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Calacattawi R, Alshahrani M, Aleid M, Aleid F, Basamih K, Alsugair G, Alqahtani R, AlKhabbaz N, Algaidi Y, Alrakayan L, Almohanna A, Madkhali A, Aljohani S, Alotibi N. Tranexamic acid as a therapeutic option for melasma management: meta-analysis and systematic review of randomized controlled trials. J DERMATOL TREAT 2024; 35:2361106. [PMID: 38843906 DOI: 10.1080/09546634.2024.2361106] [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: 04/01/2024] [Accepted: 05/13/2024] [Indexed: 07/11/2024]
Abstract
Purpose: This study aimed to evaluate the efficacy of tranexamic acid (TXA) in treating melasma through a meta-analysis and systematic review of randomized controlled trials (RCTs). The study focused on identifying associated adverse effects and comparing TXA's effectiveness with other melasma treatments.Materials and methods: Following PROSPERO and PRISMA guidelines, an extensive electronic search was conducted across four databases for RCTs on TXA use in melasma. Inclusion criteria encompassed full-text English articles with specific outcome measures, while studies with high bias risk or non-English publications were excluded. Data were extracted from 22 relevant studies and analyzed using the RevMan software, with heterogeneity identified using I² statistics and forest plots.Results: A total of 22 studies with 1280 patients were included. TXA was administered orally, topically, or via injection, with treatment durations ranging from 8 weeks to nearly 2 years. TXA significantly reduced melasma severity, evidenced by reductions in MASI, mMASI, MI, and hemi-MASI scores. Oral TXA showed the most substantial decrease in MASI scores, followed by injections and topical applications. However, studies exhibited high heterogeneity, particularly in combined treatments. Adverse effects included gastrointestinal discomfort, skin irritation, and menstrual irregularities.Conclusions: TXA is effective in treating melasma, either alone or combined with other treatments. Despite significant reductions in melasma severity, further research is necessary to standardize TXA administration methods and address long-term effects. The high heterogeneity observed suggests a need for more consistent treatment protocols.
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Affiliation(s)
- Retaj Calacattawi
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | | | - Maryam Aleid
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah Aleid
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khalid Basamih
- College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ghada Alsugair
- College of Medicine, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | | | - Noor AlKhabbaz
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yaser Algaidi
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Latifa Alrakayan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz Almohanna
- College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | - Shaima Aljohani
- College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Naif Alotibi
- College of Medicine, Taif University, Taif, Saudi Arabia
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2
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Wang LJ, Pang YB, Li WQ, He QY, Zhang XE, Liu E, Guo J. Global research trends on melasma: a bibliometric and visualized study from 2014 to 2023. Front Pharmacol 2024; 15:1421499. [PMID: 39119611 PMCID: PMC11306164 DOI: 10.3389/fphar.2024.1421499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
Melasma, a prevalent pigmentary disorder, is characterized by its complex etiology, propensity for recurrence, and resistance to treatment. However, there is currently no research on melasma through bibliometrics and visualisation. This study analyses the hotspots and trends in the field based on 2,709 publications from the Web of Science Core Collection (WOSCC). We carried out bibliometric analyses using Citespace software for different countries/regions, institutions, authors, and keywords. References were also analysed using VoSviewer. The results indicate that overall, there has been an increase in publications related to melasma since 2014. According to the analysis of the collaborative network diagram, the United States, Egyptian Knowledge Bank, and Benjakul Soottawat are the most contributing countries, institutions, and authors, respectively. Reference and keyword analyses have identified the pathogenesis and treatment of melasma as a prevalent topic in recent years. And how to find new treatment options and more effective therapeutic drugs is a future research trend. This is the first bibliometric and visual analysis of melasma-related literature to explore research hotspots and trends.
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Affiliation(s)
- Li-Jun Wang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yao-Bin Pang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wen-Quan Li
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qing-Ying He
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xue-Er Zhang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - E. Liu
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Guo
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Tang J, Li Y, Hu X, Hua W, Xu H, Li L, Xu F. Enhancing Tranexamic Acid Penetration through AQP-3 Protein Triggering via ZIF-8 Encapsulation for Melasma and Rosacea Therapy. Adv Healthc Mater 2024; 13:e2304189. [PMID: 38539056 DOI: 10.1002/adhm.202304189] [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: 11/27/2023] [Revised: 03/15/2024] [Indexed: 04/25/2024]
Abstract
The systemic use of tranexamic acid (TA) as an oral drug can bring adverse reactions, while intradermal injection leads to pain and a risk of infection. Moreover, it is difficult for highly hydrophilic TA to penetrate the skin barrier that contains lots of hydrophobic lipid compounds, which poses enormous restrictions on its topical application. Current transdermal TA delivery strategies are suffering from low drug load rates, plus their synthesis complexity, time-consumption, etc. adding to the difficulty of TA topical application in clinical therapeutics. To increase the penetration of TA, a novel approach using TA-loaded ZIF-8 (TA@ZIF-8) is developed. The encapsulation efficiency of TA@ZIF-8 reaches ≈25% through physical adsorption and chemical bonding of TA indicates by theoretical simulation and the improved TA penetration is elevated through activating the aquaporin-3 (AQP-3) protein. Additionally, in vivo and in vitro experiments demonstrate the preponderance of TA@ZIF-8 for penetration ability and the advantages in intracellular uptake, minor cytotoxicity, and inhibition of melanogenesis and inflammatory factors. Moreover, clinical trials demonstrate the safety and efficacy of TA@ZIF-8 in the treatment of melasma and rosacea. This work presents a potential topical application of TA, free from the safety concerns associated with systemic drug administration.
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Affiliation(s)
- Jie Tang
- Cosmetics Safety and Efficacy Evaluation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- NMPA Key Laboratory for Human Evaluation and Big Data of Cosmetics, Sichuan University, Chengdu, 610041, China
| | - Yu Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xuefeng Hu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Wei Hua
- Cosmetics Safety and Efficacy Evaluation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- NMPA Key Laboratory for Human Evaluation and Big Data of Cosmetics, Sichuan University, Chengdu, 610041, China
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Haoning Xu
- School of Chemistry and Environment, Southwest Minzu University, Chengdu, 610225, China
| | - Li Li
- Cosmetics Safety and Efficacy Evaluation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- NMPA Key Laboratory for Human Evaluation and Big Data of Cosmetics, Sichuan University, Chengdu, 610041, China
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Fujian Xu
- School of Chemistry and Environment, Southwest Minzu University, Chengdu, 610225, China
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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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Zhang C, Song X, Ma C, Wang M, Deng H, Yuan M, Zhu W, Shen L, Li Y, Shi L. Hyaluronic acid dissolving microneedle patch loaded with tranexamic acid for melasma treatment. Int J Biol Macromol 2024; 270:132255. [PMID: 38729504 DOI: 10.1016/j.ijbiomac.2024.132255] [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: 01/02/2024] [Revised: 04/03/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024]
Abstract
Melasma is an acquired hypermelanotic condition characterized by the presence of irregular light-to-dark brown macules that primarily manifest on the sun-exposed areas of the skin, particularly the face. The management of melasma poses significant challenges, as it is often recalcitrant to treatment and tends to recur despite successful treatment. In this study, we explored a safe, easy, and effective melasma treatment strategy. A hyaluronic acid (HA)-based microneedle (MN) patch loaded with tranexamic acid (TXA) was designed to deliver the necessary medication for melasma treatment. The MN patch features uniform needles with adequate mechanical strength and effective penetration and solubility in the skin without cytotoxicity. Remarkably, these MNs substantially reduce the thickness of the epidermis of melasma mice, curtail melanin production, and diminish dopachrome tautomerase (DCT) expression.
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Affiliation(s)
- Cai Zhang
- The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Xuejiao Song
- The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Chuan Ma
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, China
| | - Minjia Wang
- The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hui Deng
- Department of Dermatology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Miaomiao Yuan
- Shanghai Key Laboratory of Pancreatic Diseases, Precision Research Center for Refractory Diseases in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wuyou Zhu
- Shanghai Foreign Language School Affiliated to Shanghai International Studies University, Shanghai, China
| | - Lingyue Shen
- Department of Oral & Maxillofacial-Head & Neck Oncology, Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yuzhen Li
- The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
| | - Leilei Shi
- Shanghai Key Laboratory of Pancreatic Diseases, Precision Research Center for Refractory Diseases in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Crocco EI, Torloni L, Fernandes PB, de Campos MEBB, Gonzaga M, Silva FC, Nasario JPS, Guerra LO, Csipak AR, Castilho VC. Combination of 5% cysteamine and 4% nicotinamide in melasma: Efficacy, tolerability, and safety. J Cosmet Dermatol 2024; 23:1703-1712. [PMID: 38327114 DOI: 10.1111/jocd.16183] [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: 09/01/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Melasma is a chronic dermatosis that impacts the patient's quality of life and can present considerable challenges in terms of effective treatment. OBJECTIVE To evaluate the effectiveness, tolerability, and safety of 5% cysteamine combined with 4% nicotinamide in female subjects with melasma. METHODS This single-center, single-arm, prospective, open-label study evaluated patients with melasma using a combination cream of 5% cysteamine and 4% nicotinamide in a progressive regimen (60 min in the first month, 120 min in the second month, and 180 min in the third month). RESULTS Overall, 35 treated subjects exhibited reduced modified Melasma Area and Severity Index (mMASI) (p < 0.001) and decreased MelasQoL scores (p < 0.001), accompanied by improved brightness, luminosity, homogeneity, and spot intensity (p < 0.001). Photographic and colorimetric analysis revealed smaller spots and improved homogeneity. LIMITATIONS Adherence to progressive daily treatment could not be evaluated long-term. CONCLUSION A combination cream comprising 5% cysteamine and 4% nicotinamide was effective, tolerable, and safe for treating melasma.
