Preparation of paeoniflorin-glycyrrhizic acid complex transethosome gel and its preventive and therapeutic effects on melasma.

Paeoniflorin (PF) and glycyrrhizic acid (GL) have skin beautifying effects of anti-inflammation, anti-oxidation, inhibition of melanin formation, and reduction of skin pigmentation. To improve the transdermal permeability of PF and GL in transdermal drug delivery system (TDDS) and enhance their anti-melasma efficacy, PF-GL transethosome (PF-GL-TE) was prepared by ethanol injection method, and finally gelled with carbomer-940 to form PF-GL-TE gel. Consequently, the obtained PF-GL-TE is small and uniform, with an average particle size and a PDI value of about 167.9 nm and 0.102. PF-GL-TE gel showed sustained release behavior and high transdermal permeability in vitro release and transdermal tests. Meanwhile, PF-GL-TE gel played significant preventive effects on melasma induced by progesterone injection and ultraviolet radiation B (UVB) irradiation. According to the results of H&E staining and Masson staining of rat skin, PF-GL-TE gel can alleviate the skin inflammation of and reduce the loss of collagen fibers of back skin in the melasma model rats. Compared with the PF-GL mixture gel, PF-GL-TE gel significantly attenuated the oxidative damage of liver and skin by increasing the activity of SOD and reducing the content of MDA. The results of Western blot showed that PF-GL-TE gel might down-regulate melanin-related proteins expressions of MITF/TYR/TRP1 and TRP2 to prevent and treat melasma. These findings indicate that PF-GL-TE gel is an effective TDDS for delivering PF and GL into the skin, providing a promising preparation for effective prevention and treatment of melasma.

Melasma: The need for tailored photoprotection to improve clinical outcomes.

BACKGROUND/PURPOSE: Melasma is a frequent photoexacerbated hyperpigmentary disorder, which can significantly impact on the quality of life. We sought to review the pathogenesis of melasma, and the role of photoprotection in the prevention and treatment of this disorder. METHODS: We conducted a narrative review of the literature. We performed literature searches with PubMed from January 1990 to December 2021 using the keywords "melasma," "pathogenesis," "ultraviolet radiation," "visible light," "photoprotection," and "sunscreens." RESULTS: The physiopathology of melasma includes a complex interaction between genetics, sex hormones, and sun exposure. Visible light, in particular high-energy visible light (HEVL), and long-wave UVA (UVA1) play a key role in melasma pathophysiology, and recent research suggests that melasma shares many features with photoaging disorders. Melasma disproportionately affects dark-skinned individuals. Some 30% to 50% of South Americans and Asians, among other ethnicities, can present with melasma. Dark-skinned patients take fewer photoprotective measures. Also, the majority of melasma patients do not adequately follow photoprotection recommendations, including the application of sunscreen. Intensive use of a broad-spectrum sunscreen can prevent melasma in high-risk individuals, can lessen melasma severity (associated or not with depigmenting agents), and can reduce relapses. CONCLUSIONS: Due to the physiopathology of melasma, sunscreens should be broad-spectrum with high sun protection factor, and provide high protection against UVA1 and VL. Sunscreens should be cosmetically acceptable and leave no white residue. Tinted sunscreens are an excellent choice, as pigments can protect from HEVL and UVA1, and may provide camouflage, but they must offer colors that match the skin tone of each patient.

Disease characteristics, determinants, and perception of use of sunscreen and sun-protective behaviors among patients of color with melasma: A cross-sectional study.

