1
|
Maymone MBC, Mirza FN, Steiner D, Ribeiro F, Landau M, Marçon C, Celidonio TC, Soon SL, Wambier CG. Comparative long-term efficacy of phenol-croton oil chemical peels for persistent melasma at varied Croton tiglium oil concentrations. J Am Acad Dermatol 2024:S0190-9622(24)00547-4. [PMID: 38574769 DOI: 10.1016/j.jaad.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/15/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Mayra B C Maymone
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Fatima N Mirza
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Denise Steiner
- Department of Dermatology, University of Mogi das Cruzes, Mogi das Cruzes, Brazil
| | - Felipe Ribeiro
- Department of Dermatology, University of Mogi das Cruzes, Mogi das Cruzes, Brazil
| | | | | | | | | | - Carlos G Wambier
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| |
Collapse
|
2
|
Verma H, Kamat S, O’Hagan R, Khalil S, Murase J. Characterizing the readability of patient educational materials for melasma during pregnancy. Int J Womens Dermatol 2024; 10:e132. [PMID: 38332995 PMCID: PMC10852384 DOI: 10.1097/jw9.0000000000000132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024] Open
Affiliation(s)
- Hannah Verma
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Samir Kamat
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Ross O’Hagan
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Susan Khalil
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Jenny Murase
- Department of Dermatology, University of California, San Francisco, San Francisco, California
- Department of Dermatology, Palo Alto Foundation Medical Group, Palo Alto and Mount View, California
| |
Collapse
|
3
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
4
|
Galache TR, Sena MM, Tassinary JAF, Pavani C. Photobiomodulation for melasma treatment: Integrative review and state of the art. Photodermatol Photoimmunol Photomed 2024; 40:e12935. [PMID: 38018017 DOI: 10.1111/phpp.12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
5
|
González-Molina V, Martí-Pineda A, González N. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol 2022; 15:19-28. [PMID: 35642229 PMCID: PMC9122278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We conducted a review of topical agents currently used in melasma, discussing their mechanism of action, efficacy, safety, and tolerability, with an update on newer treatments. METHODS A systematic review from PubMed database was performed, using PRISMA guidelines. The search was limited to English and Spanish studies that were double or single blinded, prospective, controlled or randomized clinical trials, reviews of literature, and meta-analysis studies. RESULTS 348 studies were analyzed; 80 papers met inclusion criteria. Triple combination (TC) therapy and hydroquinone (HQ) are still the most well-studied agents with strong evidence-based recommendation. TC therapy remains the gold standard of care based on efficacy and patient tolerability. Evidence has shown ascorbic acid, azelaic acid, glycolic acid, kojic acid, salicylic acid, and niacinamide to be effective as adjuvant therapies with minimal side effects. Tranexamic acid (TA) and cysteamine have become recent agents of interest due to their good tolerability, however more trials and studies are warranted. Less evidence exists for other topical agents, such as linoleic acid, mulberry extract oil, rucinol, 2% undecylenoyl phenylalanine, and epidermal growth factors agents. LIMITATIONS Some studies discussed represented a low sample size, and there is an overall lack of recent studies with larger populations and long-term follow up. CONCLUSIONS TC therapy continues to be the gold standard of care. Topical cysteamine and TA are newer options that can be incorporated as adjuvant and maintenance treatments into a patient's regimen. Cysteamine and topical TA have no known severe adverse effects. Evidence comparing other topical adjuvant treatments to HQ, maintains HQ as the gold standard of care.