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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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8
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Ismail SA, Mohamed GA, Mohamedeen KN, Sotohy RSA, Bakr RM. Does Systemic Metformin Have a Role in Treating Melasma? Dermatol Surg 2024; 50:366-371. [PMID: 38416809 DOI: 10.1097/dss.0000000000004092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
BACKGROUND Melasma is a common pigmentary condition that affects the patients' quality of life and all the prescribed treatment options till now are not satisfactory, especially in dark-skinned patients. OBJECTIVE To evaluate the efficacy and safety of systemic metformin (1,000 mg and 500 mg) combined with trichloroacetic acid (TCA) peeling versus TCA alone in the treatment of melasma. PATIENTS AND METHODS The study included 60 melasma patients divided into 3 groups: Group A received systemic metformin (1000 mg/d), Group B received systemic metformin (500 mg/d) and Group C received placebo. The 3 treatment groups were treated by TCA 25% over the whole face bimonthly for a total of 6 sessions. Melasma area and severity index (MASI), and Melasma impact Quality of life Scale (MELASQOL) were used to assess the outcome. RESULTS There was a statistically significant decrease in the MASI, and the MELASQOL in the 3 studied groups after treatment with significantly better improvement in Group (A) than Group (C) ( p = .045). CONCLUSION Systemic metformin is a safe and promising therapeutic option for treating melasma.
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Affiliation(s)
- Sahar A Ismail
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt
| | - Ghada A Mohamed
- Department of Internal Medicine, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt
| | - Karima N Mohamedeen
- Department of Dermatology, Resident in Assiut Dermatology Clinic, Assuit, Egypt
| | - Rehab S A Sotohy
- Department of Dermatology, Faculty of Medicine, Assiut University, Assuit, Egypt
| | - Radwa M Bakr
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt
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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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Cheng Y, Zhang L, You Y. The effects of supramolecular nicotinamide combined with supramolecular salicylic acid on chloasma. J Cosmet Dermatol 2024; 23:681-686. [PMID: 38111320 DOI: 10.1111/jocd.16010] [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: 12/08/2022] [Revised: 06/06/2023] [Accepted: 09/18/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE To observe the efficacy and safety of supramolecular salicylic acid monotherapy and supramolecular nicotinamide in the treatment of chloasma. METHODS A total of 28 female patients with chloasma diagnosed in the dermatology outpatient department of our hospital were randomly divided into an experimental group and a control group, with 14 cases in each group. All patients were treated with 30% supramolecular salicylic acid every 2 weeks, for a total of 8 treatments. The experimental group was treated with 10% supramolecular nicotinamide once in the morning and once in the evening, and the control group was a blank control. Before each exfoliation treatment, subjects were photographed with a VISIA skin detector, and skin image analysis and modified melasma area and severity index (MASI) score were performed. RESULTS According to the MMASI decrease rate (%) before and after treatment, the effective rate of the experimental group was 64.29%, and the effective rate of the control group was 14.29%. The results of the GriffithS10 and VISIA were improved. During the whole treatment, there was one mild adverse reaction in both groups. CONCLUSION Salicylic acid stripping combined with nicotinamide in the treatment of chloasma is safe and effective, can improve skin conditions, and can be widely applied in clinical practice.
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Affiliation(s)
- Yao Cheng
- Department of Dermatology, The Fourth Affiliated Hospital of Harbin Medical University, Haerbin, Harbin, China
| | - Liang Zhang
- Department of Dermatology, The Fourth Affiliated Hospital of Harbin Medical University, Haerbin, Harbin, China
| | - Yan You
- Department of Dermatology, The Fourth Affiliated Hospital of Harbin Medical University, Haerbin, Harbin, China
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Goh CL, Kang HY, Morita A, Zhang C, Wu Y, Prakoeswa CRS, Sau NH, Kerob D, Flament F, Wei L. Awareness of sun exposure risks and photoprotection for preventing pigmentary disorders in Asian populations: Survey results from three Asian countries and expert panel recommendations. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12932. [PMID: 38059515 DOI: 10.1111/phpp.12932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND In this article, we review and discuss the photoprotection behavior of Asians based on the literature, along with a subanalysis of an original online survey, and make recommendations to optimize photoprotection for Asian populations to prevent photoaging and pigmentary disorders. METHODS An international panel of eight dermatologists from Asia (China, Korea, Japan, Singapore, Indonesia, and Vietnam) met to discuss sunscreen photoprotection for Asian patients. Additionally, a subanalysis of an online survey by 3000 respondents from three Asian countries (China, Indonesia, and Japan) investigated general public awareness and attitudes to sun exposure. RESULTS A pre-meeting survey of the eight experts from Asia showed key concerns of Asian patients consulting dermatologists are pigmentary disorders, especially actinic/senile lentigo, post-inflammatory hyperpigmentation, melasma, vitiligo, and Hori's nevus. The survey subanalysis of participants from China, Indonesia, and Japan with predominantly Fitzpatrick skin types (FST) II to IV revealed that they are particularly concerned about sun exposure causing photoaging and pigmentary disorders. Most of the respondents indicated they have limited knowledge on sunlight radiation and appropriate sunscreen protection factors. Only 22%, 13%, and 3% for China, Indonesia, and Japan, respectively, systematically use multiple protective measures (using sunscreen, avoiding midday sun, staying in the shade, wearing a hat, protective clothing, and sunglasses) when exposed to the sun. CONCLUSIONS Further education is needed for Asian populations on the importance of comprehensive daily photoprotection, including broad-spectrum sunscreen, with high UVA and visible light protection, to reduce and prevent photoaging and pigmentary disorders.
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Affiliation(s)
| | - Hee Young Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Wu
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - Cita Rosita Sigit Prakoeswa
- Department of Dermatology and Venerology, Faculty of Medicine, Universitas Airlangga - Dr Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Nguyen Huu Sau
- Hanoi Medical University and National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Delphine Kerob
- Laboratoire Dermatologique La Roche-Posay, Levallois-Perret, France
| | | | - Liu Wei
- Department of Dermatology, The General Hospital of Air Force PLA, Beijing, China
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12
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Sarkar R, Katoch S. Chemical Peels in Treatment of Melasma. Dermatol Clin 2024; 42:21-32. [PMID: 37977681 DOI: 10.1016/j.det.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Superficial chemical peels are one of the most popular skin resurfacing procedures in a dermatologists' clinic today due to quick application process, fast recovery, good patient acceptance, and excellent cosmetic results. The role of various peeling agents like glycolic acid, salicylic acid, trichloroacetic acid, Jessner's solution, retinoic acid, and lactic acid in the management of melasma has been established as that of an additional or maintenance therapy. This article details the current evidence and recommendations for the use of chemical peels in the treatment of melasma, a chronic and recurrent hyperpigmentary disorder.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and SSK and KSC Hospital, New Delhi 110001, India.
| | - Saloni Katoch
- Dr. KN Barua Institute of Dermatological Sciences, Guwahati, Assam, India
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Galache TR, Sena MM, Tassinary JAF, Pavani C. Photobiomodulation for melasma treatment: Integrative review and state of the art. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12935. [PMID: 38018017 DOI: 10.1111/phpp.12935] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/06/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE Photobiomodulation therapy (PBM) is a versatile technique for treating skin diseases. Melasma, a chronic hyperpigmentation condition, has recently been associated with vascular features and dermal photoaging and poses significant management challenges. We review the recent literature on melasma etiology and the evidence supporting PBM as a therapeutic modality for melasma treatment. METHODS We conducted a comprehensive literature search in three different databases from May to August 2023, focusing on studies published in the past 10 years. The inclusion criteria comprised full-text studies investigating low-power lasers and/or light-emitting diodes (LEDs) in in vitro or in vivo models, as well as clinical trials. We excluded studies discussing alternative melasma therapies or lacking experimental data. We identified additional studies by searching the reference lists of the selected articles. RESULTS We identified nine relevant studies. Clinical studies, in agreement with in vitro experiments and animal models, suggest that PBM effectively reduces melasma-associated hyperpigmentation. Specific wavelengths (red: 630 nm; amber: 585 and 590 nm; infrared: 830 and 850 nm) at radiant exposures between 1 and 20 J/cm2 exert modulatory effects on tyrosinase activity, gene expression, and protein synthesis of melanocytic pathway components, and thus significantly reduce the melanin content. Additionally, PBM is effective in improving the dermal structure and reducing erythema and neovascularization, features recently identified as pathological components of melasma. CONCLUSION PBM emerges as a promising, contemporary, and non-invasive procedure for treating melasma. Beyond its role in inhibiting melanogenesis, PBM shows potential in reducing erythema and vascularization and improving dermal conditions. However, robust and well-designed clinical trials are needed to determine optimal light parameters and to evaluate the effects of PBM on melasma thoroughly.
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Affiliation(s)
- Thais Rodrigues Galache
- Postgraduate Program in Biophotonics Medicine, Universidade Nove de Julho, UNINOVE, São Paulo, SP, Brazil
| | - Michelle Mota Sena
- Postgraduate Program in Biophotonics Medicine, Universidade Nove de Julho, UNINOVE, São Paulo, SP, Brazil
| | | | - Christiane Pavani
- Postgraduate Program in Biophotonics Medicine, Universidade Nove de Julho, UNINOVE, São Paulo, SP, Brazil
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Pimentel B, Palmeiro A, Castro C, Silva L, Catorze MG, João AL. Use of Picosecond Laser for Melasma Treatment: A Narrative Review. Photobiomodul Photomed Laser Surg 2023; 41:674-682. [PMID: 38085187 DOI: 10.1089/photob.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Background: Melasma results from the imbalance of the mechanisms that regulate skin pigmentation, causing the appearance of hyperpigmented patches. Treatment includes topical and oral agents, chemical peelings, microneedling, and laser therapy. The picosecond laser was developed to minimize pain and skin discoloration, which can sometimes be associated with laser treatments. It emits short pulses of energy that last from 300 to 500 picoseconds, leading to a more significant fragmentation of melanin, with miniminal risk of scarring and thermal lesions in the surrounding skin. Objective: The authors aimed to review the use of picosecond laser in the treatment of melasma and further provide an overview of the other current available options. Conclusions: While the use of picosecond laser for the treatment of melasma has yielded good results, further studies with longer follow-up periods and a higher number of patients are needed.
