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Introducción: El fotoenvejecimiento es una entidad creciente en la consulta de Dermatología, y su comportamiento aparece en edades tempranas de la vida. Esto trae como consecuencia el surgimiento del cáncer cutáneo de forma precoz. Esta afección resulta de la combinación de los efectos del envejecimiento biológico y las consecuencias a largo plazo de la exposición a la radiación ultravioleta, fenómeno que afecta las zonas de la piel expuestas con numerosos cambios morfofisiológicos. Objetivo: Caracterizar el fotoenvejecimiento en pacientes asistidos en consulta de Dermatología. Materiales y métodos: Se realizó un estudio descriptivo, prospectivo en consulta de Dermatología. El universo quedó constituido por 35 pacientes con diagnóstico de fotoenvejecimiento. Se recolectaron las variables en un modelo para este fin. Los resultados se procesaron en tablas para el análisis y discusión de los mismos. Resultados: La mayor frecuencia estuvo entre los 20-30 años y 31-40, con un 37,14 %. El sexo femenino presentó el 91,43 %. Se mostró prevalencia del fotoenvejecimiento grado II, con un 62,86 %, y fotoexposición todo el año, con un 68,57 %. El 74,28 % de los casos fueron trabajadores. Los pacientes con fototipo grados II y III con fotoenvejecimiento grado II, fueron los de mayor porcentaje, con 61,5 % y 56,2 % respectivamente. El 77,3 % tuvo entre 11 y 20 lesiones, y el melasma fue la de mayor incidencia, con 61,54 %. Conclusiones: Las féminas de edad media con fototipo grado III, fotoenvejecimiento grado II, y fotoexpuestas todo el año, mostraron un promedio entre 11 y 20 lesiones, siendo el melasma la más identificada.
Introduction: Photoaging is a growing entity in the Dermatology consultation, and its behavior appears in early ages of life. This results in the onset of precocious skin cancer. This affection results from the combination of the effects of biological aging and the long-term consequences of exposure to ultraviolet radiation, a phenomenon that affects exposed skin areas with numerous morphophysiological changes. Objective: To characterize photoaging in patients treated in Dermatology consultation. Materials and methods: A descriptive, prospective study was carried out in a Dermatology consultation. The universe consisted of 35 patients with diagnosis of photoaging. The variables were collected in a form for this purpose. The results were processed in tables, for their analysis and discussion. Results: The highest frequency was between 20-30 and 31-40 years, with 37.14%. Female sex accounted for 91.43%. It was shown the prevalence of grade II photoaging, with 62.86%, and photo-exposure throughout the year, with 68.75%. 74.28% of cases were workers. The patients with grade II and III phototypes, with grade II photoaging, were the ones with highest percentage, with 61.5% and 56.2% respectively. 77.3% had between 11 and 20 lesions, and melasma had the highest incidence, with 61.54%. Conclusions: Middle-aged women, with grade III photo-type, grade II photoaging, and photoexposure throughout the year, showed an average of between 11 to 20 lesions, melasma being the most identified.
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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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Introducción: El melasma facial consiste en una hiperpigmentación que se origina por un incremento de la melanina epidérmica o dérmica, o ambas, y se localiza en las áreas fotoexpuestas, lo cual afecta, en ocasiones, la autoestima de hombres y mujeres. Objetivo: Evaluar la efectividad del tratamiento con láser de helio-neón en pacientes con melasma facial. Métodos: Se realizó un estudio cuasiexperimental de intervención terapéutica en 34 pacientes con diagnóstico clínico y dermatoscópico de melasma facial, atendidos en la consulta de dermatología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso en Santiago de Cuba, de enero del 2019 a igual mes del 2020, para lo cual se conformaron dos grupos: uno de estudio, que recibió tratamiento con láser, y el otro de control, tratado con crema de hidroquinona a 2 %. La información fue procesada y resumida en valores absolutos y porcentaje; asimismo, se utilizó la prueba paramétrica de homogeneidad de la Χ2, con un nivel de significación α=0,05. Resultados: En general, la mayoría de los pacientes correspondieron al grupo etario de 39-48 años (35,3 %) y al sexo femenino (82,3 %), tenían color de la piel mestizo (76,5 %) y lesiones de tamaño mediano (58,8 %). Si bien no existieron diferencias estadísticamente significativas entre las respuestas terapéuticas de cada grupo de estudio, en los pacientes tratados con láser de helio-neón la mejoría clínica fue evidente a los 3 meses de finalizada la intervención (70,6 %). Conclusiones: El tratamiento con láser de helio-neón fue efectivo en los pacientes con melasma.
