Optimizing Melasma Management With Topical Tranexamic Acid: An Expert Consensus.

Because of its complex pathogenesis, chronicity, and high rates of recurrence, melasma is regarded as a challenging skin disorder. Topical treatments are often offered as first-line therapy. However, many patients are unaware that melasma is recurrent and requires long-term management. Hydroquinone is effective for controlling relapses and has become the standard of care for melasma in many countries. Nonetheless, it is limited by its side effect profile. Certain patient profiles who have had prior therapy and/or are refractory to treatment may be offered an alternative, that is topical tranexamic acid (TXA) alone or in combination with other modalities. This review provides a summary of current evidence on topical TXA as a treatment for certain case profiles. This paper aims to fill knowledge gaps in terms of currently available options, highlighting the role of topical TXA alone or in combination with other active ingredients (ie, topical TXA 2% with patented delivery technology). J Drugs Dermatol. 2023;22(4): doi:10.36849/JDD.7104 Citation: Desai SR, Chan LC, Handog E, et al. Optimizing melasma management with topical tranexamic acid: An expert consensus. J Drugs Dermatol. 2023;22(4):386-392. doi:10.36849/JDD.7104.

Spatial attention impairments are characterized by specific electro-encephalographic correlates and partially mediate the association between early life stress and anxiety.

Although impaired attention is a diagnostic feature of anxiety disorders, we lack an understanding of which aspects of attention are impaired, the neurobiological basis of these impairments, and the contribution of stressors. To address these gaps in knowledge, we developed and tested behavioral tasks designed to parse the subdomains of attention impairments associated with anxiety symptoms and used electro-encephalographic (EEG) recordings to probe the neural basis of attentional performance. Participants were n = 55 individuals aged 18-35 with mild-to-moderate mood and anxiety symptoms. We also assessed stressful life events that may impact mental health and attention abilities, including stressors that occurred in early life before age 18 years. Severity of anxiety was found to be specifically associated with impairments in spatial attention but not feature-based attention. These impairments in spatial attention also partially mediated the association between early-life stressors and anxiety symptoms. Impairments in spatial selective attention were associated with decreased posterior alpha oscillations in EEG recordings in a subsample of participants, whereas spatial divided attention impairments were associated with decreased frontocentral theta oscillations. Our results provide a thorough characterization of attention impairments associated with anxiety, their EEG correlates, and the impact of stressors both in early life and adulthood.

Greater baseline connectivity of the salience and negative affect circuits are associated with natural improvements in anxiety over time in untreated participants.

BACKGROUND: There is limited research examining the natural trajectories of depression and anxiety, how these trajectories relate to baseline neural circuit function, and how symptom trajectory-circuit relationships are impacted by engagement in lifestyle activities including exercise, hobbies, and social interactions. To address these gaps, we assessed these relations over three months in untreated participants. METHODS: 262 adults (59.5% female, mean age 35) with symptoms of anxiety and depression, untreated with pharmacotherapy or behavioral therapy, completed the DASS-42, WHOQOL, and custom surveys at baseline and follow-up to assess symptoms, psychosocial function, and lifestyle activity engagement. At baseline, participants underwent fMRI under task-free and task-evoked conditions. We quantified six circuits implicated in these symptoms: default mode, salience, negative and positive affect, attention, and cognitive control. RESULTS: From baseline to 3 months, some participants demonstrated a natural improvement in anxiety (24%) and depression (26%) symptoms. Greater baseline salience circuit connectivity (pFDR=0.045), specifically between the left and right insula (pFDR=0.045), and greater negative affect circuit connectivity elicited by sad faces (pFDR=0.030) were associated with anxiety symptom improvement. While engagement in lifestyle activities were not associated with anxiety improvements, engagement in hobbies moderated the association between negative affect circuit connectivity and anxiety symptom improvement (p = 0.048). LIMITATIONS: The observational design limits causal inference. CONCLUSIONS: Our findings highlight the role of the salience and negative affect circuits as potential circuit markers of natural anxiety symptom improvements over time. Future studies that identify biomarkers associated with symptom improvements are critical for the development of personalized treatment targets.