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Affiliation(s)
- Bernardo Pimentel
- Dermatology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Palmeiro
- Dermatology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Cristina Castro
- Dermatology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Leandro Silva
- Dermatology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | | | - Ana Luísa João
- Dermatology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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Ibrahim SM, Pennati BM, Stocchi R, Zingoni T. The treatment of melasma with a 785 nm wavelength laser in darker phototypes: An Egyptian experience. Skin Res Technol 2023; 29:e13534. [PMID: 38062665 PMCID: PMC10704040 DOI: 10.1111/srt.13534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
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Bernstein EF, Basilavecchio LD, Wang J. Melasma treatment with a 1064 nm, picosecond-domain laser with a fractionated multibeam lens array. Lasers Surg Med 2023; 55:801-808. [PMID: 37668307 DOI: 10.1002/lsm.23723] [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: 06/19/2023] [Revised: 08/01/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Picosecond-domain lasers have been fitted with fractionated optics for dermal remodeling. This study evaluates the safety and efficacy of a multiwavelength picosecond-domain laser, using a 1064 nm multibeam lens array, for improving the appearance of melasma. STUDY DESIGN/MATERIALS AND METHODS Twenty adults with a clinical diagnosis of melasma were enrolled and received 4 monthly 1064-nm, 450 ps laser treatments delivered with a 10 × 10 fractional array of 150 µm microbeams. Cosmetic units with melasma were treated with fluences ranging from 1.7 to 2.9 mJ/microbeam with a repetition rate of 6 Hz. Treatment effect was evaluation of digital images by dermatologists blinded as to the treatment conditions, comparing baseline and 3- and 8-month post-treatment images. Modified melasma area and severity index (mMASI) scores were determined by the study investigator based on clinical photography. Subject self-assessment of treatment effects was also recorded. RESULTS Blinded reviewers correctly identified the post-treatment image in 16 of the 20 image sets (80%). Ratings demonstrated statistically significant (p < 0.001) improvement on an 11-point scale at both the 3- and 8-month timepoints for a mean improvement of 3.7 point (range -8 to 10) or 37% improvement at the 3-month follow-up, and 2.7 (range -8 to 9) or 27% at the 8-month follow-up for all subjects. The average mMASI score showed highly significant reduction at both the 3- and 8-month follow-ups compared to baseline (p < 0.01). Most subjects (90%) were satisfied with the treatment outcome in melasma at both follow-ups, which is consistent with the treatment outcome and mMASI scores. CONCLUSION The fractionated, picosecond-domain, 1064 nm laser is safe and effective for improving melasma and should be considered as an adjunct to topical treatment regimens and sun-protection for management of melasma.
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Affiliation(s)
| | | | - Jenny Wang
- SUNY Downstate Health Sciences University, New York, USA
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17
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Wang YJ, Chang CC, Wu YH, Huang L, Shen JW, Lu ME, Chiang HM, Lin BS. Adaptability of melanocytes post ultraviolet stimulation in patients with melasma. Lasers Surg Med 2023; 55:680-689. [PMID: 37365922 DOI: 10.1002/lsm.23699] [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: 03/02/2023] [Revised: 05/17/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Dynamic in vivo changes in melanin in melasma lesions after exposure to ultraviolet (UV) irradiation have not been described. OBJECTIVES To determine whether melasma lesions and nearby perilesions demonstrated different adaptive responses to UV irradiation and whether the tanning responses were different among different locations on face. METHODS We collected sequential images from real-time cellular resolution full-field optical coherence tomography (CRFF-OCT) at melasma lesions and perilesions among 20 Asian patients. Quantitative and layer distribution analyses for melanin were performed using a computer-aided detection (CADe) system that utilizes spatial compounding-based denoising convolutional neural networks. RESULTS The detected melanin (D) is melanin with a diameter >0.5 µm, among which confetti melanin (C) has a diameter of >3.3 µm and corresponds to a melanosome-rich package. The calculated C/D ratio is proportional to active melanin transportation. Before UV exposure, melasma lesions had more detected melanin (p = 0.0271), confetti melanin (p = 0.0163), and increased C/D ratio (p = 0.0152) in the basal layer compared to those of perilesions. After exposure to UV irradiation, perilesions have both increased confetti melanin (p = 0.0452) and the C/D ratio (p = 0.0369) in basal layer, and this effect was most prominent in right cheek (p = 0.030). There were however no significant differences in the detected, confetti, or granular melanin areas before and after exposure to UV irradiation in melasma lesions in all the skin layers. CONCLUSIONS Hyperactive melanocytes with a higher baseline C/D ratio were noted in the melasma lesions. They were "fixed" on the plateau and were not responsive to UV irradiation regardless of the location on face. Perilesions retained adaptability with a dynamic response to UV irradiation, in which more confetti melanin was shed, mainly in the basal layer. Therefore, aggravating effect of UV on melasma was mainly due to UV-responsive perilesions rather than lesions.
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Affiliation(s)
- Yen-Jen Wang
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Chang-Cheng Chang
- Department of Cosmeceutics, China Medical University, Taichung, Taiwan
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan, Taiwan
- School of Medicine, College of Medicine, China Medical University Hospital, Taichung, Taiwan
- Aesthetic Medical Center, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Hung Wu
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Ling Huang
- Clinical Development, Apollo Medical Optics, Ltd., Taipei, Taiwan
| | - Jia-Wei Shen
- Department of Cosmeceutics, China Medical University, Taichung, Taiwan
| | - Meng-En Lu
- Department of Cosmeceutics, China Medical University, Taichung, Taiwan
| | - Hsiu-Mei Chiang
- Department of Cosmeceutics, China Medical University, Taichung, Taiwan
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan, Taiwan
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Akulinina I, Dodina M, Osadchuk M, Degtyarevskaya T. Optimizing diagnostic and therapeutic measures for different types of melasma based on the biophysical characteristics of facial skin. J COSMET LASER THER 2023; 25:25-32. [PMID: 37394829 DOI: 10.1080/14764172.2023.2230531] [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: 03/24/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/04/2023]
Abstract
The goal was to determine ways to optimize diagnostic and therapeutic measures for various types of melasma in the outpatient setting of the dermatovenerological ambulatory clinic. The study involved 112 women with a confirmed diagnosis of facial melasma whose disease lasted for at least 2 years. The severity of patient pigmentation was evaluated using the Melasma Area Severity Index and the Melasma Severity Scale. There was a significant increase in melanin levels across all melasma types, an increase in erythema in the dermal type, and an increase in sebum production in the epidermal type.
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Affiliation(s)
- Iuliia Akulinina
- Department of Biology and General Genetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
- Department of Dermatovenereology and Cosmetology, Federal State Budgetary Educational Institution of Further Professional Education "Russian Medical Academy of Continuous Professional Education" of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Maria Dodina
- Department of Rakhmanov Clinic of Skin and Venereal Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Mikhail Osadchuk
- Department of Polyclinic Therapy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Tatyana Degtyarevskaya
- Department of Biology and General Genetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Chib S, Jamwal VL, Kumar V, Gandhi SG, Saran S. Fungal production of kojic acid and its industrial applications. Appl Microbiol Biotechnol 2023; 107:2111-2130. [PMID: 36912905 DOI: 10.1007/s00253-023-12451-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 03/14/2023]
Abstract
Kojic acid has gained its importance after it was known worldwide that the substance functions primarily as skin-lightening agent. Kojic acid plays a vital role in skin care products, as it enhances the ability to prevent exposure to UV radiation. It inhibits the tyrosinase formation which suppresses hyperpigmentation in human skin. Besides cosmetics, kojic acid is also greatly used in food, agriculture, and pharmaceuticals industries. Conversely, according to Global Industry Analysts, the Middle East, Asia, and in Africa especially, the demand of whitening cream is very high, and probably the market will reach to $31.2 billion by 2024 from $17.9 billion of 2017. The important kojic acid-producing strains were mainly belongs to the genus Aspergillus and Penicillium. Due to its commercial potential, it continues to attract the attention for its green synthesis, and the studies are still widely conducted to improve kojic acid production. Thus, the present review is focused on the current production processes, gene regulation, and limitation of its commercial production, probable reasons, and possible solutions. For the first time, detailed information on the metabolic pathway and the genes involved in kojic acid production, along with illustrations of genes, are highlighted in the present review. Demand and market applications of kojic acid and its regulatory approvals for its safer use are also discussed. KEY POINTS: • Kojic acid is an organic acid that is primarily produced by Aspergillus species. • It is mainly used in the field of health care and cosmetic industries. • Kojic acid and its derivatives seem to be safe molecules for human use.