BACKGROUND: Melasma is an acquired state of hyperpigmentation that most commonly affects the face. The use of sunscreen is essential in melasma treatment. We sought to investigate patients' perspectives and behaviors toward sunscreen usage. METHODS: A cross-sectional hospital-based study targeted 418 melasma patients from May 2019 to May 2021. Data regarding socio-demographic characteristics and the knowledge, attitude, and behavior toward sunscreen and sun exposure were collected and analyzed. Furthermore, a complete clinical assessment was done. RESULTS: The mean age of the patients was 35.4 ± 8.6 years. Melasma distribution was mostly centro-facial (49.8%). The mean duration of the disease was 22.3 ± 11.6 months, with a mean Melasma Area and Severity Index (MASI) score of 18.6 ± 8.9. Only 170 patients believed that sun exposure played a role in their disease. Skin darkening was the most recognized effect of sun exposure by 92.9% of participants. 58.6% reported using sunscreen with a higher female predominance (p < .001), while males reported more broad-spectrum sunscreen usage (p < .001). The reason that was reported the most behind not using sunscreen was the high cost (94%). CONCLUSIONS: Our study showed a sound level of knowledge regarding the effects of sun exposure, and sunscreen advantages and disadvantages, with relatively inadequate translation into their attitudes and practices regarding sun-protective behaviors. The use of sunscreen among the patients was average in numbers with a higher female predominance.

Melasma, a photoaging disorder.

Melasma is a common hyperpigmentary disorder. The impact on the quality of life of affected individuals is well demonstrated, demanding new therapeutic strategies. However, the treatment of melasma remains highly challenging. Melasma is often considered as the main consequence of female hormone stimulation on a predisposed genetic background. Although these two factors do contribute to this acquired pigmentary disorder, the last decade has revealed several other key players and brought new pieces to the complex puzzle of the pathophysiology of melasma. Here, we summarize the latest evidence on the pathophysiology of melasma, and we suggest that melasma might be a photoaging skin disorder affecting genetically predisposed individuals. Such data must be taken into consideration by clinicians as they could have a profound impact on the treatment and the prevention of melasma.

Skin protective effect of guava leaves against UV-induced melanogenesis via inhibition of ORAI1 channel and tyrosinase activity.

Ultraviolet (UV) irradiation is a major environmental factor affecting photoageing, which is characterized by skin wrinkle formation and hyperpigmentation. Although many factors are involved in the photoageing process, UV irradiation is thought to play a major role in melanogenesis. Tyrosinase is the key enzyme in melanin synthesis; therefore, many whitening agents target tyrosinase through various mechanisms, such as direct interference of tyrosinase catalytic activity or inhibition of tyrosinase mRNA expression. Furthermore, the highly selective calcium channel ORAI1 has been shown to be associated with UV-induced melanogenesis. Thus, ORAI1 antagonists may have applications in the prevention of melanogenesis. Here, we aimed to identify the antimelanogenesis agents from methanolic extract of guava leaves (Psidium guajava) that can inhibit tyrosinase and ORAI1 channel. The n-butanol (47.47%±7.503% inhibition at 10 µg/mL) and hexane (57.88%±7.09% inhibition at 10 µg/mL) fractions were found to inhibit ORAI1 channel activity. In addition, both fractions showed effective tyrosinase inhibitory activity (68.3%±0.50% and 56.9%±1.53% inhibition, respectively). We also confirmed that the hexane fraction decreased the melanin content induced by UVB irradiation and the ET-1-induced melanogenesis in murine B16F10 melanoma cells. These results suggest that the leaves of P. guajava can be used to protect against direct and indirect UV-induced melanogenesis.

Melanocytic Nevi in Children: A Review.

Common moles on the skin, known scientifically as melanocytic nevi, are seen frequently in the pediatric population. They are broadly grouped into two groups: congenital (generally present at birth or in infancy) or acquired. Congenital melanocytic nevi (CMN) are classified based on size and morphologic features. Neurocutaneous melanosis and melanoma represent two important complications, with overall risk affected by nevus size, location, appearance, and number of satellite lesions. Regular lifelong skin surveillance is required for high-risk CMN. Acquired melanocytic nevi (AMN) tend to appear in childhood and increase in number through adolescence. Risk factors for melanoma in children with moles include having more than 50 AMN, clinically atypical AMN, family history of melanoma, excessive ultraviolet light exposure, lightly pigmented skin, and immunosuppression. Children with risk factors should be monitored regularly. The periodic health examination presents an opportunity to perform total body skin examination to screen for concerning lesions and to provide anticipatory guidance about sun protection. [Pediatr Ann. 2016;45(8):e293-e298.].

