO2 ) laser, erbium yttrium aluminum garnet and yttrium scandium gallium garnet (YSGG) laser. These data were integrated with the expert opinion of the authors. CONCLUSION Taking into account the unique characteristics and cosmetic concerns of the Asian population, fractional resurfacing can be considered a safe and effective option for the treatment of atrophic and hypertrophic scarring, and photorejuvenation in ethnic skin types. Select cases of melasma may be treated with fractionated non-ablative devices, but utilized with caution. The predominant complication associated with fractional resurfacing for these conditions is post-inflammatory hyperpigmentation (PIH) and rebound worsening of melasma. A greater number of treatments at lower density settings and wider treatment intervals typically produce the lowest risks of PIH without compromising treatment efficacy. Lasers Surg. Med. 49:45-59, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Heidi Wat
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada, T6G 2G3
| | - Douglas C Wu
- Goldman, Butterwick, Groff, Fabi, and Wu Cosmetic Laser Dermatology, San Diego, California, 92121
| | - Henry Hin Lee Chan
- Division of Dermatology, Department of Medicine, University of Hong Kong, Hong Kong, SAR, China.,Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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15
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Rodrigues M, Pandya AG. Melasma: clinical diagnosis and management options. Australas J Dermatol 2015; 56:151-63. [DOI: 10.1111/ajd.12290] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 11/19/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Michelle Rodrigues
- Department of Dermatology; St Vincent's Hospital; Melbourne Victoria
- Department of Dermatology; The Royal Children's Hospital; Melbourne
- The Skin and Cancer Foundation; Inc
| | - Amit G Pandya
- Department of Dermatology; University of Texas; Southwestern Medical Centre; Dallas Texas USA
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Alsaad SMS, Ross EV, Mishra V, Miller L. A split face study to document the safety and efficacy of clearance of melasma with a 5 ns q switched Nd YAG laser versus a 50 ns q switched Nd YAG laser. Lasers Surg Med 2014; 46:736-40. [PMID: 25411141 DOI: 10.1002/lsm.22303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES To determine the safety and efficacy of a 50 ns Q switched Nd YAG laser vs. a 5 ns Q switched Nd YAG laser for clearance of melasma. To compare subject satisfaction, efficacy, and comfort level between the two lasers. STUDY DESIGN/MATERIALS AND METHODS This is a prospective, randomized split face clinical study. The study was approved by the Scripps IRB. Ten healthy female subjects with moderate to severe melasma were enrolled. Each subject had three laser treatments one month apart. Patients were followed up approximately 1 month, 3 months, and 6 months after the final laser treatment. A treatment session consisted of a microdermabrasion, 1064 nm QS laser, and topicals. Subjects were asked to rate treatment pain based on a numerical scale range 0-10 (0 = no pain and 10 = worst pain). A melasma area and severity index (MASI) grading system was applied. Also, melanin measurements were acquired by a reflectance spectrophotometer. Side effects were documented during the study including post treatment erythema. RESULTS Eight patients completed the study. Subjects showed improvement on both sides of the face. From baseline to 1 month post the final laser treatment, the average MASI scores showed a 16% reduction for the 50 ns QS 1064 nm laser vs. a 27% reduction for the 5 ns QS 1064 nm laser (both significant versus baseline pigment, P < 0.05). This difference in MASI scores between the two lasers was not statistically significant (P = 0.87930). Laser treatments displayed mild erythema that resolved after one day. The melanin meter measurements showed a reduction in pigment readings on both sides. Three months after the final treatment there was some relapse in the melasma, as the mean pigment reduction fell to 12% for the 50 ns laser and 11% for the 5 ns laser. By 3 months pigment reduction was not statistically significant for either laser, and no significant differences in pigment reduction were noted between the two pulse durations. There was a statistically significant difference (P < 0.05) in pain scores reported by the subjects (scale 0-10), the mean pain score for 50 ns QS 1064 nm laser was 1.2 and for the 5 ns QS 2.9 the score was 2.9. CONCLUSIONS In this study, we showed that a combination of microdermabrasion, QS1064 nm laser, and topicals decreased the MASI and meter scores without clinically significant side effects. Moreover, the longer pulsed Q switched 1064 nm laser i.e. (50 ns) was associated with less pain than its shorter pulse width counterpart.