Introduction: Melasma is a hyperpigmentation caused by an increase in epidermal or dermal melanin concentration, or both, and it is located on photoexposed cutaneous regions. It affects sometimes men's and women's self-esteem. Objective: To evaluate the effectiveness of helium-neon laser treatment in patients with melasma. Methods: A quasi-experimental study of therapeutic intervention in 34 patients with clinical and dermoscopic diagnosis of melasma, who were assisted at the Dermatology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out from January, 2019, to the same month in 2020, for which two groups were formed: the study group, that received laser treatment, and the control group, treated with 2% hydroquinone cream. The information was processed and expressed in absolute values and percentage; likewise, the Χ2 test for homogeneity was used, with a significance level of α=0.05. Results: In general, most of the patients belonged to 39-48 age group (35.3%) and were female (82.3%), with mixed skin color (76.5%) and medium-sized lesions (58.8%). Although there were no statistically significant differences between the therapeutic responses of each study group, clinical improvement in patients treated with helium-neon laser was evident 3 months post-intervention (70.6%). Conclusions: Helium-neon laser treatment was effective in patients with melasma.
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Objective:To observe the clinical efficacy of micro-needle therapy combined with Biotrisse BTS Lumin OX and Biotrisse BTS Brightline in the treatment of melasma.Methods:From September 2019 to June 2021, 80 patients with facial chloasma, aged 28-48 (37.3±4.9) years, were selected from Nanjing Jiangning Guze Clinic. The micro-needle therapy was combined with lumin OX and brightline for 6 times, and the observation time was 120 days. The mMASI score and VISIA photos before and after treatment were used to improve the results.Results:Eighty patients with refractory melasma on the face were treated with micro-needle therapy for 7 times (1 time per week for the first 5 times, and twice a week for the 9th and 10th weeks). The photos before and after treatment were compared and the mMASI of the patients' facial chloasma was compared. The scores were analyzed statistically, and the melasma were improved to varying degrees. Before treatment, the mMASI score was 5.4±3.22; 90 days later, the mMASI was 3.22±2.16, and the score decreased significantly ( t=5.9, P<0.05); after 120 days, mMASI score was 1.6±0.68, and the score decreased significantly ( t=7.55, P<0.05). Pigmentation occurred in one patient after treatment, and hypopigmentation after repair treatment; none of the patients had adverse reactions such as hypopigmentation. All the 80 patients had different degrees of improvement in pores and skin texture. Conclusions:The combination of micro-needling with lumin OX and brightline in the treatment of chloasma has a definite effect without obvious side effects. It provides a new method for the treatment of chloasma.