Melanosis coli, diagnóstico endoscópico: reporte de caso / Melanosis coli, endoscopic diagnosis: case report

La melanosis coli consiste en una pigmentación negruzca de la mucosa del intestino grueso, producida por absorción de productos aromáticos, por uso excesivo de laxantes derivados del antraceno. Se presentó el primer caso de melanosis coli diagnosticado en los últimos 30 años de trabajo, en el departamento de Gastroenterología del Hospital Faustino Pérez, de Matanzas. Se trata de un paciente con antecedentes de estreñimiento crónico, al cual se le diagnóstica esta entidad por estudio videoendoscópico del colon, corroborándose por estudio histológico, concluyéndose que esta entidad constituye una condición inocua que no traduce manifestaciones clínicas. Casi siempre, aparece de forma accidental en pacientes a los que se les realiza estudios endoscópicos del tracto digestivo inferior y con historia de abuso de laxantes. Para evitarla se recomienda régimen higiénico dietético adecuado, consumo de alimentos ricos en fibras, ejercicios físicos sistemáticos y proscribiendo el uso de laxantes derivados de las antroquinonas. Por tanto, es de gran importancia para Gastroenterólogos estar conscientes de su existencia. A pesar, de que no esté dilucidada todavía la importancia clínica de esta entidad(AU)

The Melanosis coli consist in a blackish pigmentation of the large intestine mucosa, produced for the absorption of aromatic products due to the excessive usage of anthracene-derived laxatives. We present the first case of Melanosis coli diagnosed in the Gastroenterology Department of the Hospital Faustino Perez, of Matanzas in the last 30 years. It is the case of a patient with antecedents of chronic constipation, to whom the disease is diagnosed as a result of a colon videoendoscopic study, corroborated by histological study, concluding that this disease is an innocuous condition without clinical manifestations. It almost always appears in an accidental way, in patients to whom endoscopic studies of the low digestive tract are carried out, and having a history of laxatives abuse. To avoid it, an adequate hygiene-epidemiologic regime, rich-in-fibers food consumption, systemic physical training and the proscription of anthraquinone-derived laxatives are need. It is very importance for the gastroenterologists to be conscious of the existence of this entity, although its clinical importance is not elucidated yet(AU)

Undesirable Enzymatic Browning in Crustaceans: Causative Effects and Its Inhibition by Phenolic Compounds.

Undesirable enzymatic browning mediated by polyphenol oxidase (E.C. 1.14.18.1) on the surface of seafood from crustaceans have been a great concern to food processors, causing quality losses of seafood products. Seafoods especially from crustaceans are worldwide consumed due to their delicacy and nutritional value. However, black spot formation (melanosis) is the major problem occurring in crustaceans during postmortem handling and refrigerated storage induce deleterious changes in organoleptic properties and, therefore, decreases commercial value. Polyphenoloxidase (PPO), the copper-containing metalloprotein involved in oxidation of phenol to quinone is the major biochemical reaction of melanosis formation. This enzymatic mechanism causes unappealing blackening in postharvest crustaceans. To alleviate the melanosis formation in crustaceans, use of phenolic compounds from plant extract can serve as antimelanotics and appears to be a good alternative to the conventional sulfites which are associated with health-related disorders. In this review, we focuses on the unique features about the structure, distribution, and properties of PPO as well as mechanism of melanosis formation and provide a comprehensive deeper insight on the factors affecting melanosis formation and its inhibition by various antimelanotics including newly discovered plant phenolic compounds.

Near-visible light and UV photoprotection in the treatment of melasma: a double-blind randomized trial.