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Affiliation(s)
- Shifali Chib
- Fermentation and Microbial Biotechnology, CSIR-Indian Institute of Integrative Medicine, Canal Road, Jammu, 180001, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Vijay Lakshmi Jamwal
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
- Infectious Disease Division, CSIR-Indian Institute of Integrative Medicine, Canal Road, Jammu, 180001, India
| | - Vinod Kumar
- Fermentation and Microbial Biotechnology, CSIR-Indian Institute of Integrative Medicine, Canal Road, Jammu, 180001, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Sumit G Gandhi
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
- Infectious Disease Division, CSIR-Indian Institute of Integrative Medicine, Canal Road, Jammu, 180001, India
| | - Saurabh Saran
- Fermentation and Microbial Biotechnology, CSIR-Indian Institute of Integrative Medicine, Canal Road, Jammu, 180001, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
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20
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Liang S, Shang S, Zhang W, Tan A, Zhou B, Mei X, Li L. Comparison of the efficacy and safety of picosecond Nd:YAG laser (1,064 nm), picosecond alexandrite laser (755 nm) and 2% hydroquinone cream in the treatment of melasma: A randomized, controlled, assessor-blinded trial. Front Med (Lausanne) 2023; 10:1132823. [PMID: 37056729 PMCID: PMC10086227 DOI: 10.3389/fmed.2023.1132823] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundIncreasing numbers of studies demonstrated that picosecond lasers (Picos) were effective and safe for melasma. However, A limited number of randomized controlled trials (RCTs) regarding Picos contribute to a modest level of evidence. Topical hydroquinone (HQ) remains to be the first-line therapy.ObjectiveTo compare the efficacy and safety of non-fractional picosecond Nd:YAG laser (PSNYL), non-fractional picosecond alexandrite laser (PSAL), and 2% HQ cream in the treatment of melasma.MethodSixty melasma patients with Fitzpatrick skin types (FST) III-IV were randomly assigned to the PSNY, PSAL, and HQ groups at a 1:1:1 ratio. Patients in PSNYL and PSAL groups received 3 laser sessions at 4-week intervals. The 2% HQ cream was applied twice daily for 12 weeks in patients of the HQ group. The primary outcome, the melasma area and severity index (MASI) score, was evaluated at weeks 0, 4, 8, 12, 16, 20, and 24. The patient assessment score by quartile rating scale was rated at weeks 12, 16, 20, and 24.ResultsFifty-nine (98.3%) subjects were included in the analysis. Each group showed significant change from baseline in MASI scores from week 4 to week 24. The MASI score in the PSNYL group showed the greatest reduction compared to the PSAL group (p = 0.016) and HQ group (p = 0.018). The PSAL group demonstrated comparable MASI improvement as the HQ group (p = 0.998). The PSNYL group had the highest patient assessment score, followed by the PSAL group and then the HQ group, although only the differences between PSNYL and HQ groups at weeks 12 and 16 were significant. Four patients (6.8%) experienced recurrence. Other unanticipated events were transient and subsided after 1 week to 6 months.ConclusionThe efficacy of non-fractional PSNYL was superior to that of non-fractional PSAL, which was not inferior to 2% HQ, thus non-fractional Picos providing an alternative for melasma patients with FSTs III-IV. The safety profiles of PSNYL, PSAL, and 2% HQ cream were similar.Clinical Trial Registrationhttps://www.chictr.org.cn/showprojen.aspx?proj=130994, ChiCTR2100050089.
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21
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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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22
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Parisi M, Verrillo M, Luciano MA, Caiazzo G, Quaranta M, Scognamiglio F, Di Meo V, Villani A, Cantelli M, Gallo L, Altobelli GG, Poggi S, Spaccini R, Fabbrocini G. Use of Natural Agents and Agrifood Wastes for the Treatment of Skin Photoaging. PLANTS (BASEL, SWITZERLAND) 2023; 12:plants12040840. [PMID: 36840187 PMCID: PMC9966275 DOI: 10.3390/plants12040840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 06/12/2023]
Abstract
Photoaging is the premature aging of the skin caused by repeated exposure to ultraviolet (UV) rays. The harmful effects of UV rays-from the sun or from artificial sources-alter normal skin structures and cause visible damage, especially in the most exposed areas. Fighting premature aging is one of the most important challenges of the medical landscape. Additionally, consumers are looking for care products that offer multiple benefits with reduced environmental and economic impact. The growing requests for bioactive compounds from aromatic plants for pharmaceutical and cosmetic applications have to find new sustainable methods to increase the effectiveness of new active formulations derived from eco-compatible technologies. The principle of sustainable practices and the circular economy favor the use of bioactive components derived from recycled biomass. The guidelines of the European Commission support the reuse of various types of organic biomass and organic waste, thus transforming waste management problems into economic opportunities. This review aims to elucidate the main mechanisms of photoaging and how these can be managed using natural renewable sources and specific bioactive derivatives, such as humic extracts from recycled organic biomass, as potential new actors in modern medicine.
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Affiliation(s)
- Melania Parisi
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Mariavittoria Verrillo
- Centro Interdipartimentale di Ricerca per la Risonanza Magnetica Nucleare per l’Ambiente, l’Agroalimentare, ed i Nuovi Materiali (CERMANU), Università di Napoli Federico II, Via Università 100, 80055 Portici, Italy
- Department of Agricultural Sciences, Università di Napoli Federico II, Via Università 100, 80055 Portici, Italy
| | - Maria Antonietta Luciano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Giuseppina Caiazzo
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Maria Quaranta
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Francesco Scognamiglio
- Department of Agricultural Sciences, Università di Napoli Federico II, Via Università 100, 80055 Portici, Italy
| | - Vincenzo Di Meo
- Department of Agricultural Sciences, Università di Napoli Federico II, Via Università 100, 80055 Portici, Italy
| | - Alessia Villani
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Mariateresa Cantelli
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Lucia Gallo
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Giovanna G. Altobelli
- Department of Advanced Biomedical Sciences, Università degli Studi di Napoli Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Serena Poggi
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Riccardo Spaccini
- Centro Interdipartimentale di Ricerca per la Risonanza Magnetica Nucleare per l’Ambiente, l’Agroalimentare, ed i Nuovi Materiali (CERMANU), Università di Napoli Federico II, Via Università 100, 80055 Portici, Italy
- Department of Agricultural Sciences, Università di Napoli Federico II, Via Università 100, 80055 Portici, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
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Liu W, Chen Q, Xia Y. New Mechanistic Insights of Melasma. Clin Cosmet Investig Dermatol 2023; 16:429-442. [PMID: 36817641 PMCID: PMC9936885 DOI: 10.2147/ccid.s396272] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/10/2023] [Indexed: 02/16/2023]
Abstract
Melasma is a common acquired disorder of pigmentation that negatively impacts quality of life. Present treatments show poor therapeutic effect with frequent recurrence. This in large part is due to the currently limited understanding of the disease's etiology. It is urgent to elucidate the pathogenesis of melasma to further the discovery of new therapeutic strategies. Recent studies show that melasma is triggered or aggravated by a variety of factors, including genetic susceptibility, ultraviolet radiation, and sex hormone dysregulation. Ultraviolet B radiation upregulates the expression of several melanocyte-specific genes and stimulates the release of key factors that participate in the synthesis of melanin. There is a significant increase in melanin in both the epidermal and dermal layers of affected skin, possibly due to abnormalities in crosstalk between the melanocytes and other cells. Melanogenesis is regulated through various signaling networks including the Wnt/β-catenin, PI3K/Akt, cAMP/PKA, and SCF/c-kit-mediated signaling pathways. In addition, inflammatory mediators, oxidative stress, neuroactive molecules, sebocytes, etc, have also been proved to be related to the pathogenesis of melasma. This review provides a comprehensive update on the current understanding of the pathogenesis of melasma.
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Affiliation(s)
- Wei Liu
- Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, People’s Republic of China
| | - Qin Chen
- Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, People’s Republic of China
| | - Yumin Xia
- Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, People’s Republic of China,Correspondence: Yumin Xia, Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, 157 Xiwu Road, Xi’an, 710004, People’s Republic of China, Tel +86 29 87679969, Fax +86 29 87678425, Email
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Zilles JC, Duarte LP, Ruaro TC, Zimmer AR, Kulkamp-Guerreiro IC, Contri RV. Nanoemulsion Containing Kojic Dipalmitate and Rosehip Oil: A Promising Formulation to Treat Melasma. Pharmaceutics 2023; 15:pharmaceutics15020468. [PMID: 36839792 PMCID: PMC9959276 DOI: 10.3390/pharmaceutics15020468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023] Open
Abstract
Melasma is a hard-to-treat hyperpigmentation disorder. Combined incorporation of kojic dipalmitate (KDP), the esterified form of kojic acid, and rosehip oil, an oil with antioxidant and skin-regenerating properties, into nanocarrier systems appears to be a suitable strategy to develop high-performance formulations. A high-energy method (Ultra-Turrax®) was used to develop nanoemulsions containing up to 2 mg/mL KDP, 5% rosehip oil, and 7.5% surfactant. Formulations were characterized regarding droplet size, size distribution, pH, density, morphology, KDP content, incorporation efficiency, and stability under different temperature conditions. A scale-up study was conducted. Skin permeation, antioxidant potential, and tyrosinase inhibitory activity were assessed in vitro. Cell viability studies were also performed. Results showed that nanoemulsions containing 1 and 2 mg/mL KDP had incorporation efficiencies greater than 95%, droplet size smaller than 130 nm, suitable size distribution, zeta potential of approximately -10 mV, and good stability over 30 days of refrigerated storage. The nanoemulsion containing 1 mg/mL KDP was chosen for further evaluation because it had lower nanocrystal formation, greater scale-up feasibility and allowed KDP permeation up to the epidermis similarly than observed for 2 mg/mL KDP. This formulation (1 mg/mL KDP) showed antioxidant and depigmenting efficacy, close to that of 1 mM ascorbic acid. No cytotoxicity was observed in formulations concentrations ranging from 0.06% to 1%.