Collapse
Affiliation(s)
- Valeria González-Molina
- Dr. González-Molina is with St. Luke's Episcopal Hospital Transitional Year Program in Ponce, Puerto Rico
| | - Alicia Martí-Pineda
- Dr. Martí-Pineda is with the Universidad Central del Caribe School of Medicine in Bayamon, Puerto Rico
| | | |
Collapse
|
6
|
Pan J, Zhao JH, Lv YW, Zeng SW, Zhao JY, Gao FL. Clinical Study of a Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser with Different Parameters in the Treatment of Chloasma: A Randomized-Controlled Trial. Photobiomodul Photomed Laser Surg 2022; 40:183-188. [PMID: 35298285 DOI: 10.1089/photob.2021.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To explore the clinical efficacy of a Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser with different parameters in the treatment of chloasma. Methods: In this study, 30 patients with chloasma, symmetrically distributed on the left and right sides of the face and who were treated with a Fayton Q-switched 1064 nm Nd:YAG laser, were recruited. The patients were randomly selected for the treatment of facial lesions on the left and right sides of the face using a spot diameter of 9 mm and an energy density of 0.8 J/cm2 on one side, and, on the opposite side, a spot diameter of 6 mm with an energy density of 1.2 J/cm2. The laser frequency was 5 Hz and treatment was conducted once every 7-10 days and repeated eight times as a course of treatment. At the end of the course of treatment, as well as 1, 3, and 6 months after treatment, front-facing images and 45° left- and right-side images were taken, respectively. The curative effect of the treatment was evaluated using the Melasma Area Severity Index (MASI) score. Results: The results of this study showed that the total effective rate of a Fayton Q-switched 1064 nm Nd:YAG laser in the treatment of chloasma was 60%. Conclusions: Using a Q-switched 1064 nm Nd:YAG laser represents a safe and effective approach for the treatment of chloasma. The therapeutic effects of the parameter sets, that is, a spot diameter of 9 mm and an energy density of 0.8 J/cm2, and a spot diameter of 6 mm with an energy density of 1.2 J/cm2, were similar. The treatment time and average effective times of the latter were relatively shortened. Clinical Trial Registration number researchregistry6799.
Collapse
Affiliation(s)
- Jing Pan
- Department of Dermatology and Venereology and Beijing Jishuitan Hospital, Beijing, China
| | - Jing-Hui Zhao
- Department of Dermatology and Venereology and Beijing Jishuitan Hospital, Beijing, China
| | - Yan-Wei Lv
- Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, Beijing, China
| | - Shu-Wen Zeng
- Department of Dermatology, Beijing Xiuzhong Medical Center, Beijing, China
| | - Jun-Ying Zhao
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Feng-Lin Gao
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Rattananukrom T, Suchonwanit P, Thadanipon K, Vachiramon V. A Comparative Study of Dermatoscopic Features of Melasma and Hori's Nevus in Asian Patients. J Clin Aesthet Dermatol 2022; 15:16-20. [PMID: 35342501 PMCID: PMC8944292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Dermatoscopy is a noninvasive diagnostic tool for pigmented lesions. However, data regarding dermatoscopic features in melasma and Hori's nevus, which are commonly found in Asian populations, are still lacking. In addition, melasma coexisting with Hori's nevus presents a particular diagnostic challenge and they generally require different treatments. OBJECTIVE We sought to describe the dermatoscopic features of melasma and Hori's nevus and to establish diagnostic clues for each condition. METHODS Fifty patients with melasma and 46 patients with Hori's nevus were enrolled in the study. Dermatoscopic pictures were taken with Dermlite DL200 HR (3Gen, San Juan Capistrano, Califorinia) and evaluated by two blinded board-certified dermatologists. RESULTS The dermatoscopic features more prominently seen in melasma compared to Hori's nevus include light brown pigmentation (98% vs. 10.9%, P<0.001), regular pigment network (38% vs. 2.2%, P<0.001), irregular pigment network (98% vs. 63%, P<0.001), arcuate structure (68% vs. 13%, P<0.001), circles (48% vs. 10.9%, P<0.001), sparing of follicles and sweat gland openings (98% vs. 4.3%, P<0.001), and telangiectasias (52% vs. 19.6%, P=0.001). In contrast, the common features of Hori's nevus include blue-brown or grey pigmentation (63% vs. 0%, P=0.001) and speckled homogenous pattern (52.2% vs. 0%, P<0.001). CONCLUSION Dermatoscopy is a useful diagnostic tool for distinguishing between melasma and Hori's nevus. In patients with coexistence of both conditions, dermatoscopy can be used to confirm the diagnosis and aid the proper treatment.