BACKGROUND: Melasma is an acquired hyperpigmentation on sun-exposed areas. Multiple approaches are used to treat it, but all include broad ultraviolet (UV)-spectrum sunscreens. Visible light (VL) can induce pigmentary changes similar to those caused by UV radiation on darker-skinned patients. OBJECTIVE: To assess the efficacy of sunscreen with broad-spectrum UV protection that contains iron oxide as a VL-absorbing pigment (UV-VL) compared with a regular UV-only broad-spectrum sunscreen for melasma patients exposed to intense solar conditions. METHODS: Sixty-eight patients with melasma were randomized in two groups to receive either UV-VL sunscreen or UV-only sunscreen, both with sun protection factor ≥ 50, over 8 weeks. All patients received 4% hydroquinone as a depigmenting treatment. At onset and at conclusion of the study, they were assessed by the Melasma Activity and Severity Index (MASI; a subjective scale), colorimetry (L*) and histological analysis of melanin. RESULTS: Sixty-one patients concluded the study. At 8 weeks, the UV-VL group showed 15%, 28% and 4% greater improvements than the UV-only group in MASI scores, colorimetric values and melanin assessments, respectively. CONCLUSIONS: UV-VL sunscreen enhances the depigmenting efficacy of hydroquinone compared with UV-only sunscreen in treatment of melasma. These findings suggest a role for VL in melasma pathogenesis.

Splenic melanosis during normal murine C57BL/6 hair cycle and after chemotherapy.

Cancer chemotherapy is associated with serious side effects, including temporary hair loss and impairment of pigmentation. We suspect that ectopic melanin deposition occurring due to chemotherapy may add to these effects worsening the already unpleasant symptoms. We associated the ectopic occurrence of follicular melanin after chemotherapy with splenic melanosis - an interesting example of extradermal melanin localization - and we expected an increase in splenic melanin deposition after chemotherapy. Using the C57BL/6 murine model of synchronized hair cycle induced by depilation, we visualized splenic melanin by means of several histological and histochemical protocols of staining: hematoxylin and eosin, May-Grünwald-Giemsa and Fontana-Masson. Unexpectedly, the splenic deposition of melanin decreased due to application of cyclophosphamide (i.p. 120 mg/ kg body weight on day 9 post depilation). The drop was abrupt and lasted for at least 5 days (day 13-18 post depilation), as compared with normal hair cycle. Moreover, in mice with normal, depilation-induced hair cycle we observed a similar drop shortly before entering catagen (day 15 post depilation), followed by a slow and partial increase in splenic melanization up to day 27 post depilation in both groups. We conclude that cyclophosphamide negatively affects splenic melanization and/or extradermal transfer of ectopic melanin from the dystrophic hair follicles, but the most powerful down-regulator of splenic melanosis is normal and dystrophic catagen - the phase of hair follicle involution and re-modelling.

Use of fractional laser in mixed-race patients.

The use of fractional lasers in mixed race patients has always been a challenge. Post-inflammatory hyperpigmentation or worsening of existing melasma is a risk and its presence can be unpredictable. The authors present their experience in patients with Fitzpatrick skin types IV to VI using fractional lasers. Pre- and post-laser regimens to avoid complications are presented and results are evaluated.

Factores de riesgo para la ocurrencia de melasma en pacientes de un hospital de referencia / Factors associated with the occurrence of melasma in patients at a referral hospital

Objetivo. Determinar los factores de riesgo para la ocurrencia de melasma en pacientes adultos del servicio de Dermatolog¡a del Hospital Nacional Daniel A. Carri¢n durante el a¤o 2011. Methodolog¡a. Estudio de casos y controles. La poblacion de estudio estuvo conformada por pacientes atendidos en el Servicio de Dermatolog¡a del Hospital Nacional Daniel A. Carri¢n en el Callao. Per£. Se evalu¢ la presencia de factores de riesgo para la ocurrencia de meelasma tales como edad, sexo fototipo cut neo, lugar de procedencia, lugar de nacimiento del paciente, antecedentes de fotoexposici¢n, gestaciones previas y uso de hormonas sexuales femeninas. Se calcularon odds ratios (OR) crudos y ajustados con un nivel de confianza de 95%, mediante el uso del programa estad¡stico Stata12. Resultados. Se evalu¢ 78 casos y 76 controles. El an lisi bivariado mostr¢ que tanto el sexo femenino (OR, 10,2; IC95% 3,3-30,9), el haber nacido en Lima a Callao (OR, 2,7; IC95%, 1,2-160,4) asi como la procedencia de los padres de Lima o Callao (OR padre, 16; IC95%. 1.9-136; OR madre, 18,7; IC95%, 2,2-160,4) estuvieron asociados a la presencia de melasma. el uso de fotoprotector fue mayor entre los casos (p<0,01). el uso de hormonas sexuales femeninas estuvo fuertemente asociado al aumento de melasma (OR, 43,3; IC95%, 3,7 a 505). El an lisis multivariado encontr¢ que el sexo femenino(OR, 10,9; IC95%, 3,3-30,9) y el uso de anticonceptivos orales (OR, 44,9; IC95%, 3,35-603,9) constituyeron factores de riesgo para la presencia de melasma, con ajuste para variables potencialmente confusoras como el sexo del producto de la £¤tima gestaci¢n, lugar de nacimiento as¡ como de la procedencia del padre y la madre. Conclusion. El sexo femenino y el uso de anticonceptivos orales contituyen factores de riesgo para melasma en pacientes del Hospital Daniel A. Carri¢n.