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Background: Melasma is an acquired dyschromia with several histologic alterations in the epidermis, basement membrane and upper dermis. The treatment of melasma is challenging due to the irregular response and chronicity of the disease. To date, there are no curative strategies, largely due to the limited understanding of the intrinsic effects of each treatment. Objectives: The objective of the study was to evaluate the histological changes promoted by triple combination cream, with or without complementary treatment with microneedling and oral tranexamic acid, in the treatment of melasma. Methods: A factorial, randomised, controlled and evaluator-blinded clinical trial was performed involving 64 women with facial melasma, divided in four groups, who underwent 60 days of treatment with triple combination cream alone (control group) or combined with two monthly microneedling sessions (microneedling group), TA 250 mg twice daily (tranexamic acid group), or both tranexamic acid group and microneedling group. The participants underwent biopsy of the area with melasma at inclusion (D1) and D60. The primary outcomes were the variation (D1 × D60) between the variables: Thickness of the epidermis and stratum corneum, stratum corneum compaction and solar elastosis; melanin density in the epidermis and upper dermis; proportion between the extension of the nonintact and intact basement membrane zone; mast cell count in the upper dermis; melanocyte count in the basal layer, pendulum melanocyte count and melanocyte area; immunostaining density of vascular endothelial growth factor; stem cell factor and keratinocyte growth factor. Results: One participant in the TG discontinued tranexamic acid due persistent headache; and herpes simplex occurred in three patients after microneedling. The groups showed a 24% (CI95%: 17–35%; P < 0.01) reduction in epidermal melanin density. There was no change in dermal melanin density or the area of melanocytes after treatment. There was an overall 25% (CI95%: 7–42%; P < 0.01) reduction in the number of pendulum melanocytes, especially in the microneedling and tranexamic acid group, that presented a 41% (CI95%: 7–73%; P < 0.01) reduction. The extension of the nonintact basal membrane relative to the intact basal membrane decreased after treatment, especially in microneedling group and microneedling and tranexamic acid group. There was an increase of 13% (CI95%: 5–21%; P = 0.02) in epidermal thickness and 6% (CI95%: 0–22%; P = 0.04) thinning of the stratum corneum in the groups. All groups showed stratum corneum compaction. Solar elastosis improved only in the microneedling group and microneedling and tranexamic acid group. Vascular endothelial growth factor immunostaining increased 14% (CI95%: 4–24%; P = 0.03) in the groups; and stem cell factor increased only in microneedling group. There was no change in the number of mast cells, CD34 and keratinocyte growth factor immunostaining. Limitations: The site of biopsy may not represent all of the facial melasma and the immunohistochemical sensitivity of the cytokines does not have a stoichiometric relationship with proteins. Conclusion: A greater thickness of the epidermis is associated with melasma bleaching. Dermal melanin seems to have no impact on melasma prognosis. Damage to the skin barrier and stimulus of angiogenesis should be avoided in the treatment of melasma. Microneedling complements the topical treatment of melasma by improving patterns of skin photoaging. Oral tranexamic acid complements the topical treatment of melasma by inhibiting the stem cell factor.
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Abstract Background: In addition to melanocytic hyperfunction, changes are observed in the upper dermis of melasma, and fibroblasts play a central role in collagen synthesis and pigmentation induction. Objective: To explore the morphology, growth rate, and gene expression profile of fibroblasts from the skin with melasma in comparison to fibroblasts from the adjacent healthy skin. Methods: Ten women with facial melasma were biopsied (lesion and adjacent healthy skin), and the fragments were processed for fibroblast culture. Samples from five participants were seeded to evaluate growth (days 2, 5 and 8) and senescence (SA-β-gal) curves. The samples from the other participants were submitted to real-time PCR to comparatively evaluation of the expression of 39 genes. Results: Cultured fibroblasts from melasma skin were morphologically less fusiform in appearance and on average a 34% (95% CI 4%-63%) greater proportion of cells labeled with SA-β-gal than the fibroblasts from the adjacent skin. The cell growth rate was lower for the melasma samples after eight days (p < 0.01). The WNT3A, EDN3, ESR2, PTG2, MMP1, and SOD2 genes were up-regulated, whereas the COL4A1, CSF2, DKK3, COL7A1, TIMP4, CCL2, and CDH11 genes were down-regulated in melasma skin fibroblasts when compared to the ones from adjacent healthy skin. Study limitations: Small sample size; absence of functional tests. Conclusions: Fibroblasts from the skin with melasma showed a lower growth rate, less fusiform morphology and greater accumulation of SA-β-gal than those from adjacent photo exposed skin. Moreover, their gene expression profile comprised factors that may contribute to upper dermis damage and sustained melanogenesis.
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Background: A group of heterogenous entities having the common clinical feature of altered facial pigmentation have been informally called as facial melanoses. Since, the cosmetic disfigurement is easily visible, it has a lot of impact on the psychological well being of the person. To assess the patients of facial hyper Aim: pigmentary disorders for demographic , etiological and clinical profile. A prospective clinical study was conducted in a tertiary care ce Methods: nter in Ananthapuram over period of 6 months. 100 patients with facial hyper pigmentary disorders were assessed by detailed history and clinical examination. In our study, most common age group Results: which sought treatment was 30-50 years. Female were predominantly affected. five different facial melanosis were observed which included melasma, postinfiammatory hyperpigmentation, reihl's melanosis, exogenous ochronosis,topical steroid damaged face. Reihl's melanosis was the most common disorder reported by 30 patients out of 100. Limitations: Dermoscopy could not be done to resource constraint. Conclusion: Increase in awareness and concern with appearance has led to an increase in reported incidence of facial melanosis in both sexes. Prior application of over-the-counter products poses difficulty in correct evaluation and treatment. Psychological evaluation forms an integral part of the treatment of these patients.