Collapse
Affiliation(s)
- Teerapong Rattananukrom
- All authors are with the Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital at Mahidol University in Bangkok, Thailand
- Dr. Thadanipon is also with the Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital at Mahidol University in Bangkok, Thailand
| | - Poonkiat Suchonwanit
- All authors are with the Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital at Mahidol University in Bangkok, Thailand
- Dr. Thadanipon is also with the Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital at Mahidol University in Bangkok, Thailand
| | - Kunlawat Thadanipon
- All authors are with the Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital at Mahidol University in Bangkok, Thailand
- Dr. Thadanipon is also with the Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital at Mahidol University in Bangkok, Thailand
| | - Vasanop Vachiramon
- All authors are with the Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital at Mahidol University in Bangkok, Thailand
- Dr. Thadanipon is also with the Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital at Mahidol University in Bangkok, Thailand
| |
Collapse
|
8
|
Phansuk K, Vachiramon V, Jurairattanaporn N, Chanprapaph K, Rattananukrom T. Dermal Pathology in Melasma: An Update Review. Clin Cosmet Investig Dermatol 2022; 15:11-19. [PMID: 35023942 PMCID: PMC8747646 DOI: 10.2147/ccid.s343332] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Melasma is a complex and multipathophysiological condition that is challenging to treat. The roles of each element in the dermis were highlighted in this recent year due to targeting it with emerging therapies. Although some studies have demonstrated abnormal findings in the dermis of melasma lesions, there are no integrated data regarding these findings. PURPOSE This article aims to discuss each finding in the dermis of melasma lesions and to provide some ideas about treatment options. METHODS An Internet search was completed using the MEDLINE, Embase, Scopus, and Google Scholar databases for relevant literature through June 2021 and reference lists of respective articles. Only the articles published in English language were included. RESULTS Several studies have focused on the dermal changes in melasma. Common findings included basement membrane disruption, pendulous melanocytes, marked solar elastosis, increased melanophages, increased mast cells, and neovascularization. In addition, each of them had the specified mechanism that may relate with the others. CONCLUSION Several changes in the dermis of melasma lesion may be connected with pathological changes in the epidermis. This may serve as a potential target treatment for melasma, which requires a multimodal approach.
Collapse
Affiliation(s)
- Kachanat Phansuk
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vasanop Vachiramon
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Natthachat Jurairattanaporn
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Rattananukrom
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
9
|
Ahramiyanpour N, Saki N, Akbari Z, Shamsi-Meymandi S, Amiri R, Heiran A. Efficacy of topical cysteamine hydrochloride in treating melasma: a systematic review. J Cosmet Dermatol 2021; 20:3593-3602. [PMID: 34591360 DOI: 10.1111/jocd.14494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Melasma remains a recurrent, chronic, therapeutically challenging, and psychologically burdening condition. Several different modalities and approaches have been utilized, and some with notable success to experimentally manage the condition. Cysteamines, with their depigmentation properties, have only recently been intensely studied. One such formulation is the topical 5% cysteamine hydrochloride, the structure of which is notably more stable and with a less foul odor than its prior counterparts. We, therefore, aimed to assess the efficacy of the mentioned formulation in the treatment of melasma. METHODS The PubMed, SCOPUS, ISI Web of Science, and Embase, Cochrane, and Proquest databases were thoroughly searched for English studies evaluating the effects of the topical agent mentioned. RESULTS Eight studies (five RCTs, two case reports, and one case series) were included after three rounds of screening, most of which were carried out in Iran. Statistical significance was noted when assessing decreased melanin content and satisfaction rates. CONCLUSIONS It appears that the cysteamine cream could be comparably efficient in treating melasma while accompanied only by minor and transient adverse events. However, current evidence is limited by insufficient sample size, long-term follow-up, and only to epidermal melasma, highlighting the need for appropriately designed randomized controlled clinical trials to draw a conclusive image of the cysteamine's role in treating this recalcitrant condition.
