Topical tranexamic acid as an adjuvant treatment in melasma: Side-by-side comparison clinical study.

BACKGROUND: Tranexamic acid (TNA) is a novel therapeutic agent for hyperpigmented skin disorders. The efficacy and safety of topical TNA in patients with melasma has not been heretofore studied. The main objective of this study is to evaluate the efficacy and safety of topical TNA combined with intense pulsed light (IPL) treatment in Asians with melasma. METHODS: A randomized, split-face (internally controlled) study was conducted in 15 women who received four monthly sessions of IPL to both sides of the face. Topical TNA or vehicle was applied to a randomly assigned side during and after IPL treatment. Patients were followed up for 12 weeks after completing the IPL treatments. Baseline and follow-up melanin index (MI; measured by Mexameter®, Courage and Khazaka, Cologne, Germany) and modified melasma area and severity index (mMASI) scores were determined. RESULTS: Thirteen subjects completed the study without serious adverse events. MI and mMASI decreased significantly from baseline to 12 weeks after the last IPL treatment on the topical TNA side but not on the vehicle side. The efficacy of topical TNA in preventing rebound pigmentation after IPL treatment was also statistically significant. CONCLUSION: Topical TNA can be considered an effective and safe adjuvant to conventional treatment for melasma.

Pulse in pulse intense pulsed light for melasma treatment: a pilot study.

BACKGROUND: A new type of intense pulsed light IPL with pulse-in-pulse (PIP) mode (multiple fractionated subpulses in one pulse width) has recently been developed. OBJECTIVE: To evaluate the clinical efficacy and safety of PIP IPL in patients with melasma. MATERIALS AND METHODS: Half of each patient's face was treated with IPL and six treatment sessions with a low-fluence quality-switched neodymium-doped yttrium aluminum garnet laser (IPL/T) every 2 weeks. The other half was treated with PIP IPL. Outcome assessments included photography, modified Melasma Area and Severity Index (MASI) score, and patient satisfaction. The melanin and erythema indices were used for objective evaluation. Patients were followed up for 6 months after the last treatment. RESULTS: All patients completed the study successfully. On both treated sides, the melanin index decreased significantly after treatment. The modified MASI score also fell 54.4% on the PIP IPL side and 50.0% on the IPL/T side. No patients reported serious aggravation of melasma for 6 months after the last treatment. Patients favored PIP IPL due to less discomfort during and after treatments. CONCLUSION: PIP IPL may be a safe and promising treatment for melasma.

Long-pulsed Nd:YAG laser on periorbital wrinkles in Asian patients: randomized split face study.

BACKGROUND AND OBJECTIVE: This study evaluated clinical usefulness of long-pulsed Nd:YAG laser (LPNY) for periorbital wrinkles in Asian patients. METHODS: Twenty seven Korean patients were treated with several passes of LPNY (5 mm spot size, fluence: 54.7-61.8 J/cm(2), pulse duration: 56.5 microseconds). Three treatment sessions were conducted every 2 weeks on the half side of face that was randomly assigned. Outcome assessments included photography, global evaluation by two blinded independent dermatologists (using Fitzpatrick Wrinkle Classification System), and objective measurements of skin elasticity. Adverse events were documented. Patients reported their degree of satisfaction on a 6-point {0-5) visual analog scale (VAS). RESULTS: All patients showed modest improvement. The mean wrinkle score on the treated side decreased by 34.9% (p < 0.05), while it did not change significantly on the control site. Skin elasticity (R2) increased significantly on the treated site. The average VAS score was 2.85 at 2 months but it dropped down to 1.05 at 6 months follow-up. No adverse effects were noted except 2 weeks lasting erythema in one patient. CONCLUSION: LPNY may be considered as a safe treatment option for periorbital wrinkles in Asian patients. However, three treatment sessions are not enough for maintaining optimal clinical outcome.