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Melasma is a skin condition characterized by dark spots and patches on the nose, cheeks, forehead and jaw line. Although it is completely harmless, it causes skin discoloration which is difficult to fade away with routine skin care. Melasma can lead to social isolation and stigmatization adversely affecting the quality of daily life which definitely has a major impact on individual’s psychological state and social relationship. The symptomatology of Vyanga given in various available Ayurvedic classics are Mandala (circular patches), Shyava (brown), Tanu (thin), Niruja (painless), etc. The clinical features of melasma can be correlated with Vyanga and condition can be treated based on the Vyanga Chikitsa. Objectives: To evaluate the efficacy of Haritakyadi Lepa in the management of Vyanga and to review the etiopathology and the clinical aspect of the Vyanga. Result: Based on the collected data, efforts were made to evaluate the efficacy of Haritakyadi Lepa followed by Sadyo Virechana with Manibhadra Guda in the subjects of melasma vis-à-vis Vyanga. Conclusion: In contemporary science, topical steroids have been described in the management of melasma. Alternative to that Haritakyadi Lepa along with Madhu selected for treatment, has shown very effective result in Vyanga.
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Background: Melasma is the commonest cause of facial hypermelanosis in skin type IV-VI. First-line treatment includes a triple combination containing topical corticosteroid and hydroquinone which have side effects on prolonged use. Chemical peels are a second-line management option with the laser being used in refractory cases, but the worsening of hyperpigmentation in darker skin types can occur following laser therapy. Sunscreen is a must to prevent relapses. Aims and Objectives: (i) To compare the effects of treatment with a proprietary combination (phenyl ethyl resorcinol, nonapeptide-1, aminoethyl phosphinic acid, antioxidants and sunscreen) versus sunscreen alone in limiting or reducing, melasma and preventing recurrence as a maintenance regimen after the initial use of triple combination,(ii) to evaluate the safety of the formulation studied, and (iii) to study the improvement of the quality of life of the patients after using the study formulation versus placebo. Methods: It was a prospective double-blinded parallel-group randomized controlled pilot study. A total of 46 subjects were recruited by consecutive sampling methods and randomized to 23 each in case and control groups. The study period was eight months with three phases. Phase 1 constituted the application of triple combination for eight weeks by both groups followed by phase 2 with the case group applying proprietary medicine and the control group applying sunscreen. Phase 3 was a follow-up period to see the sustenance of results in both groups as well as any evidence of relapses. Sunscreen was applied in all three phases. Results: Case group in the study showed improvement in the melasma severity score and mean melanin index as measured by mexameter but it did not attain statistical significance as compared to the control group. The melasma area and severity index score showed a consistent reduction in the case group, whereas it increased in the control group from baseline. Limitations: Small sample size and a short follow-up period of our study were major limitations. Conclusion: The proprietary combination, which has sunscreen as one of its constituents, is more effective in maintaining remission after triple combination without any added inconvenience of application of two separate preparations as compared to sunscreen alone
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Tranexamic acid can treat melasma through multiple steps, such as inhibiting dermal angiogenesis, reducing the number of mast cells and inhibiting their activity, reducing damage to the basement membrane zone, inhibiting melanin synthesis and transport in the epidermis, and promoting the recovery of skin barrier function. This review summarizes the action mechanism and efficacy of tranexamic acid in the treatment of melasma, providing more evidence for its clinical application.
