Histological changes in facial melasma after treatment with triple combination cream with or without oral tranexamic acid and/or microneedling: A randomised clinical trial

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.

Estudo piloto sobre a eficácia e segurança do uso da cisteamina 5% como terapia de contato por toda noite no tratamento do melasma facial / Efficacy and safety of the 5% cysteamine cream left in overnight for facial melasma: a pilot study

Não se aplica, trata-se de uma carta

Not applicable, this is a letter.

Análise de componentes da síndrome metabólica e complicações em pacientes com diabetes mellitus tipo 2 do centro de triagem de diabetes da Universidade Federal de São Paulo / Analysis of metabolic syndrome components and complications in patients with diabetes mellitus type 2 from the center of diabetes' screening sector, Federal University of São Paulo

JUSTIFICATIVA E OBJETIVOS: O diagnóstico e tratamento precoce da síndrome metabólica (SM) em pacientes portadores de diabetes mellitus tipo 2 (DM2) previne complicações.O objetivo deste estudo foi avaliar a prevalência decomponentes da SM em pacientes portadores de DM2, bem como a prevalência de complicações crônicas auto-referidas em pacientes portadores de DM2. MÉTODO: Estudo transversal, de dados secundários, com análise de prontuários de todos os pacientes atendidos no setor de triagem do Centro de Diabetes, no período de agosto de 2005 a julho de 2008. RESULTADOS: O número de pacientes com DM2 que respeitavam os critérios da pesquisa foi de 763 pacientes. O conjunto de valores da pressão arterial sistólica e diastólica apresentou mediana de 149 e 85 mmHg, respectivamente.A hipertensão foi diagnosticada em 49,7% dos pacientes. Em relação aos valores da glicemia capilar observou-se mediana de 180 mg/dL. O conjunto de valores da circunferência abdominal (CA) de pacientes do sexo masculino apresentou mediana de 100 cm, já as mulheres, uma medianade 96 cm. Os resultados da pesquisa apontaram para a associação positiva entre hipertensão arterial e CA aumentada em homens e mulheres com DM2. Na consulta de triagem os pacientes referiram diagnósticos anteriores de doença cardiovascular (10,35%), neuropatia periférica (13,63%), neuropatia autonômica (3,28%), nefropatia (9,30%) e retinopatia(17,30%). CONCLUSÃO: O rastreamento de componentes da síndrome metabólica é muito importante, e deveria ser obrigatório, no controle de pacientes portadores de DM2.

BACKGROUND AND OBJECTIVES: Precocious diagnosis and treatment of metabolic syndrome (MS) in patients with diabetes mellitus type 2 (DM2) prevent complications.The objective of this study was to assess SM components in patients with DM2, as well as the prevalence of self-reportedchronic complications in patients with DM2. METHOD: Cross-sectional study with chart analysis of all patients treated at the Center of diabetes' screening sectorfrom August 2005 to July 2008. RESULTS: The number of patients with DM2, which respected the research criteria, was 763. The set of values for systolic and diastolic arterial pressure presented median of 149 and 85 mmHg respectively. Hypertension was diagnosedin 49.7% of the patients. Regarding the values of capillary glucose, a median of 180 mg/dL was found. The set of values for abdominal circumference (AC) in male patients presented median of 100 cm, where as in female patients the median was of 96 cm. The results of this research indicate positive association between arterial hypertension and enlarged AC in men and women with DM2. In consultation at the screening sector, patients reported previous diagnosesof cardiovascular disease (10.35%), peripheral neuropathy(13.63%), autonomic neuropathy (3.28%), nephropathy(9.30) and retinopathy (17.30%). CONCLUSION: The search for components of the metabolic syndrome is very important, and should be mandatory in the management of type 2 diabetic patients.