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Affiliation(s)
- Júlia Capp Zilles
- Programa de Pós-Graduação em Ciências Farmacêuticas–PPGCF, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, RS, Brazil
| | - Larissa Pedron Duarte
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, RS, Brazil
| | - Thaís Carine Ruaro
- Programa de Pós-Graduação em Ciências Farmacêuticas–PPGCF, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, RS, Brazil
| | - Aline Rigon Zimmer
- Programa de Pós-Graduação em Ciências Farmacêuticas–PPGCF, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, RS, Brazil
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, RS, Brazil
| | - Irene Clemes Kulkamp-Guerreiro
- Programa de Pós-Graduação em Ciências Farmacêuticas–PPGCF, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, RS, Brazil
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, RS, Brazil
| | - Renata Vidor Contri
- Programa de Pós-Graduação em Ciências Farmacêuticas–PPGCF, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, RS, Brazil
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, RS, Brazil
- Correspondence: ; Tel.: +55-51-3308-5416
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Alfredo MG, Maribel PM, Eloy PR, Susana GE, Luis LGS, Carmen GM. Depigmenting topical therapy based on a synergistic combination of compounds targeting the key pathways involved in melasma pathophysiology. Exp Dermatol 2023; 32:611-619. [PMID: 36682042 DOI: 10.1111/exd.14752] [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: 07/12/2022] [Revised: 12/01/2022] [Accepted: 01/14/2023] [Indexed: 01/23/2023]
Abstract
Melasma has a complex pathophysiology with different cell types and signalling pathways involved. Paracrine factors secreted by keratinocytes, fibroblasts and endothelial cells act on melanocytes and stimulate melanogenesis. These paracrine factors are involved in the oxidative stress, inflammatory, vascular and hormonal pathways, among others. Damage of the dermoepidermal barrier also occurs and facilitates melanin deposition in the dermis, also known as dermal or mixed melasma. We used artificial intelligence tools to define the best combination of compounds for skin pigmentation inhibition. Mathematical models suggested the combination of retinol, diosmin and ferulic acid to be the most effective one. In vitro cellular tyrosinase activity assay proved that this combination had a synergistic depigmenting effect. Further assays proved that the combination could inhibit key pathways involved in melasma by downregulating ET-1 and COX-2 gene expression and IBMX-induced dendricity in human melanocytes, and upregulated the gene expression of IL-1b, TIMP3 and several endogenous antioxidant enzymes. The combination also reduced melanin levels in a phototype VI 3D epidermis model. These results indicate that the combination of retinol, diosmin and ferulic acid is an effective synergistic complex for the treatment of melasma by regulating the key molecular pathways involved in skin hyperpigmentation pathophysiology.
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Affiliation(s)
| | | | | | | | - Luis G S Luis
- Medical Unit, Mesoestetic Pharma Group, Barcelona, Spain
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26
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Conahan LJ, Robertson S. Sun-Protective Behaviors in Patients with Melasma. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Piętowska Z, Nowicka D, Szepietowski JC. Understanding Melasma-How Can Pharmacology and Cosmetology Procedures and Prevention Help to Achieve Optimal Treatment Results? A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912084. [PMID: 36231404 PMCID: PMC9564742 DOI: 10.3390/ijerph191912084] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 05/06/2023]
Abstract
Melasma is a chronic skin condition that involves the overproduction of melanin in areas exposed to ultraviolet radiation. Melasma treatment is long-term and complicated with recurrence and resistance to treatment. The pathogenesis of melasma is highly complex with multiple pathologies occurring outside of the skin pigment cells. It includes photoaging, excessive melanogenesis, an increased number of mast cells, increased vascularization, and basement membrane damage. In addition, skin lesions related to melasma and their surrounding skin have nearly 300 genes differentially expressed from healthy skin. Traditionally, melasma was treated with topical agents, including hydroquinone, tretinoin, glucocorticosteroids and various formulations; however, the current approach includes the topical application of a variety of substances, chemical peels, laser and light treatments, mesotherapy, microneedling and/or the use of systemic therapy. The treatment plan for patients with melasma begins with the elimination of risk factors, strict protection against ultraviolet radiation, and the topical use of lightening agents. Hyperpigmentation treatment alone can be ineffective unless combined with regenerative methods and photoprotection. In this review, we show that in-depth knowledge associated with proper communication and the establishment of a relationship with the patient help to achieve good adherence and compliance in this long-term, time-consuming and difficult procedure.
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Affiliation(s)
- Zuzanna Piętowska
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, 50-368 Wrocław, Poland
| | - Danuta Nowicka
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, 50-368 Wrocław, Poland
- Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wrocław, Poland
- Correspondence:
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, 50-368 Wrocław, Poland
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Wang WJ, Wu TY, Tu YK, Kuo KL, Tsai CY, Chie WC. The optimal dose of oral tranexamic acid in melasma: A network meta-analysis. Indian J Dermatol Venereol Leprol 2022; 89:189-194. [PMID: 36332095 DOI: 10.25259/ijdvl_530_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/01/2022] [Indexed: 11/04/2022]
Abstract
Background
Melasma is a chronic skin condition that adversely impacts quality of life. Although many therapeutic modalities are available there is no single best treatment for melasma. Oral tranexamic acid has been used for the treatment of this condition but its optimal dose is yet to be established.
Objectives
We used network meta-analysis to determine the optimal dose of oral tranexamic acid for the treatment of melasma.
Methods
We conducted a comprehensive search of all studies of oral tranexamic acid for the treatment of melasma up to September 2020 using PubMed, EMBASE and the Cochrane Library database. The quality of the studies was evaluated using the Jadad score and the Cochrane’s risk of bias assessment tool. Only high quality randomised controlled trials were selected. Some studies lacked standard deviation of changes from baseline and these were estimated using the correlation coefficient obtained from another similar study.
Results
A total of 92 studies were identified of which 6 randomized controlled trials comprising 599 patients were included to form 3 pair-wise network comparisons. The mean age of the patients in these studies ranged from 30.3 to 46.5 years and the treatment duration ranged from 8 to 12 weeks. The Jadad scores ranged from 5 to 8.
The optimal dose and duration of oral tranexamic acid was estimated to be 750 mg per day for 12 consecutive weeks.
Limitations
Some confounding factors might not have been described in the original studies. Although clear rules were followed, the Melasma Area and Severity Index and the modified Melasma Area and Severity Index were scored by independent physicians and hence inter-observer bias could not be excluded.
Conclusion
Oral tranexamic acid is a promising drug for the treatment of melasma. This is the first network meta-analysis to determine the optimal dose of this drug and to report the effects of different dosages. The optimal dose is 250 mg three times per day for 12 weeks, but 250 mg twice daily may be an acceptable option in poorly adherent patients. Our findings will allow physicians to balance drug effects and medication adherence. Personalized treatment plans are warranted.
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Affiliation(s)
| | - Tai-Yin Wu
- University of Taipei and Taipei City Hospital and National Taiwan University, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Ching-Yao Tsai
- Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
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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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Zilles JC, Dos Santos FL, Kulkamp-Guerreiro IC, Contri RV. Biological activities and safety data of kojic acid and its derivatives - a review. Exp Dermatol 2022; 31:1500-1521. [PMID: 35960194 DOI: 10.1111/exd.14662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/30/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022]
Abstract
Kojic acid presents a variety of applications for human use, especially as a depigmenting agent. Its derivatives are also proposed in order to prevent chemical degradation, prevent adverse effects and improve efficacy. The aim of this study was to peer review the current scientific literature concerning the biological activities and safety data of kojic acid or its derivatives, aiming at human use, and trying to elucidate the action mechanisms. Three different databases were assessed and the word "kojic" was crossed with "toxicity", "adverse effect", "efficacy", "effect", "activity" and "safety". Articles were selected according to pre-defined criteria. Besides the depigmenting activity, kojic acid and derivatives can act as antioxidant, antimicrobial, anti-inflammatory, radioprotector, anticonvulsant and obesity management agents, and present potential as antitumor substances. Depigmenting activity is due to the molecules, after penetrating the cell, binding to tyrosinase active site, regulating melanogenesis factors, leucocytes modulation and free radical scavenging activity. Hence, polarity, size and ligands are also important factors for activity. Kojic acid and derivatives present cytotoxicity to some cancerous cell lines, including melanoma, hepatocellular carcinoma, ovarian cancer, breast cancer and colon cancer. Regarding safety, kojic acid or its derivatives are safe molecules for human use in the concentrations tested. Kojic acid and its derivatives have great potential for cosmetic, pharmaceutical and medical applications.
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Affiliation(s)
- Júlia Capp Zilles
- Programa de Pós-Graduação em Ciências Farmacêuticas - PPGCF, Universidade Federal do Rio grande do Sul, 90610-000, Porto Alegre, RS, Brazil
| | | | - Irene Clemes Kulkamp-Guerreiro
- Faculdade de Farmácia Universidade Federal do Rio grande do Sul, 90610-000, Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Ciências Farmacêuticas - PPGCF, Universidade Federal do Rio grande do Sul, 90610-000, Porto Alegre, RS, Brazil
| | - Renata Vidor Contri
- Faculdade de Farmácia Universidade Federal do Rio grande do Sul, 90610-000, Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Ciências Farmacêuticas - PPGCF, Universidade Federal do Rio grande do Sul, 90610-000, Porto Alegre, RS, Brazil
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Yang J, Zeng J, Lu J. Mechanisms of ultraviolet-induced melasma formation: A review. J Dermatol 2022; 49:1201-1210. [PMID: 35946331 DOI: 10.1111/1346-8138.16542] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/03/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
Melasma, a pigmentation disorder, commonly occurs in exposed skin areas and can be attributed to several factors. Ultraviolet radiation (UVR) is the primary factor that induces and aggravates melasma. Considering gene expression, exposed skin areas experience abnormal gene expression, involving melanin metabolism, oxidative stress, impaired skin barrier function, and abnormal composition of nerve factors. From a histological perspective, UVR can cause basement membrane collapse, melanocyte sinking, and disorders of skin lipid metabolism. Emerging therapies have focused on these pathological alterations in melasma, including platelet-rich plasma, mesotherapy, and phytochemicals. Understanding the role of UVR in the development of melasma can facilitate early prevention and highlight the future direction of melasma treatment.