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Objective:To evaluate the efficacy and safety of radiofrequency introduction of L-vitamin C in patients with melasma.Methods:From March to June 2019, 20 patients with melasma were admitted to the Department of Dermatology, the Seventh Medical Center of PLA General Hospital, including 19 females and 1 male, aged 30-60 years, with an average age of 43.5 years. All patients were treated with 22 percent of L-vitamin C once a week, a total of 8 times of treatment and followed up for 12 weeks. Each subject was assessed with standardized clinical photo, skin tests (VISIA skin image analyzer and CK multifunctional skin tester) and patient self-assessment. In addition, the adverse reactions were recorded.Results:Physician evaluation and patient self-evaluation showed that skin symptoms were improved obviously after treatment. 90% of the subjects thought that all of the skin moisture, pores, fine lines, glossiness, and color spots were improved after 12 weeks. The skin texture, ultraviolet stain and the brown spots which were detected with VISIA skin image analyzer were all improved after one week and one month. Difference was statistically significant ( P<0.05). Skin glossiness was significantly improved, skin moisture content increased and melanin decreased, which were detected with CK multifunctional skin tester. The differences were statistically significant ( P<0.05). But there was no significant change in transdermal water loss and red pigment index ( P>0.05). Conclusions:22% L-vitamin C can be used to treat melasma and improve photoaging safely without affecting skin barrier function.
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RESUMEN Introducción: el daño actínico crónico es un grupo de alteraciones en la estructura, función y apariencia de la piel como resultado de la exposición no controlada a las radiaciones ultravioletas. Puede provocar el cáncer de piel. Objetivo: caracterizar a los pacientes con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en el departamento de Cochabamba, Bolivia. Materiales y métodos: se realizó un estudio clínico descriptivo, prospectivo, en un universo de 1 833 pacientes diagnosticados con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en Cochabamba, entre septiembre de 2017 y septiembre de 2018. Se evaluaron las variables edad, sexo, color y fototipo de piel, ocupación, uso de medios de protección solar, exposición a otro tipo de radiaciones, manifestaciones clínicas de fotodaño y altitud del lugar de residencia. Resultados: predominaron el grupo de edad de 25 a 59 años, el sexo femenino, el color de piel mestizo (77,08 %), el fototipo de piel IV (76,98 %) y la ocupación comerciante (72,56 %). La mayoría de los pacientes (82,7 %) no utilizaron medios de protección solar, y el 99,8 % no tuvieron exposición a otro tipo de radiaciones. Las lesiones por fotodaño que prevalecieron fueron melasma (83,03 %) y lentigos (12,22 %). El 99,29 % vivían en zonas de gran altitud. Conclusiones: se caracterizaron los pacientes con daño actínico crónico, obteniendo en algunas variables estudiadas resultados similares a los mencionados por otros investigadores (AU).
ABSTRACT Introduction: chronic actinic damage is a group of alterations in the structure, function, and appearance of the skin as a result of uncontrolled exposure to ultraviolet radiation. It can cause skin cancer. Objective: to characterize the patients with chronic actinic damage, treated at the Dermatology consultation of Valle Hermoso Community Hospital, in the department of Cochabamba, Bolivia. Materials and methods: a descriptive, prospective clinical study was conducted in a universe of 1,833 patients diagnosed with chronic actinic damage, treated at the Dermatology clinic of the Valle Hermoso Community Hospital, Cochabamba, between September 2017 and September 2018. The variables age, sex, skin color, skin phototype, occupation, use of sun protectors, exposure to other types of radiation, clinical manifestations of photodamage and altitude of the place of residence were evaluated. Results: the age group from 25 to 59 years, the female sex, mestizo skin color (77.08 %), the IV skin phototype (76.98 %) and merchant occupation (72.56 %) predominated. Most patients (82.7 %) did not use sun protection means, and 99.8 % had no other radiation exposure. The prevailing photodamage lesions were melasma (83.03 %) and lentigo (12.22 %). 99.29 % lived in high altitude areas. Conclusions: the patients with chronic actinic damage were characterized, obtaining in some variables studied results similar to those mentioned by other researchers (AU).
