Melasma: A Condition of Asian Skin

Different therapeutic approaches in melasma: advances and limitations

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.

Characterizing differences in outpatient dermatologic care utilization among disaggregated Asian American subgroups

Despite having significantly higher rates of atopic dermatitis, psoriasis, and pigmentary disorders compared to White patients, studies suggest that Asian Americans are underrepresented in outpatient dermatology clinics. In this study, we utilize the National Health Interview Survey (NHIS) and prioritize disaggregated analyses to evaluate differences between the most populous Asian American subgroups (Chinese, Filipino, Indian, and "Other") in utilization of outpatient dermatologic care. We utilized multivariable logistic regression to compare outpatient dermatologic care use between each Asian American subgroup and Non-Hispanic Whites. Out of 96,559 adults, our study included 5264 self-identified Asian American and 91,295 non-Hispanic White adults. Most Asian participants were female, had health insurance, and had incomes > 2 times above the federal poverty line. We found that, compared to 21.4% for NH whites, lifetime prevalence of total body skin exam was highest among Filipino Americans (12.3%) and lowest among Indian Americans (7%). Additionally, all Asian American subgroups had a significantly lower odd than NH Whites of ever having a total body skin exam, with Indian Americans having the lowest odds. While the benefit of TBSEs in Indian Americans is unclear, it is possible that differing cultural perceptions about dermatologic needs, barriers to care, or immigration status may be contributing to the observed difference. Furthermore, the Indian diaspora encapsulates a range of skin tones, risk factors, and behaviors that may differentially influence dermatologic disease risk, similar to trends identified among Hispanic patients (Trepanowski et al. in J Am Acad Dermatol 88:1206-1209, 2023). Additional research utilizing the seven national databases that have been identified as providing disaggregated Asian racial information (Kamal et al. in J Am Acad Dermatol, 2023) may be useful to further illuminate avenues for intervention.

Awareness of sun exposure risks and photoprotection for preventing pigmentary disorders in Asian populations: Survey results from three Asian countries and expert panel recommendations

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.

Safety and efficacy of superficial micro-focused ultrasound with visualization for melasma in Asians: An uncontrolled pilot study

BACKGROUND

The pathophysiology of melasma is multifactorial, resulting in treatment resistance and a high recurrence rate. Recent research suggests that focused ultrasound might treat melasma effectively.

OBJECTIVES

To investigate the efficacy and safety of superficial micro-focused ultrasound with visualization (MFU-V) for melasma in Asians.

METHODS

Patients (n = 20) with mixed melasma on both cheeks received 2 MFU-V treatments spaced 1 month apart. At monthly visits over 5 months, treatment efficacy and safety were evaluated. Standardized photographs were clinically assessed using the modified Melasma Area and Severity Index (mMASI), and 6-point grading scales for melasma lightening and area of involvement. Patients provided pain, global aesthetic improvement scale (GAIS), and satisfaction assessments.

RESULTS

In 40 cheeks, the mean mMASI score was significantly reduced from 13.2 at baseline to 2.4 at month 4, and 2.8 at month 5. Twenty-nine cheeks (72.5%) showed lightening of melasma at month 4 that persisted until month 5, with improvements up to 75% compared to baseline. Melasma area decreased overall, with sites containing >30% melasma involvement decreasing from 55% to 20% by month 5, and none with 70%-89% involvement. Melasma lightening and area improved visibly in 40% and 20% of cheeks, respectively, as early as 1 month after index MFU-V treatment. Improvements continued after the second treatment and persisted until study closure, correlating with patient GAIS and satisfaction scores. Procedure was well tolerated with only mild-to-moderate pain reported in 92.5% of treatments.

CONCLUSION

Superficial MFU-V is a safe and effective treatment for melasma.

Research-based findings on scope of liposome-based cosmeceuticals: an updated review

Background

Cosmeceuticals are cosmetic products with biologically active components that have drug-like benefits. Cosmeceuticals are currently rapidly growing segments encompassing the personal care industry and numerous topical cosmetics-based therapies for treating different skin conditions. The barrier nature of skin causes limitations to topical treatment. The effectiveness of this cosmeceutical product has been enhanced a few folds by using nanotechnological modifications.

Main body

PubMed electronic searches for the literature were performed using combinations of the following terms: “cosmeceutical,” “liposome-based cosmeceuticals,” “acne and liposome,” “photo-aging and liposome,” “hyperpigmentation and liposome,” “wrinkles and liposome,” “fungal infections and liposome,” and “hair damage and liposome” from the earliest publication date available to January 5, 2022. Among the various nanotechnological approaches, liposomes offer numerous advantages such as topical cosmeceutical products, starting from improved moisturization, biodegradability, biocompatibility, enhanced permeation and retention, improved bioavailability of the active ingredients, increased esthetic appeal of cosmeceutical products, slow and extended dermal release. This review outlines various liposome-based cosmeceutical products that has been investigated to treat skin disorders such as photoaging, wrinkles, hyperpigmentation, hair damage and fungal infections.

Conclusion

Liposome-based cosmeceuticals provide a better opportunity to deliver therapeutic moiety for various skin conditions and offer potential promise for future clinical applications.

Graphical Abstract

Association of testosterone level with melasma in men: a case-control study in Indonesia

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.