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Affiliation(s)
- Jian Yang
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinrong Zeng
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jianyun Lu
- The Third Xiangya Hospital, Central South University, Changsha, China
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Chen J, Liu J, Wu J. Treatment of melasma by a combination of intense pulsed light with advanced optimal pulse technology and human-like collagen repair dressing: A case series study. Medicine (Baltimore) 2022; 101:e29492. [PMID: 35945756 PMCID: PMC9351870 DOI: 10.1097/md.0000000000029492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To observe the efficacy and safety of a combination of intense pulsed light (IPL) with advanced optimal pulse technology (AOPT) and human-like collagen repair dressing in the treatment of melasma. Ten patients with melasma were treated using IPL with AOPT once a month for a total of 8 times, and received the treatment of external human-like collagen repair dressing after each operation. The efficacy was evaluated with the modified Melasma Area Severity Index (mMASI) score and satisfaction score, respectively, before treatment, after each treatment and at 4 months after the end of the whole treatment course. The melasma was significantly lightened in all 10 patients after 8 times of treatments. The mMASI score before treatment was (8.6 ± 3.8) points, which decreased significantly to (5.1 ± 2.7) points after 8 times of treatments, and there was a significant difference in mMASI score between before and after 8 times of treatments (P = .001). The mMASI score was (3.3 ± 2.2) points at 4 months after the end of whole treatment course, and there was no significant difference in mMASI score between after 8 times of treatments and 4 months after the end of whole treatment course (P > .05). The satisfaction score was (7.2 ± 1.4) points after 8 times of treatments and (7.1 ± 1.4) points at 4 months after the end of whole treatment course, there was no significant difference in satisfaction score between after 8 times of treatments and 4 months after the end of whole treatment course (P > .05). A combination of IPL with AOPT and human-like collagen repair dressing can effectively decrease the severity of melasma, and is associated with a higher patient satisfaction score and a lower risk of relapse after discontinuation of treatment.
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Affiliation(s)
- Juping Chen
- Affiliated Hospital of Yangzhou University, Yangzhou, People’s Republic of China
- * Correspondence: Juping Chen, Affiliated Hospital of Yangzhou University, Yangzhou 225009, People’s Republic of China (e-mail: )
| | - Jun Liu
- Affiliated Hospital of Yangzhou University, Yangzhou, People’s Republic of China
| | - Jianhong Wu
- Affiliated Hospital of Yangzhou University, Yangzhou, People’s Republic of China
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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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The Low-Fluence Q-Switched Nd:YAG Laser Treatment for Melasma: A Systematic Review. Medicina (B Aires) 2022; 58:medicina58070936. [PMID: 35888655 PMCID: PMC9323185 DOI: 10.3390/medicina58070936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Melasma is a common pigmentary disorder with a complex pathogenesis, of which the treatment is challenging. Conventional treatment often leads to inconsistent results with unexpected pigmentary side effects and high recurrence rates. Recently, the low-fluence Q-switched Nd:YAG laser (LFQSNY) has been widely used for treating melasma, especially in Asia. We reviewed literatures on the LFQSNY treatment of melasma published between 2009 and May 2022 to evaluate the efficacy and adverse events, including its combination therapy. A systematic PubMed search was conducted and a total of 42 articles were included in this study. It was hard to summarize the heterogenous studies, but LFQSNY appeared to be a generally effective and safe treatment for melasma considering the results of previous conventional therapies. However, mottled hypopigmentation has been occasionally reported to develop and persist as an adverse event of LFQSNY, which may be associated with the high accumulated laser energy. When used aggressively, even LFQSNY can induce hyperpigmentation via unwanted inflammation, especially in darker skin. Although few studies have reported considerable recurrence rates three months after treatment, unfortunately, there is a lack of the long-term follow-up results of LFQSNY in melasma. To enhance the effectiveness and reduce the adverse events, LFQSNY has been used in combination with other treatment modalities in melasma, including topical bleaching agents, oral tranexamic acid, chemical peeling, or diverse energy-based devices, which generally reduced side effects with or without significant superior efficacy compared to LFQSNY alone.
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Espósito MCC, Espósito ACC, Lemos FK, Jorge MFS, D’Elia MPB, Miot HA. Melasma: Trends in worldwide Internet searches (2000-2019). Indian J Dermatol Venereol Leprol 2022; 88:675-677. [DOI: 10.25259/ijdvl_845_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 03/01/2022] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Felipe Kesrouani Lemos
- Engenharia de Produção, Faculdade de Engenharia de Bauru, UNESP, Av. Eng. Luís Edmundo Carrijo Coube, Bauru, SP, Brazil
| | | | | | - Hélio Amante Miot
- Dermatologia, Departamento de Dermatologia, FMB-Unesp, Distrito de Rubião Júnior, sem número, Botucatu, SP, Brazil
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Gulfan MCB, Wanitphakdeedecha R, Wongdama S, Jantanapornchai N, Yan C, Rakchart S. Efficacy and Safety of Using Noninsulated Microneedle Radiofrequency Alone Versus in Combination with Polynucleotides for the Treatment of Melasma: A Pilot Study. Dermatol Ther (Heidelb) 2022; 12:1325-1336. [PMID: 35538360 PMCID: PMC9209614 DOI: 10.1007/s13555-022-00728-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction This split-face, double-blind, randomized controlled study investigated the efficacy and safety of using a microneedling radiofrequency (RF) device with polynucleotides (PN) versus RF alone for the treatment of melasma. Methods Thirty adult participants with melasma (Fitzpatrick skin types III–V) received three treatments with an invasive, bipolar, pulsed-type microneedling RF device on both sides of the face. The treatment sessions occurred once every 2 weeks. The hemifaces of each participant were designated for treatment and control with PN and normal saline solution (NSS), applied after treatment with RF. Measurements were made of melanin index (MI), erythema index (EI), skin roughness (by the Antera 3D system), modified melasma area severity index (mMASI) for each hemiface, and patients’ self-assessed improvement. These occurred at baseline and again following the final treatment (2 weeks and 1, 2, 3, and 6 months after). Mean values were obtained for MI, EI, skin roughness, and mMASI. A generalized estimating equation (GEE) was used to compare the obtained values for the outcome measures across all assessment points. Results All patients were women (mean age, 43.2 ± 7.0 years). Mixed melasma predominated (61.5%; n = 16), and the mean duration of melasma was 8.9 ± 6.5 years. Twenty-six participants were followed up to the 6-month assessment point. Significant improvements were observed from baseline in MI, skin roughness, and mMASI scores for both the PN and control sides at 6 months, with no statistically significant differences between sides. Patients’ self-assessed improvement scores also showed a positive trend. Melasma recurrence was observed in three patients at 2, 3, and 4 months after the last treatment session (10% recurrence rate). Conclusions The combination of an invasive, bipolar, pulsed-type microneedling RF with PN is not superior compared with microneedling RF alone in the treatment of melasma. Microneedling RF may be considered as safe and efficacious for the improvement of skin roughness, and as an adjunctive treatment option for melasma. Clinical Trial Registration This study was registered on ClinicalTrials.gov and assigned NCT number TCTR20210804002.
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Affiliation(s)
- Ma Christina B Gulfan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Supisara Wongdama
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuttagarn Jantanapornchai
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chadakan Yan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Hatem S, Elkheshen SA, Kamel AO, Nasr M, Moftah NH, Ragai MH, Elezaby RS, El Hoffy NM. Functionalized chitosan nanoparticles for cutaneous delivery of a skin whitening agent: an approach to clinically augment the therapeutic efficacy for melasma treatment. Drug Deliv 2022; 29:1212-1231. [PMID: 35403519 PMCID: PMC9004510 DOI: 10.1080/10717544.2022.2058652] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The increase in the production of melanin level inside the skin prompts a patient-inconvenient skin color disorder namely; melasma. This arouses the need to develop efficacious treatment modalities, among which are topical nano-delivery systems. This study aimed to formulate functionalized chitosan nanoparticles (CSNPs) in gel form for enhanced topical delivery of alpha-arbutin as a skin whitening agent to treat melasma. Ionic gelation method was employed to prepare α-arbutin-CSNPs utilizing a 24 full factorial design followed by In vitro, Ex vivo and clinical evaluation of the nano-dispersions and their gel forms. Results revealed that the obtained CSNPs were in the nanometer range with positive zeta potential, high entrapment efficiency, good stability characteristics and exhibited sustained release of α-arbutin over 24 h. Ex vivo deposition of CSNPs proved their superiority in accumulating the drug in deep skin layers with no transdermal delivery. DSC and FTIR studies revealed the successful amorphization of α-arbutin into the nanoparticulate system with no interaction between the drug and the carrier system. The comparative split-face clinical study revealed that α-arbutin loaded CSNPs hydrogels showed better therapeutic efficacy compared to the free drug hydrogel in melasma patients, as displayed by the decrease in: modified melasma area and severity index (mMASI) scores, epidermal melanin particle size surface area (MPSA) and the number of epidermal monoclonal mouse anti–melanoma antigen recognized by T cells-1 (MART-1) positive cells which proved that the aforementioned system is a promising modality for melasma treatment.
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Affiliation(s)
- Shymaa Hatem
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, New Cairo, Egypt
| | - Seham A. Elkheshen
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Amany O. Kamel
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Maha Nasr
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Noha H. Moftah
- Department of Dermatology, STD's and Andrology, Faculty of Medicine, Minia University, Al-Minya, Egypt
| | - Maha H Ragai
- Department of Dermatology, STD's and Andrology, Faculty of Medicine, Minia University, Al-Minya, Egypt
| | - Reham S. Elezaby
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Nada M. El Hoffy
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, New Cairo, Egypt
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Machine Learning Algorithms: Prediction and Feature Selection for Clinical Refracture after Surgically Treated Fragility Fracture. J Clin Med 2022; 11:jcm11072021. [PMID: 35407629 PMCID: PMC8999234 DOI: 10.3390/jcm11072021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/08/2022] [Accepted: 04/02/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The number of patients with fragility fracture has been increasing. Although the increasing number of patients with fragility fracture increased the rate of fracture (refracture), the causes of refracture are multifactorial, and its predictors are still not clarified. In this issue, we collected a registry-based longitudinal dataset that contained more than 7000 patients with fragility fractures treated surgically to detect potential predictors for clinical refracture. METHODS Based on the fact that machine learning algorithms are often used for the analysis of a large-scale dataset, we developed automatic prediction models and clarified the relevant features for patients with clinical refracture. Formats of input data containing perioperative clinical information were table data. Clinical refracture was documented as the primary outcome if the diagnosis of fracture was made at postoperative outpatient care. A decision-tree-based model, LightGBM, had moderate accuracy for the prediction in the test and the independent dataset, whereas the other models had poor accuracy or worse. RESULTS From a clinical perspective, rheumatoid arthritis (RA) and chronic kidney disease (CKD) were noted as the relevant features for patients with clinical refracture, both of which were associated with secondary osteoporosis. CONCLUSION The decision-tree-based algorithm showed the precise prediction of clinical refracture, in which RA and CKD were detected as the potential predictors. Understanding these predictors may improve the management of patients with fragility fractures.