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Humans , Male , Female , Patients/classification , Photosensitivity Disorders/epidemiology , Photosensitivity Disorders/diagnosis , Radiation Effects , Clinical Diagnosis , Lentigo/diagnosis , Melanosis/diagnosisABSTRACT
El Melasma es una patología con alta prevalencia a nivel mundial presente en alrededor de un 10% de la población Latinoamericana. Se caracteriza por ser una hipermelanosis cutánea adquirida que ocurre con más frecuencia en cara y cuello de mujeres con fototipos de piel III-VI de Fitzpatrick. Su patogenia aún no ha sido completamente dilucidada; sin embargo, existe evidencia que respalda la asociación del melasma con la radiación ultravioleta, la luz visible, la estimulación hormonal, factores genéticos y procesos inflamatorios. Su diagnóstico es fundamentalmente clínico, y es apoyado por instrumentos de medición que nos permiten objetivar la severidad e impacto en la calidad de vida de los pacientes afectados. El tratamiento continúa siendo un desafío ya que, si bien existen múltiples terapias que han demostrado efectividad, aún no han logrado una remisión completa, presentando una alta tasa de recurrencia. Dentro de las opciones terapéuticas destacan los tratamientos tópicos combinados, los peelings químicos y las terapias basadas en láser, sin embargo, lo más importante es hacer énfasis en la fotoprotección como medida preventiva. En esta revisión pretendemos actualizar sobre los últimos avances tanto de la fisiopatología como del tratamiento del melasma
Melasma is a pathology with a high prevalence worldwide, present in approximately 10% of the Latin American population. It is a cutaneous hypermelanosis that presents itself more frequently on the face and neck of women with Fitzpatrick skin phototypes III-VI. Its pathogenesis has not yet been fully elucidated, however, there is evidence that supports its association with ultraviolet radiation, hormonal stimulation, genetic factors, and inflammatory processes. Its diagnosis is fundamentally clinical, and is supported by clinical scores that allow us to objectify the severity and impact on the quality of life of patients who suffer from it. Treatment continues to be a challenge since, although there are multiple therapies that have demonstrated effectiveness, they have not yet achieved a complete and / or definitive remission of the disease, presenting a high recurrence rate. Treatment options include combined topical therapy, chemical peels and laser-based treatments. Much emphasis has been placed lately on photoprotection of the skin as a preventive measure. In this review we intend to update the latest advances in both the pathophysiology and treatment of melasma
Subject(s)
Humans , Melanosis/etiology , Melanosis/therapy , Melanosis/pathologyABSTRACT
Melasma， as a kind of melanosis， often occurs over the face of young and middle-aged women， which seriously affects the physical and mental health of patients. At present， it is believed that the occurrence of melasma is related to various factors such as ultraviolet radiation and changes in sex hormone levels in the body. However， the exact pathogenesis of melasma is still unclear and its clinical efficacy is not ideal. Therefore， it is of great clinical significance and social value to carry out basic researches on melasma diseases. Among them， the animal model of melasma acts as an important tool for studying melasma， and it is particularly important to clarify the pathophysiological mechanism of the occurrence and development of melasma. The common modeling methods include ultraviolet modeling， progesterone modeling and ultraviolet combined with progesterone modeling. However， there are still some problems in the practical application of animal models of melasma due to many influencing factors in the preparation of such animal models， and there is still a lack of a more complete and recognized model preparation scheme to this day， which reduces the success rate of model preparation and limits its application and popularization to some extent. In view of the key problems in the establishment and application of animal models of melasma， we comprehensively summarized the research status of the models from such aspects as experimental animals， modeling methods and model evaluation， and discussed the effects of different modeling methods and animal species， animal age and other factors on animal model of melasma by referring to and sorting out the recent literatures at home and abroad in recent years. This is to provide references for the preparation of more scientific， reasonable， economic and convenient animal models of melasma， lay a foundation for in-depth researches on the pathogenesis， prevention and treatment of melasma， and also provide reference for other animal model research.
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Background: Melasma is a common acquired hyperpigmentary disorder of the sun exposed skin, especially the face. The pathogenesis is unclear but interplay between genetic factors, hormones and ultraviolet radiation is important. We have evaluated the histological characteristics of melasma and compared the findings with adjacent normal skin. Methods: Skin biopsies were taken from both melasma and the surrounding perilesional normal skin in 50 Indian women. The sections were stained with hematoxylin and eosin, Fontana–Masson and Verhoeff–Van Gieson stains. Results: Biopsy from melasma showed significant epidermal atrophy, basal cell hyperpigmentation and solar elastosis when compared with the perilesional skin. We found that the proportion of pendulous melanocytes was significantly higher in the lesional biopsy compared with the perilesional biopsy (76% vs 42%, P < 0.001). Similarly, pigmentary incontinence and features of solar elastosis were significantly higher in the lesional skin compared with the perilesional skin. Conclusion: The characteristic histopathological features such as epidermal atrophy, basal cell hyperpigmentation and solar elastosis suggest the role of chronic sun exposure in the pathogenesis of melasma. Presence of pendulous melanocytes is a characteristic feature of melasma. The presence of pendulous melanocytes may have prognostic implications in melasma.