Objective. Evaluated the factors associated with the ocurrence of melasma in adult patients of the Dermatology Department of the Hospital Nacional Daniel A. Carrion in 2011. Methods. We conducted a case-control study. The study population consisted of patients attending the Dermatology Department of the Hospital Nacional Daniel A. Carri¢n in Callao, Per£. We evaluated the presence of factors associated with the ocurrence of melasma such as age, sex, skin phototype, place of origin and birth of the patient, history of photo exposure, previous pregnancies, and use of sesual hormones. We calculated crude and adjusted ORs with a confidence level of 95% using the statistical software stata 12. Results. We evaluated 78 cases and 76 controls. The bivariate analysis showed that female sex (OR, 10,2; 95%CI, 3,3-30,9), being born in Lima and Callao (OR, 2,7;95%CI, 1,2-6,2) and parents origin of Lima and Callao (father OR, 16; 95% CI, 2,2-160,4) were associated with the presence of melasma. The use of sunscreen was higher among cases (p<0,01). The use of secual hormones was strongly associated with melasma (OR, 43,3; 95%CI, 3,35-603,9) as the only factor associated with the occurrence of melasma, adjusted by the sex of the baby, place of birth and origin of the father and the mother. Role of female gender was not evaluated because of dependency among variables. conclusion. Melasma is a highly prevalent entity in our environment female gender and the uso of hormonal medication were identified as only factors associated to this condition in our population.

The treatment of melasma by silymarin cream.

BACKGROUND: Melasma is an acquired increased pigmentation of the skin characterized by symmetrical and confluent grey-brown patches usually on the areas of the face exposed to the sun. Silymarin strongly prevents photocarcinogenesis, and significantly prevented melanin production. The objectives of this study were the assessment of safety and efficacy of topical Silymain (SM) cream in a double-blind placebo controlled study for treatment of melasma patients. METHODS: Experimentally on 24 Albino rabbits were randomly divided into 4 equal groups. [A] No treatment, [B] received placebo, [C] treated with SM cream (0.1), & [D] treated by SM (0.2), were applied topically before UV sun light exposure for 30 days, assessed clinically & tissue pathology. Clinically on 96 adults diagnosed with melasma randomized to three equal groups to receive one of the tested drugs applied twice daily for 4 weeks, evaluated by the response; lesion size, melasma area and severity index score, Physician global assessment, and subjective assessment. RESULTS: The Clinical and histopathology observations were reduced significantly in SM groups. Clinically; all patients showed significant excellent pigment improvement & lesion size reduction with SM treatments from the 1st week. All patients were fully satisfied 100%. No side effects were observed. CONCLUSIONS: Silymarin showed tremendous improvement of melasma in a dose-dependent manner, and was effective in prevention of skin damage caused by U.V. sunlight. It is a safe new candidate effective treatment for melasma. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry - ACTRN12612000602820.

[Photoprotection, melasma and quality of life in pregnant women]. / Fotoproteção, melasma e qualidade de vida em gestantes.

