Intradermal Injection of 100mg Tranexamic Acid Versus Topical 4% Hydroquinone for the Treatment of Melasma: A Randomized, Controlled Trial.

Objective: Melasma is an acquired and chronic hyperpigmentation disorder associated with a negative impact on patients' quality of life. This study compares the efficacy of 100mg/mL intradermal TA with 4% topical HQ on female patients presenting with melasma lesions. Methods: In this randomized double-blind controlled trial, 48 women with melasma were allocated into two groups, treated with either 100mg/mL intradermal TA or topical 4% HQ. The MASI (Melasma Area and Severity Index) score was assessed by paired t-tests and repeated measured ANOVAs. The Dynamic Physician General Assessment (PGA) was also performed by taking photographs with a digital camera. Results: The average MASI score for the HQ and TA groups was 7.7 (3.0 SD) and 5.9 (2.5 SD), respectively. In both groups, the MASI decreased significantly after three months of treatment; however, the decrease was not significant between the two groups (P=0.1). All participants developed mild degrees of burning pain in the injection site without serious adverse effects. Limitations: First, we only used the MASI score to measure melasma degree. Second, this is a single-center study with a small sample size. Third, the before-after photos were not taken with a high-quality camera. Conclusion: The results of our study showed that both TA and continuous HQ significantly reduced the MASI score of patients without any significant differences and serious side effects. Although many treatment modalities are available for melasma, this condition is still challenging for dermatologists with a high recurrence rate after treatment.

A double-blind, placebo-controlled randomized trial of skin-lightening cream containing lycopene and wheat bran extract on melasma.

OBJECTIVE: Melasma is an acquired hyperpigmentation disorder, and reactive oxygen species play important role in regulating melanin synthesis. Lycopene is one of the most effective oxygen neutralizers among tomato-derived carotenoids. Also, hydroquinone is a compound that has been used for the treatment of hyperpigmentation by mechanism of tyrosinase inhibition and can be found in wheat. METHODS: An appropriate cream formulation containing 0.05% tomato lycopene and 3.45% wheat bran extract was prepared, and physicochemical characterization was performed. The prepared formulations were applied twice a day for three months in combination with SPF = 30 sunscreen by 22 patients diagnosed with melasma. MASI score in two groups was evaluated at weeks 0, 3, 6, 9, and 12 and 1 month after the treatment. RESULTS: The prepared formulation shows smooth and homogeneous appearance with suitable spreadability and viscosity. The MASI score of intervention group from the sixth week until the end of the treatment was significantly decreased compared to the onset of the treatment (P < .05), and the mean difference of the MASI score and the rate of skin discoloration in intervention group (0.53 ± 0.47 and 3.73 ± 1.90, respectively) were significantly higher than in placebo group (0.14 ± 0.20 and 0.91 ± 0.07, respectively; P < .05). Size of melasma during the study was decreased significantly from 6.59 ± 3.47 to 5.97 ± 3.83 (P < .05). CONCLUSION: The data of mean difference of the MASI score indicated skin improvement in intervention group. Meanwhile, no recurrence was observed one month after the end of the treatment. These data suggest that the prepared formulation containing lycopene and wheat bran extract is safe and could be promising as an efficacious cosmetic treatment.

Efficacy of platelet-rich plasma in the treatment of androgenetic (male-patterned) alopecia: A pilot randomized controlled trial.

BACKGROUND: Platelet-rich plasma (PRP) has been proposed as an effective treatment for different diseases. OBJECTIVE: The aim of this study is to evaluate the efficacy of PRP in the treatment of androgenetic alopecia (AGA). MATERIAL AND METHODS: In this study, 19 men with AGA were recruited among whom 17 men completed the trial. At the beginning, 2 square-shaped areas of 2.5 × 2.5 centimeters, at least 3 cm apart from each other were selected on the scalp of each patient as case and control sites. Then, 1.5 ml of PRP was injected in the case site, while in the control site the same amount of normal saline was injected. These were injected in 2 sessions, 1 month apart. The terminal and vellus hairs were counted in each square at the beginning of the study, and then 1, 3, and 6 months after the first injection. RESULTS: In the case squares, the mean number of terminal and vellus hairs was 87 and 43 at the beginning and 85 and 42, respectively, at the end of six months. CONCLUSIONS: Our study showed that the PRP was not effective in treating AGA of grade 4-6.

A comparative study of the mini-punch grafting and hair follicle transplantation in the treatment of refractory and stable vitiligo.

BACKGROUND: Some vitiligo lesions are resistant to all medical treatments. OBJECTIVE: We sought to compare the efficacy of hair follicle transplantation and mini-punch grafting for the treatment of refractory vitiligo lesions. METHODS: A total of 25 patients with stable and resistant vitiligo participated in the study. In each patient, a resistant vitiligo patch was divided into 2 equal parts. One part was treated with hair follicle transplantation and the other part with mini-punch grafting. Postsurgically, the recipient areas were exposed to narrowband ultraviolet B twice a week for 6 months. The diameter of the repigmentation around each graft was measured monthly. RESULTS: At the end of the sixth month, 68% of follicle grafts, and 72% of mini-punch grafts, had repigmentation. The mean diameter of repigmentation around follicle grafts was 5 ± 1.7 mm and around punch grafts was 5.3 ± 1.6 mm. There was no significant difference between the 2 groups statistically (P = .18). LIMITATIONS: Small sample size and short time of follow-up are limitations. CONCLUSIONS: Because the results of the 2 methods are not statistically different and mini-punch grafting is much easier to do than follicular transplantation, we recommend mini-punch grafting to treat drug-resistant vitiligo.

Is topical minoxidil solution effective on androgenetic alopecia in routine daily practice?

OBJECTIVES: Minoxidil solution stimulates hair growth in androgenetic alopecia. In order to maintain any beneficial effect, applications must continue indefinitely. The purpose of this study was to evaluate the ratio of patients who were satisfied with the drug and continued to use it versus those who were displeased and did not continue their treatment, and the reasons for the discontinuation. METHODS: A total of 1495 men aged 20-40 years who suffered from androgenetic hair loss were selected among patients who were referred to two private dermatologists. They were subjected to treatment with 5% topical minoxidil solution. These patients were treated with no difference from the routine office patients. Factors such as the duration of treatment, adverse effects, the patient's satisfaction and the causes of treatment cessation were also closely studied. RESULTS: Almost all the patients gradually avoided continuing the treatment. Only in a few patients was the cessation of medication due to adverse effects. The causes of discontinuation in the majority of patients were the low effect of medication and an aversion to this topical treatment method. CONCLUSIONS: The insignificant cosmetic effect of minoxidil solution caused discontinuity of treatment among almost all patients.