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Background: Now a day’s melasma is a common pigmentarysyndrome among Asians and treatment is challenging. Oraltranexamic acid (TA) has materialized as a potential treatmentfor refractory melasma.Objective: In this study our main objective is to evaluateefficacy of oral tranexamic acid over melasma.Method: This opened clinical trial study was carried out atTertiary medical hospital Dhaka from June 2016 to July 2018where informed consent was sought from the total 120 patientsto take part in the study. At the baseline visit, history ofmelasma regarding length of time present, relationship topregnancy, oral contraceptive, drug history were noted.Result: During the experiment, maximum patients belong to21-25 years age group and percentage of female were 82%higher than male. Also, after 6 months follow up of 250mgdose of tranexamic acid (TA) treatment result, where patientsrating for excellent, good, fair, and poor outcome accounted21% patients, 66%, 13%, and 11 % patient, respectively.Conclusion: From our result and analysis we can say that,oral TA can be a very much effective treatment for refractorymelasma. Careful screening for personal and familial riskfactors for thromboembolism should be done beforeintroduction.
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Background:Melasma is one of the most common causes of acquired facial melanosis in Indian patients. Dermatoscopy is a non invasive office tool which magnifies the surface and sub-surface structures of skin. It helps in early diagnosis and monitoring the treatment of melasma. The present study was carried out to evaluate melasma both clinically and dermoscopically.Methods:Atotal of 90 patients with clinical diagnosis of melasma were enrolled in the study. Clinical and dermatoscopic evaluation were done and all findings recorded.Results:Out of 90 patients enrolled, 83 were females and 7 were males. Centrofacial type was the most common clinical type of melasma (57.7%). On dermatoscopic examination, 56.2% had epidermal melasma, 36.7% had mixed melasma and 11.1% had dermal melasma. The most common dermatoscopic pattern was sparing of follicles seen in 80% of cases.Conclusion:Melasma has significant psychological impact in the patient. Dermatoscopy Ahelps in diagnosis, prognosis and monitoring of therapeutic efficacy. It also reduces the need of invasive techniques like biopsy on face.
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Background: Melasma poses a great challenge as its treatment modalities are unsatisfactory. Treatment using tranexamic acid is a novel concept. Aim: This study aimed to compare the therapeutic efficacy and safety of oral tranexamic acid and tranexamic acid microinjections in patients with melasma. Methods: This is a prospective, randomized, open-label study with a sample size of 64, 32 in each treatment arm. Thirty-two patients were administered localized microinjections (4 mg/ml) of tranexamic acid monthly in 1 arm, while in the other arm, 32 were given oral tranexamic acid 250 mg twice a day. Patients were followed up for 3 consecutive months. Clinical photographs were taken at each visit, and a modified melasma area and severity index scoring was performed at the beginning and end of treatment. Results: Improvement in melasma area and severity index score in the oral group was 57.5% as compared to 43.5% in the intralesional group. All 32 patients in the oral group (100%) showed >50% improvement, out of which 8 showed >75% improvement. In the intralesional group, 17 (53%) patients had >50% improvement, of which 3 had >75% improvement. The remaining 15 patients in this group had <50% improvement. Thus, the oral group showed a more significant response as compared to the intralesional group. No major adverse effects were observed in both the groups. At 6-month follow-up, two patients (6.2%) in the oral group had recurrence as compared to three patients (9.4%) in the intralesional group. Limitations: A small sample size was one of the limitations in this study. The dose of tranexamic acid in microinjections and the frequency of injections could have been increased. Conclusion: Tranexamic acid provides rapid and sustained improvement in the treatment of melasma. It is easily available and affordable. Oral route is undoubtedly efficacious, but the results of microinjections, while encouraging, can probably be enhanced by either increasing the frequency of injections or increasing the concentration of the preparation.