PURPOSE: To evaluate habits of sun exposure and sun protection of pregnant women in a public hospital, to assess orientation about photo protection during the prenatal care, and to detect the presence of melasma and its impact on their quality of life. METHODS: A descriptive cross sectional study conducted among women of 18 years old and older, after delivery, who participated in a program of prenatal care in the South Region of Brazil. The sample was non-probabilistic by convenience. Data collection occurred from July to August 2011 through direct interview using a structured questionnaire to obtain personal information and photo protection habits during pregnancy, skin assessment and photographic record of lesions through informed consent. The skin was classified per Fitzpatrick's phototypes and the melasma was diagnosed clinically. In the patients with melasma, the MELASQoL-PB version was applied. The analysis was performed using Statistica, version 8.0, and the significance level of p<0.05. RESULTS: In the sample (109 mothers) predominated white women (60.6% phototype III), young (average age 24.4 years SD=6.1) and housewives (59.6%). The majority (80%) stayed exposed to sunlight for 1-2 hours per day between 10 am and 3 pm, and from those (72%) did not apply any photoprotection due to lack of sunscreen habit. Other physical means of sun protection were used by 15% of these patients. Information during prenatal care about the risks of sun exposure was reported by 34% of the mothers interviewed. There was a trend toward a significant association between prenatal guidance and daily use of sunscreen (p=0.088). About 20% of mothers had melasma. The average score MELASQol-PB (25) showed a negative impact on quality of life of these patients. CONCLUSION: In these women, sun exposure occurred at inappropriate times, without proper guidance and without the use of an effective sunscreen. The mothers with melasma complained about the appearance of their skin, frustration and embarrassment.

Fotoproteção, melasma e qualidade de vida em gestantes / Photoprotection, melasma and quality of life in pregnant women

OBJETIVO: Avaliar hábitos de exposição solar e fotoproteção entre gestantes de um hospital público, orientação sobre fotoproteção durante o pré-natal, presença de melasma e seu impacto na qualidade de vida. MÉTODOS: Estudo transversal descritivo realizado em puérperas, com mais de 18 anos, participantes de um programa de assistência pré-natal da Região Sul do Brasil. A amostra foi não probabilística por conveniência. A coleta de dados ocorreu de julho a agosto de 2011, empregando-se entrevista direta, utilizando questionário estruturado para obter informações pessoais e dos hábitos de fotoproteção durante a gestação, avaliação cutânea e registro fotográfico de lesões mediante consentimento informado. A pele foi classificada em fototipos segundo Fitzpatrick e o melasma foi diagnosticado clinicamente. Entre as portadoras do melasma, foi aplicada a versão do MELASQoL-PB. A análise foi realizada com o programa Statistica®, versão 8.0, sendo o nível de significância p<0,05. RESULTADOS: Na amostra (109 puérperas) predominaram as mulheres brancas (60,6% fototipo III), jovens (média de idade 24,4 anos DP=6,1) e donas de casa (59,6%). A maioria (80%) permanecia exposta ao sol por 1-2 horas por dia entre às 10 e 15 horas, e, destas, 72% não aplicavam fotoprotetor alegando falta de hábito. Outros meios físicos de proteção solar eram utilizados por 15% destas pacientes. Informação durante o pré-natal sobre os riscos da exposição solar foi relatada por 34% das puérperas. Houve uma tendência a uma associação significativa entre a orientação no pré-natal e uso diário de protetor solar. Cerca de 20% das puérperas apresentavam melasma. A média do escore do MELASQol-PB (25) apontou impacto negativo na qualidade de vida dessas pacientes. CONCLUSÕES: Nestas puérperas, a exposição solar ocorreu em horários impróprios, sem orientação adequada e sem uma efetiva proteção solar. As portadoras de melasma queixavam da aparência da pele, frustração e constrangimento.