Collapse
Affiliation(s)
- Najmeh Ahramiyanpour
- Department of Dermatology, Afzalipoor Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Nasrin Saki
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Dermatology Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Akbari
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Simin Shamsi-Meymandi
- Department of Dermatology, Afzalipoor Hospital, Kerman University of Medical Sciences, Kerman, Iran.,Pathology and Stem Cell Research Center, Afzalipoor Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Rezvan Amiri
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Heiran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
10
|
Tuknayat A, Bhalla M, Thami GP. Platelet-rich plasma is a promising therapy for melasma. J Cosmet Dermatol 2021; 20:2431-2436. [PMID: 34013618 DOI: 10.1111/jocd.14229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Platelet-rich plasma (PRP) is an autologous blood product which has recently been used in multiple spheres of dermatology including facial rejuvenation, androgenetic alopecia, acne scars, and wound healing. Its use in melasma is comparatively an understudied topic. MATERIAL AND METHODS An extensive systematic literature search of the PubMed electronic database and Cochrane central register of controlled trials was done using the keywords "platelet rich plasma" and "melasma" in the title. Relevant studies were selected and data were analyzed by two different authors. Four articles were excluded as they did not adhere to the inclusion criteria of this review and a total of 6 articles were reviewed.The relevant references of the included articles were also traced and included. DISCUSSION These studies showed that PRP has been used effectively not only as an adjuvant therapy but also as a standalone treatment for melasma. PRP contains about 30 growth factors, transforming growth factor beta (TGF-β) being one of the growth factors having a predominant role in treatment of melasma. TGF-β decreases signal transduction of microphthalmia-induced transcription factor and thus decreases tyrosinase and tyrosinase-related proteins. In addition to this, PRP also has an additional benefit of inducing collagen synthesis thus improving the quality and texture of the skin. But there is a scarcity of data and large randomized controlled trials. This review is an effort to highlight and upscale the use of this excellent blood product for melasma which is quite a treatment refractory disorder.
Collapse
Affiliation(s)
- Ankita Tuknayat
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - Mala Bhalla
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - Gurvinder Pal Thami
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| |
Collapse
|
11
|
Badran AY, Ali AU, Gomaa AS. Efficacy of topical versus intradermal injection of Tranexamic Acid In Egyptian melasma Patients: A randomised clinical trial. Australas J Dermatol 2021; 62:e373-e379. [PMID: 33782959 DOI: 10.1111/ajd.13575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/19/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Melasma is one of the common pigmentary problems affecting females in our community, owing to the frequent use of hormonal contraceptives as well as our sunny climate. A lot of treatment options are available but none of them is completely satisfactory. Many patients prefer the use of topical preparations and minimally invasive methods. Tranexamic acid (TA) is a potential treatment option for hyperpigmentation with different delivery routes. AIM We designed the study in order to evaluate the efficacy of TA in melasma using 2 different routes of delivery. PATIENTS AND METHODS A randomised clinical trial was performed on 60 female patients with melasma, they randomly divided into three groups; A, B and C. Group (A) patients received TA (4 mg/mL) intradermal injections every 2 weeks with, group B received TA (10 mg/mL) intradermal injections every 2 weeks, group C received TA cream (10% concentration) twice daily, treatment continued for 12 weeks in all groups. Melasma Area and Severity Index (MASI) scores were measured for each patient before and after completion of treatment. RESULTS The percentage of MASI score reduction was highest in group B (62.7%) versus (39.1%) in group A, while the percentage of MASI reduction was the lowest in group C (4.2%). CONCLUSION Tranexamic acid is a safe effective and well-tolerated treatment option for melasma patients. Intradermal injection of TA leads to better results than the topical application. Topical TA cream (even in a high concentration) produce fair improvement of melasma.