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The Q-switched Nd:YAG laser is an established modality of treatment for epidermal and dermal pigmented lesions. The dual wavelengths of 1064nm and 532nm are suited for the darker skin tones encountered in India. Though this laser has become the one of choice for conditions such as nevus of Ota, Hori's nevus and tattoos, its role in the management of melasma and other acquired dermal melanoses is not clear. Despite several studies having been done on the Q-switched Nd:YAG laser in melasma, there is no consensus on the protocol or number of sessions required. Acquired dermal melanoses are heterogenous entities with the common features of pigment incontinence and dermal melanophages resulting in greyish macular hyperpigmentation. This article reviews the current literature on laser toning in melasma and the role of the Q-switched Nd:YAG laser in stubborn pigmentary disorders such as lichen planus pigmentosus. As the pathology is primarily dermal or mixed epidermal-dermal in these conditions, the longer wavelength of 1064nm is preferred due to its deeper penetration. Generally multiple sessions are needed for successful outcomes. Low fluence Q-switched Nd:YAG laser at 1064nm utilizing the multi-pass technique with a large spot size has been suggested as a modality to treat melasma. Varying degrees of success have been reported but recurrences are common on discontinuing laser therapy. Adverse effects such as mottled hypopigmentation have been reported following laser toning; these can be minimized by using larger spot sizes of 8 to 10mm with longer intervals (2 weeks) between sessions.
ABSTRACT
Objective@#To evaluate the clinical efficacy of Q-switched Nd:YAG laser in the treatment of melasma, and to explore factors influencing the efficacy.@*Methods@#Forty-four female patients with melasma were enrolled into this study, who received treatment with Q-switched Nd:YAG laser once every 2-3 weeks for a total of 10 sessions in Department of Dermatology, Hangzhou Third Hospital between August 2017 and October 2017. Skin lesions were classified into epidermal type and mixed type by reflectance confocal microscopy, and a VISIA skin imaging detector was used to evaluate if subclinical melasma existed in patients. According to the modified melasma area and severity index (mMASI) , the severity of skin lesions before and after the treatment, as well as the efficacy, was evaluated by dermatologists. Statistical analysis was carried out by using paired t test, chi-square test and multivariate unconditional Logistic regression.@*Results@#Of the 44 patients, 5 were cured, 15 received marked improvement, 12 received improvement, 12 showed no response, and the total response rate was 45.4%. The mMASI score significantly decreased after the treatment (3.2 ± 2.1) compared with that before the treatment (6.7 ± 2.9, t = 8.955, P < 0.001) . The mMASI score changed along with the treatment sessions. Specifically speaking, the mMASI score started to be significantly lower after the 3rd treatment than after the previous treatment (t = 3.780, P < 0.01) , and gradually decreased along with the increase in treatment sessions till the 8th treatment session, and no significant difference was observed between the 8th and 7th treatment sessions (t = 1.735, P > 0.01) . The response rate was significantly higher in the patients with stable melasma than in those with progressive melasma (χ2 = 16.454, P < 0.05) , in patients without dendritic melanocytes in skin lesions than in those with dendritic melanocytes in skin lesions (χ2 = 9.582, P < 0.05) , and in patients without subclinical melasma than in those with subclinical melasma (χ2 = 6.188, P < 0.05) , while there was no significant difference in the response rate between the patients with epidermal-type melasma and those with mixed-type melasma (χ2 = 2.463, P = 0.120) . Logistic regression analysis showed that clinical stages (OR [95% CI] = 0.180 [0.046 - 0.746], P = 0.018) , dendritic melanocytes (OR [95% CI] = 0.231 [0.059 - 0.769], P = 0.018) and subclinical melasma (OR [95% CI] = 0.158 [0.063 - 0.854], P = 0.011) were associated with the efficacy.@*Conclusion@#Q-switched Nd:YAG laser is effective and safe for the treatment of melasma, especially for patients with stable melasma, without dendritic melanocytes in skin lesions, and those without subclinical melasma.