PURPOSE: To evaluate habits of sun exposure and sun protection of pregnant women in a public hospital, to assess orientation about photo protection during the prenatal care, and to detect the presence of melasma and its impact on their quality of life. METHODS: A descriptive cross sectional study conducted among women of 18 years old and older, after delivery, who participated in a program of prenatal care in the South Region of Brazil. The sample was non-probabilistic by convenience. Data collection occurred from July to August 2011 through direct interview using a structured questionnaire to obtain personal information and photo protection habits during pregnancy, skin assessment and photographic record of lesions through informed consent. The skin was classified per Fitzpatrick's phototypes and the melasma was diagnosed clinically. In the patients with melasma, the MELASQoL-PB version was applied. The analysis was performed using Statistica®, version 8.0, and the significance level of p<0.05. RESULTS: In the sample (109 mothers) predominated white women (60.6% phototype III), young (average age 24.4 years SD=6.1) and housewives (59.6%). The majority (80%) stayed exposed to sunlight for 1-2 hours per day between 10 am and 3 pm, and from those (72%) did not apply any photoprotection due to lack of sunscreen habit. Other physical means of sun protection were used by 15% of these patients. Information during prenatal care about the risks of sun exposure was reported by 34% of the mothers interviewed. There was a trend toward a significant association between prenatal guidance and daily use of sunscreen (p=0.088). About 20% of mothers had melasma. The average score MELASQol-PB (25) showed a negative impact on quality of life of these patients. CONCLUSION: In these women, sun exposure occurred at inappropriate times, without proper guidance and without the use of an effective sunscreen. The mothers with melasma complained about the appearance of their skin, frustration and embarrassment.

Preventing melasma recurrence: prescribing a maintenance regimen with an effective triple combination cream based on long-standing clinical severity.

BACKGROUND: The relapsing nature of melasma emphasizes the need to maintain efficacy achieved after acute treatment. OBJECTIVE: To compare clinical efficacy and safety of two 6-month Triple Combination (TC; containing fluocinolone acetonide, hydroquinone and tretinoin) maintenance regimens in subjects with moderate to severe melasma, after daily treatment up to 8 weeks. METHODS: This randomized, investigator-blinded, controlled study had a maintenance phase of 6 months. Sixteen centres in Brazil and Mexico enrolled 242 subjects 18 years or older attaining no or mild melasma after 8 weeks of daily TC applications. Subjects were randomized to receive TC in a twice weekly or tapering regimen [3/week (1st month), 2/week (2nd month), 1/week (4th month)]. Efficacy and safety measurements included median time to relapse and relapse-free rate, Global Severity Score, Melasma Area and Severity Index score (MASI), subject's assessment, quality of life questionnaire (MelasQol), and adverse events. RESULTS: The majority (78.8%) had no or mild melasma (GSS ≤ 1) at week 8 and entered maintenance phase. After 6 months, 53% of patients remained relapse-free with improved quality of life, and time to relapse was similar between groups (about 190 days). Melasma severity at study entry, not maintenance baseline, influenced relapse rate. The twice weekly regimen tended to show better effectiveness in postponing relapse in severe melasma. Both regimens were safe. CONCLUSIONS: After resolution of melasma with TC, maintenance therapy over 6 months was successful in preventing relapse in over half of the patients who entered maintenance phase. Prescribing medicines should be adapted to patients based on melasma severity.

Inhibitory effects of progestogens on the estrogen stimulation of melanocytes in vitro.

BACKGROUND: The use of oral estrogen-progestogen contraceptives may cause melasma, an epidermal hyperpigmentation in sun-exposed areas of the face. It is assumed that elevated estrogen levels lead to the activation of melanocytes, while the role of the gestagen component of contraceptives in pigmentation remains unclear and may vary between the different progestogens. In this study, we analyzed the distinct effects of progesterone and chlormadinone acetate (CMA) on melanocytes in comparison with estrogen. STUDY DESIGN: Human melanocytes were exposed to different concentrations of 17beta-estradiol and progestogens and analyzed for proliferation by a fluorometric cell viability assay and for pigmentation by a (3)H-labeled tyrosine assay. Subgroups of cells were additionally irradiated with UVA or UVB. RESULTS: Proliferation of melanocytes was induced by 17beta-estradiol (0.1 and 1 nM) in approximately half of the experiments, while progesterone (100 nM) and CMA (100 nM) reduced the proliferation rate by 38% and 27%, respectively. The pigmentation activity was slightly stimulated by 17beta-estradiol, whereas progestogens had no effect on the tyrosinase activity. CONCLUSIONS: Our data suggest that progesterone and CMA can inhibit proliferation of human melanocytes, which counteracts the stimulatory effects of estrogen. This may be of relevance for the choice of progestogen in oral contraceptives to prevent the development of melasma.