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Botsali A, Esme P, Erbil H, Caliskan E. Comparison of fractional erbium:YAG laser-assisted tranexamic acid delivery alone and in combination with oral tranexamic acid in melasma. Lasers Med Sci 2022; 37:2823-2830. [PMID: 35347552 PMCID: PMC8960089 DOI: 10.1007/s10103-022-03547-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
Tranexamic acid (TA) emerged as a promising agent for melasma. However, due to its hydrophilic structure, topical TA should be combined with a penetration-enhancing strategy to augment efficacy. To evaluate the efficacy of fractional erbium:YAG laser-assisted delivery (LAD) of topical TA 5% either with or without oral TA treatment in recalcitrant melasma patients. The authors retrospectively assessed the treatment outcomes of melasma patients treated by fractional erbium:YAG LAD of topical TA 5%. Patients receiving a standard protocol including four biweekly laser sessions were eligible. The study included two groups: group 1 patients received oral TA and LAD of topical TA 5%, and group 2 patients received only LAD of topical TA 5%. Two blinded dermatologists reported pre-treatment and post-treatment modified MASI (mMASI) scores. Mean mMASI scores in both group 1 (n = 15) and group 2 (n = 19) were significantly lower at the end of the treatment than baseline values (p = 0.001; p = 0.022, respectively). The decrease of mMASI scores were higher in group 1 (median = 2.1) (64.7%) than in group 2 (median = 1.2) (41.8%) (p = 0.027). Fractional erbium:YAG LAD of topical TA 5% is an efficient treatment regimen for melasma patients recalcitrant to conventional treatment approaches. The implementation of oral TA to this regimen improves the therapeutic outcomes.
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Affiliation(s)
- Aysenur Botsali
- Department of Dermatology, Gülhane Faculty of Medicine, University of Health Sciences, General Dr. Tevfik Sağlam Cad, SBÜ Gülhane EAH Dermatoloji AD, 06030, Keçiören, Ankara, Turkey.
| | - Pelin Esme
- Department of Dermatology, Gülhane Faculty of Medicine, University of Health Sciences, General Dr. Tevfik Sağlam Cad, SBÜ Gülhane EAH Dermatoloji AD, 06030, Keçiören, Ankara, Turkey
| | - Hakan Erbil
- Dr. Hakan Erbil, Private Clinic, Ankara, Turkey
| | - Ercan Caliskan
- Department of Dermatology, Gülhane Faculty of Medicine, University of Health Sciences, General Dr. Tevfik Sağlam Cad, SBÜ Gülhane EAH Dermatoloji AD, 06030, Keçiören, Ankara, Turkey
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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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Reple SIF, de Oliveira DTG, Perez MM, da Veiga GL, da Cunha MG, Fonseca FLA, da Costa Aguiar Alves B. Genotoxicity of permanent hair dye associated with melasma. J Cosmet Dermatol 2022; 21:5252-5253. [PMID: 35182008 DOI: 10.1111/jocd.14867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/16/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Sonia Isabel Friedlaender Reple
- Laboratório de Análises Clínicas do Centro Universitário FMABC, Av. Príncipe de Gales, 821, 09060-650, Santo André, SP, Brazil
| | | | - Matheus Moreira Perez
- Laboratório de Análises Clínicas do Centro Universitário FMABC, Av. Príncipe de Gales, 821, 09060-650, Santo André, SP, Brazil
| | - Gláucia Luciano da Veiga
- Laboratório de Análises Clínicas do Centro Universitário FMABC, Av. Príncipe de Gales, 821, 09060-650, Santo André, SP, Brazil
| | - Marisa Gonzaga da Cunha
- Disciplina de Dermatologia do Centro Universitário FMABC, Av. Príncipe de Gales, 821, 09060-650, Santo André, SP, Brazil
| | - Fernando Luiz Affonso Fonseca
- Laboratório de Análises Clínicas do Centro Universitário FMABC, Av. Príncipe de Gales, 821, 09060-650, Santo André, SP, Brazil.,Departamento de Ciências Farmacêuticas da, Universidade Federal de São Paulo, Rua Prof. Artur Riedel, 275, 09972-270, Diadema, SP, Brazil
| | - Beatriz da Costa Aguiar Alves
- Laboratório de Análises Clínicas do Centro Universitário FMABC, Av. Príncipe de Gales, 821, 09060-650, Santo André, SP, Brazil
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Nukana RP, Rusyati LMM, Praharsini GAA, Winaya KK, Suryawati N, Karna NLPRV. Association of testosterone level with melasma in men: a case-control study in Indonesia. Pan Afr Med J 2022; 43:194. [PMID: 36942149 PMCID: PMC10024555 DOI: 10.11604/pamj.2022.43.194.37435] [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: 09/19/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction melasma is a common acquired hypermelanosis which occurs mostly in face that caused by many factors. One of the pathogenesis of melasma in men is affected by testosterone. This study aimed to investigate the relationship between testosterone levels and melasma in men and its association with the severity of melasma as measured by the melasma area and severity index (MASI) score. Methods a case-control study involving 30 subjects with melasma and 30 subjects without melasma who were treated at the outpatient clinic of Dermatovenereology of Ngoerah General Hospital from June to August 2022. Descriptive statistical analysis is to determine frequencies and percentages. Bivariate analysis was used to find any risk factor between testosterone level and melasma. Data obtained from the two groups then analyzed for correlation between the MASI score and testosterone levels. Results mean age of the subjects in the melasma group was 43.83±6.30 and in control group was 43.80±6.09. Mean testosterone level in the melasma group (7.55±1.77) was significantly lower than the control group (21.07±6.65; p = 0.001). Subject with testosterone level ≥8.92 nmol/L has 6.9 times risk of melasma compare to control (aOR: 6.986, 95% CI 1.905-25.622; p = 0.003). Conclusion low testosterone levels possibly have a role in pathogenesis of melasma in men.
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Affiliation(s)
- Ratih Purnamasari Nukana
- Department of Dermatology and Venereology, Faculty of Medicine Udayana University, Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Luh Made Mas Rusyati
- Department of Dermatology and Venereology, Faculty of Medicine Udayana University, Ngoerah General Hospital, Denpasar, Bali, Indonesia
- Corresponding author: Luh Made Mas Rusyati, Department of Dermatology and Venereology, Faculty of Medicine Udayana University, Ngoerah General Hospital, Denpasar, Bali, Indonesia.
| | - Gusti Ayu Agung Praharsini
- Department of Dermatology and Venereology, Faculty of Medicine Udayana University, Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Ketut Kwartantaya Winaya
- Department of Dermatology and Venereology, Faculty of Medicine Udayana University, Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Nyoman Suryawati
- Department of Dermatology and Venereology, Faculty of Medicine Udayana University, Ngoerah General Hospital, Denpasar, Bali, Indonesia
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Tang L, Xian J, Zhang Y, Zhang C, Yu H, Tan Q, Zhang X. Efficacy of acupuncture for melasma: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e28298. [PMID: 34918707 PMCID: PMC8678063 DOI: 10.1097/md.0000000000028298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Melasma is a common acquired hyperpigmentation of the skin. The clinical manifestations are light brown or dark brown patches symmetrically distributed on the cheeks, forehead, and mandibular with different shades and unclear borders. The treatment of melasma is extremely challenging due to its easy relapse and hard to cure. As a classical method of traditional Chinese medicine, acupuncture has been used to treat melasma in clinical practice. However, there is no systematic review and meta-analysis of acupuncture on melasma. This study aims to assess the efficacy of acupuncture for melasma. METHODS We will perform a comprehensive retrieval in the following electronic databases: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), Wan Fang Database, VIP database, Chinese Biomedical Literature Service System (SinoMed), Chinese Biomedicine (CBM) database, and TCM Literature Analysis from inception to July 1, 2021, to identify any eligible study. We include all randomized controlled trials (RCTs) without any limitation of blinding or publication language, and exclude cohort studies and case reports. The meta-analyses will be conducted by using the Stata16. We will use the Cochrane risk of bias tool for randomized trials to assess the risk of bias of included studies. The X2 and I2 tests will be utilized to assess the statistical heterogeneity of evidence. We will conduct a meta-analysis if the studies can be combined. Otherwise, a narrative synthesis will be performed. Article screening and data extraction will be independently evaluated by 2 reviewers trained in methodology according to the established selection criteria. Any disagreements between the 2 reviewers will be resolved by reaching a consensus with the other authors (the third reviewer). RESULTS This study will systematically evaluate the clinical efficacy of acupuncture for melasma. CONCLUSION The conclusion of this study will provide evidence to ensure the efficacy of acupuncture for melasma, so as to provide an objective and scientific basis for clinical practice. ETHICS AND DISSEMINATION No ethical approval will be required because the data used are not linked to individual patient. The results of this review will be published in a peer-reviewed journal. REGISTRATION NUMBER INPLASY2021110097.
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Affiliation(s)
- Liheng Tang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jin Xian
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ye Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Changyun Zhang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Huijuan Yu
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Qiwen Tan
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xin Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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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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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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Wang Y, Zhao J, Jiang L, Mu Y. The Application of Skin Care Product in Melasma Treatment. Clin Cosmet Investig Dermatol 2021; 14:1165-1171. [PMID: 34526794 PMCID: PMC8435474 DOI: 10.2147/ccid.s323748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/22/2021] [Indexed: 01/01/2023]
Abstract
Melasma is an acquired and chronic hyperpigmentation disorder which is recognized as one of the most psychologically distressing and difficult to cure forms of skin hyperpigmentation. It is associated with substantial quality of life impairments. Treatments of melasma include local application, oral medication, physical laser therapy and program combination therapy. However, routine treatment usually leads to the damage of skin barrier function, resulting in adverse reactions such as erythema, pruritus, post-inflammatory pigmentation and even scar. Skin care products contain a variety of active ingredients, which are widely concerned by cosmetic dermatologists because of high safety, good tolerance and the effect of improving the damaged skin barrier. Using skin care products alone or in combination with routine treatment not only can improve the curative effect for melasma, reduce side effects and recurrence rate, but also improve patient satisfaction. This article mainly describes the application of skin care products in the treatment of melasma.