Collapse
Affiliation(s)
- Aya Y Badran
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut, Egypt
| | - Ahmed U Ali
- Department of Pharmaceutics, Faculty of Pharmacy and Industrial Pharmacy, Sinai University, Arish, Egypt
| | - Ahmed S Gomaa
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut, Egypt
| |
Collapse
|
12
|
Barolet D. Dual Effect of Photobiomodulation on Melasma: Downregulation of Hyperpigmentation and Enhanced Solar Resistance-A Pilot Study. J Clin Aesthet Dermatol 2018; 11:28-34. [PMID: 29657669 PMCID: PMC5891084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Overview. Melasma is a resistant, sun-induced facial hyperpigmentation capable of remaining present for decades with ensuing psychological distress. Treatment is difficult and focuses on an array of measures to reduce skin hyperpigmentation resulting from triggered hyperactive melanocytes. The pathogenesis of melanoma is not clearly understood but it has been reported that some growth factors and specific cell-signaling pathways are involved. Objective. The objective of the current study was to evaluate the use of pulsed photobiomodulation to modulate melasma via the regulation of gene expression pertaining to skin pigmentation. Methods. We evaluated a two-step approach via a spilt-face pilot study involving seven patients with bilateral dermal melasma who had formerly undergone unsuccessful treatments. During treatment, the initial mobilization phase with microdermabrasion was closely followed by the modulation phase, delivering low-energy pulsed photons (940nm) to downregulate highly metabolic melanocytes in the dermis. A weekly treatment was performed for eight consecutive weeks. White light pictures, ultraviolet pictures, melanin index scores, and Melasma Area and Severity Index scores were obtained at baseline and at Week 12. Results. The pulsed photobiomodulation-treated side versus the control side showed statistically significant results for pigment reduction. Conclusion. This pilot study shows that dermal melasma can be significantly improved with pulsed photobiomodulation. Interestingly, it might also precondition the skin, helping it to build a resistance to future solar ultraviolet ray exposure.
Collapse
Affiliation(s)
- Daniel Barolet
- Dr. Barolet is with the Department of Medicine, Dermatology Division, McGill University in Montreal, Québec, Canada, and with the RoseLab Skin Optics Laboratory in Laval, Canada
| |
Collapse
|
13
|
Fernandez-Flores A, Barja JM, Vilas-Sueiro A, Alija A. Histopathological findings in pregnancy associated cutaneous hyperpigmentation. J Cutan Pathol 2018; 45:286-289. [PMID: 29345316 DOI: 10.1111/cup.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 11/26/2022]
Abstract
Hyperpigmentation in pregnancy is a common phenomenon, experienced to some degree by up to 90% of pregnant women. It mainly involves sun-exposed areas, but it can extend to non-exposed zones. Cases with extensive hyperpigmentation are rarely reported. In this paper, we describe the case of a 30-year-old phototype V woman in her 37th week of pregnancy, who presented with brownish hyperpigmentation of the skin in extensive areas, including both axillae, the abdomen and the lowest part of the back. In the abdomen, there was a reinforcement of the hyperpigmentation through the linea nigra and the umbilicus. The hyperpigmentation affected the buttocks as well and involved the intertriginous area between them. Histopathologic analysis showed a hyperpigmented basal layer of the epidermis with no melanocytic atypia or melanocytic nests. Histochemical staining for iron did not show any deposits. Immunohistochemical studies for HMB-45, Melan A and SOX10 demonstrated an increased number of melanocytes. There was hyperpigmentation of basal layer keratinocytes. We also performed immunohistochemical stains for estrogen and progesterone receptors, which were both negative. The patient was examined 3 months after delivery, evidencing a significant clearing of the lesions.