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Affiliation(s)
- Salman M S Alsaad
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
Melasma is an acquired pigmentary disorder characterized by symmetrical hyperpigmented macules on the face. Its pathogenesis is complex and involves the interplay of various factors such as genetic predisposition, ultraviolet radiation, hormonal factors, and drugs. An insight into the pathogenesis is important to devise treatment modalities that accurately target the disease process and prevent relapses. Hydroquinone remains the gold standard of treatment though many newer drugs, especially plant extracts, have been developed in the last few years. In this article, we review the pathogenetic factors involved in melasma. We also describe the newer treatment options available and their efficacy. We carried out a PubMed search using the following terms “melasma, pathogenesis, etiology, diagnosis, treatment” and have included data of the last few years.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Pooja Arora
- Department of Dermatology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Vijay Kumar Garg
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Noh TK, Choi SJ, Chung BY, Kang JS, Lee JH, Lee MW, Chang SE. Inflammatory features of melasma lesions in Asian skin. J Dermatol 2014; 41:788-94. [DOI: 10.1111/1346-8138.12573] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 06/13/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Tai Kyung Noh
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Seok Joo Choi
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Bo Young Chung
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | | | - Jong Hee Lee
- Department of Dermatology; Samsung Medical Center; Sungkwunkwan University School of Medicine; Seoul Korea
| | - Mi Woo Lee
- 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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Rivas S, Pandya AG. Treatment of melasma with topical agents, peels and lasers: an evidence-based review. Am J Clin Dermatol 2013; 14:359-76. [PMID: 23881551 DOI: 10.1007/s40257-013-0038-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Melasma is an acquired disorder of hyperpigmentation occurring on the face and predominantly affecting women of childbearing age. It is a chronic, often relapsing condition with a negative impact on quality of life. Current treatments for melasma are unsatisfactory. OBJECTIVE The aim of this article was to conduct an evidence-based review of interventions available for the treatment of melasma. METHODS A systematic literature search was performed using PubMed and the keywords 'melasma' or 'chloasma' in the title. The search was further refined by using a filter for 'controlled clinical trials' and 'randomized controlled trial'. The included studies were used to develop recommendations for treatment. RESULTS The electronic search yielded a total of 80 citations. Forty studies were included in this review, which had a total of 2,912 participants. Three different therapeutic modalities were investigated-topical agents, chemical peels, and laser and light therapies. Topical depigmenting agents were found to be the most effective in treating moderate-to-severe melasma, with combination therapies, such as triple-combination therapy (hydroquinone, tretinoin, and fluocinolone acetonide), yielding the best results. Chemical peels as well as laser and light therapies were found to have moderate benefit but more studies are needed to determine their efficacy and long-term safety. Adverse events associated with treatment were mild and short-lasting and included skin irritation, dryness, burning, and erythema. The data could not be statistically pooled because of the heterogeneity of treatments and lack of consistency across study designs. CONCLUSIONS Topical combination therapies were found to be more effective than monotherapy. Triple combination therapy was found to be the most effective, but approximately 40 % of patients develop erythema and peeling. Chemical peels and laser and light therapies produced mixed results, with increased risk of irritation and subsequent hyperpigmentation, particularly in darker-skinned individuals. Hence, current treatments available for melasma remain unsatisfactory. Many of the studies lacked long-term follow-up. Limitations of current literature include the heterogeneity of study designs, small sample sizes, and poor follow-up rates. Additional evidence for the effects and role of sunscreens is needed. Categorization or stratification of demographic data should also be included in future studies, such as age, melasma type, and duration of melasma prior to initiation of treatment. Patient's perception of improvement versus investigator's assessment of improvement should also be included in future studies and standardized methods of study design and assessment of outcomes are needed to form definitive conclusions on the efficacy of different treatment modalities.
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Affiliation(s)
- Shelly Rivas
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
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Kim HS, Kim EK, Jung KE, Park YM, Kim HO, Lee JY. A split-face comparison of low-fluence Q-switched Nd: YAG laser plus 1550 nm fractional photothermolysis vs. Q-switched Nd: YAG monotherapy for facial melasma in Asian skin. J COSMET LASER THER 2013; 15:143-9. [DOI: 10.3109/14764172.2013.769274] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Melasma is a common disorder of hyperpigmentation, which has a severe impact on the quality of life. Inspite of tremendous research, the treatment remains frustrating both to the patient and the treating physician. Dark skin types (Fitzpatrick types IV to VI) are especially difficult to treat owing to the increased risk of post-inflammatory hyperpigmentation (PIH). The treatment ranges from a variety of easily applied topical therapies to agents like lasers and chemical peels. Peels are a well-known modality of treatment for melasma, having shown promising results in many clinical trials. However, in darker races, the choice of the peeling agent becomes relatively limited; so, there is the need for priming agents and additional maintenance peels. Although a number of new agents have come up, there is little published evidence supporting their use in day-to -day practice. The traditional glycolic peels prove to be the best both in terms of safety as well as efficacy. Lactic acid peels being relatively inexpensive and having shown equally good results in a few studies, definitely need further experimentation. We also recommend the use of a new peeling agent, the easy phytic solution, which does not require neutralisation unlike the traditional alpha-hydroxy peels. The choice of peeling agent, the peel concentration as well as the frequency and duration of peels are all important to achieve optimum results.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College, and Lok Nayak Hospital, New Delhi, India
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