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Affiliation(s)
- Yu Wang
- Department of Dermatology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, 637000, People's Republic of China
| | - Jianmei Zhao
- Department of Dermatology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, 637000, People's Republic of China
| | - Lu Jiang
- Department of Dermatology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, 637000, People's Republic of China
| | - Yunzhu Mu
- Department of Dermatology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, 637000, People's Republic of China
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Chan TK, Bramono D, Bourokba N, Krishna V, Wang ST, Neo BH, Lim RYX, Kim H, Misra N, Lim S, Betts RJ. Polycyclic aromatic hydrocarbons regulate the pigmentation pathway and induce DNA damage responses in keratinocytes, a process driven by systemic immunity. J Dermatol Sci 2021; 104:83-94. [PMID: 34690024 DOI: 10.1016/j.jdermsci.2021.09.003] [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: 01/18/2021] [Revised: 05/18/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Urban pollution is correlated with an increased prevalence of skin pigmentation disorders, however the physiological processes underlying this association are unclear. OBJECTIVES To delineate the relationship between polycyclic aromatic hydrocarbons (PAHs), a key constituent of atmospheric pollution, and immunity/skin pigmentation pathways. METHODS We exposed peripheral blood mononuclear cells (PBMC) to PAHs and performed cytokines/chemokine profiling. We then examined the effect of immune activation on pigmentation by co-culturing PBMC and Benzo(a)pyrene (BaP) with reconstructed human pigmented epidermis (RHPE). To study the mechanism, we treated keratinocytes with conditioned medium from BaP-exposed PBMC and studied DNA damage responses, aryl hydrocarbon receptor (AhR) activation and pro-pigmentation factor, proopiomelanocortin (POMC) secretion. RESULTS PAHs induced up-regulation of inflammatory cytokines/chemokine in PBMC. Co-culturing of RHPE with PBMC+BaP resulted in increased melanin content and localization. BaP-conditioned medium significantly increased DNA damage, p53 stabilization, AhR activation and POMC secretion in keratinocytes. We found that IFNγ induced DNA damage, while TNFα and IL-8 potentiated POMC secretion in keratinocytes. Importantly, BaP-conditioned medium-induced DNA damage and POMC secretion is prevented by antioxidants vitamin E, vitamin C and sulforaphane, as well as the prototypical corticosteroid dexamethasone. Finally, vitamin C and sulforaphane enhanced the genome protective and depigmentation effects of dexamethasone, providing proof-of-concept for a combinatorial approach for the prevention and/or correction of PAH-induced pigment spots formation. CONCLUSION Our study reveals the importance of systemic immunity in regulating PAH-induced skin pigmentation, and provide a new keratinocyte DNA damage response mechanistic target for the prevention or reversal of pollution-associated skin pigmentation.
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Affiliation(s)
| | | | | | | | | | | | | | - Hyoju Kim
- L'Oréal Research & Innovation, Singapore
| | - Namita Misra
- L'Oréal Research & Innovation, Aulnay sous Bois, France
| | - Shawn Lim
- L'Oréal Research & Innovation, Singapore
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Sthalekar B, Agarwal M, Sharma V, Patil CY, Desai M. Prospective Study of Growth Factor Concentrate Therapy for Treatment of Melasma. Indian Dermatol Online J 2021; 12:549-554. [PMID: 34430458 PMCID: PMC8354406 DOI: 10.4103/idoj.idoj_750_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/13/2020] [Accepted: 02/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Melasma is a common acquired pigmentary skin disorder. Currently, there are various treatment options available but none is effective universally. Objective: Assess the role of Yuskin®, a growth factor concentrate (GFC) therapy, a modified platelet rich plasma (PRP) technique for the treatment of melasma. Materials and Methods: Subjects of Fitzpatrick skin type IV–V, of either gender, more than equal to 18 years of age, with a clinical diagnosis of melasma were enrolled in the study. Total three sessions of GFC monotherapy were given with one-month interval (day 0, day 30, and day 60) and follow up of subjects was done at day 90 for the final clinical assessment. Results: Out of 40 subjects enrolled, 30 subjects completed three GFC sessions and 26, completed day 90 follow-up. Statistically significant decrease in the mean mMASI scores was observed at all visits compared to baseline (P < 0.005 for each visit). Totally, 66.7% of severe melasma subjects showed improvement to mild to moderate category. Significant improvement in mean mMASI score was seen in subjects who had mild to moderate melasma at baseline (P < 0.05). Overall, aesthetic improvement was reported in 88.5% of subjects. Side effects reported were mild such as injection site pain, erythema, oedema and bruising, and resolved spontaneously within a few hours to few days of onset. Conclusion: Significant improvement in melasma was observed with GFC monotherapy, which needs further confirmation in larger randomized controlled studies. Overall, it was well tolerated. Thus, GFC therapy can be a safe, effective, and new option in the armamentarium of melasma management.
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Affiliation(s)
| | - Madhuri Agarwal
- Department of Dermatology, Yavana Aesthetics Clinic, Mumbai, Maharashtra, India
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Efficacy and Safety of Platelet-Rich Plasma in Melasma: A Systematic Review and Meta-Analysis. Dermatol Ther (Heidelb) 2021; 11:1587-1597. [PMID: 34269967 PMCID: PMC8484406 DOI: 10.1007/s13555-021-00575-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/26/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction Melasma is a chronic and recurrent skin problem for which an effective therapy is currently lacking. Platelet-rich plasma (PRP) has recently emerged as a novel treatment for melasma, but to date there has been no systematic evaluation of its efficacy and safety. Methods The Web of Science, PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and the Cochrane Library databases were searched for relevant articles using the search items “melasma,” “chloasma” and “platelet‐rich plasma.” STATA version 15.1 software was used to analyze data. Study outcomes were calculated using standardized mean differences with 95% confidence intervals (CIs). Results The database search identified ten studies involving 395 adult patients that met the inclusion criteria and were included in the meta-analysis. Analysis of pre- and post-treatment data from these studies revealed that the post-treatment modified Melasma Area and Severity Index (mMASI) score decreased by 1.18 (95% CI 0.89–1.47; p = 0.02). Subjective satisfaction evaluation of PRP treatment showed that melasma treated with the combination therapy of PRP + microneedling may have been the most efficacious treatment compared to PRP alone or in combination with intradermal injection. Adverse reactions were minor, with only a few patients reporting local congestion, temporary erythema, hyperpigmentation and discoloration. Conclusion These results support the efficacy and safety of PRP used in combination or alone as treatment for melasma. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00575-z.
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Esmat S, Z Elramly A, Shahin D, Hilal RF. Combining Low Power Fractional CO 2 With QS-NdYAG Toning in the Treatment of Melasma Reduces the Incidence of Punctate Leukoderma. Lasers Surg Med 2021; 53:1325-1340. [PMID: 34164829 DOI: 10.1002/lsm.23441] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/17/2021] [Accepted: 05/23/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Q-switched Nd:YAG (QS-Nd:YAG) toning (low fluence, large spot size, and high frequency) has been used successfully for the treatment of melasma, especially in dark skin phototypes. Punctate leukoderma was found to be a frequent complication that reduced the safety of this procedure. Combining low power fractional CO2 laser, which is another effective melasma laser therapy, might improve the efficacy and safety of this procedure. The aim of this study was to evaluate the effect of combining low power fractional CO2 laser with QS-Nd:YAG toning in the treatment of melasma. STUDY DESIGN/MATERIALS AND METHODS A randomized comparative split-face study included a total of 30 patients with bilateral, symmetrical melasma. All patients received QS-Nd:YAG toning on one randomly selected side of the face, while the other side randomly received either low power fractional CO2 alone (group A) or combined QS-Nd:YAG toning with low power fractional CO2 (group B). QS-Nd:YAG toning sessions were scheduled every two weeks for nine consecutive sessions, and low power fractional CO2 sessions were received every 4 weeks for three consecutive sessions. The assessment was done using the modified melasma area and severity index (mMASI) score, spectrophotometry (melanin index [MI] and erythema index [EI]), photography, blinded physician assessment, and patient satisfaction (at baseline, 1 week and 8-12 weeks after the last treatment sessions). RESULTS A significant reduction in the mMASI score and MI was obtained with all treatment regimens. On comparing different modalities, group A reduction in mMASI and MI was significantly greater on the side receiving QS-ND:YAG toning (64.03% and 8.27%, respectively), than the side receiving low power fractional CO2 laser alone (36.02%. 2.64%, respectively). On the other hand, reduction of mMASI score and MI showed no statistical significance between the side receiving QS-Nd:YAG toning alone and the combined modality. Punctate leukoderma occurred in four cases (13%) on the side receiving QS-Nd:YAG toning. CONCLUSION QS-Nd:YAG toning is significantly more effective than low power fractional CO2 in the treatment of melasma when used separately. Although combining low power fractional CO2 with QS-Nd:YAG toning does not increase its efficacy, it minimizes the incidence of the undesirable punctate leukoderma complication and achieves lower recurrence. This combination can thus be recommended as a safe and effective measure for the treatment of melasma. © 2021 Wiley Periodicals LLC.
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Affiliation(s)
- Samia Esmat
- Department of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, 11956, Egypt
| | - Amany Z Elramly
- Department of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, 11956, Egypt
| | - Dina Shahin
- Ministry of Health, Cairo University, Cairo, 11562, Egypt
| | - Rana F Hilal
- Department of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, 11956, Egypt
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