Collapse
Affiliation(s)
- Angel Fernandez-Flores
- Department of Cellular Pathology, Hospital El Bierzo, Ponferrada, Spain.,Department CellCOM-SB Group, Biomedical Investigation Institute of A Coruña, A Coruña, Spain.,Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain
| | - Juan M Barja
- Department of Dermatology, Hospital El Bierzo, Ponferrada, Spain
| | | | - Antonio Alija
- Department of Dermatology, Hospital El Bierzo, Ponferrada, Spain
| |
Collapse
|
14
|
Shi HF, Xu F, Shi Y, Ren CY, Wu XY, Xu B, Li J, Zhang DJ. Effect of ear-acupoint pressing and Ear Apex (HX6,7) bloodletting on haemorheology in chloasma patients with Gan depression pattern. Chin J Integr Med 2015; 22:42-8. [PMID: 26108524 DOI: 10.1007/s11655-015-2109-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore the therapeutical effect of ear-acupoint pressing combined with Ear Apex (HX6,7) bloodletting on haemorheology in chloasma patients with Gan (Liver) depression pattern. METHODS A total of 180 chloasma patients were randomly assigned to three groups, 60 cases in each. Patients in the earacupuncture (EA) group were treated with ear-acupoint pressing combined with Ear Apex (HX6,7) bloodletting; vitamins C and E were put into practice in the Western medicine (WM) group together with 0.025% tretinoin cream for local external application; patients in the placebo group were treated with urea-cream by external use, while 30 healthy volunteers were in the control group. After a treatment course of 2 months, the changes of haemorheology, injury skin area, colour score and symptom score before and after the treatment were observed. RESULTS There was no significant difference on whole blood reduced viscosity (high shear, medium shear, and low shear), erythrocyte aggregation index, hematocrit, plasma viscosity among the four groups (F =2.65, P>0.05). Compared with those before treatment, the whole blood viscosity (high shear) and whole blood reduced viscosity (high shear) after treatment in the EA group, the WM group and the placebo group were with no statistical significance (P>0.05). The injury skin area and colour score after treatment were significantly lower than those before treatment in the EA group and the WM group (P<0.05), while there was no significant difference in placebo group (P>0.05). Clinical symptoms of the EA group were obviously improved after the 2-month treatment, which was significantly different compared with those before treatment (P<0.05), there was significant difference compared with those of WM group and placebo group (P<0.05). CONCLUSION There was no significant difference on haemorheology index between healthy people and chloasma patients without angionosis, cerebrovascular disease, hematopathy, metabolic disease or any other organic disease. Ear-acupoint pressing combined with Ear Apex (HX6,7) bloodletting can effectively improve concurrent symptoms, lighten chloasma and lower chloasma area in patients accompanied by Gan depression.
Collapse
Affiliation(s)
- Hong-Fei Shi
- The First Affiliated Hospital of Medical College of Zhejiang University, Hangzhou, 310003, China
| | - Fu Xu
- Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, 310006, China
| | - Yan Shi
- The First People's Hospital of Hangzhou, Hangzhou, 310006, China.
| | - Chun-Yun Ren
- The First Affiliated Hospital of Medical College of Zhejiang University, Hangzhou, 310003, China
| | - Xiao-Yi Wu
- The First Affiliated Hospital of Medical College of Zhejiang University, Hangzhou, 310003, China
| | - Bing Xu
- The First Affiliated Hospital of Medical College of Zhejiang University, Hangzhou, 310003, China
| | - Jun Li
- The First Affiliated Hospital of Medical College of Zhejiang University, Hangzhou, 310003, China
| | - De-Jian Zhang
- The First Affiliated Hospital of Medical College of Zhejiang University, Hangzhou, 310003, China
| |
Collapse
|