Melasma: A Step-by-Step Approach Towards a Multimodal Combination Therapy.

Melasma is a common challenge in the field of pigmentary skin disorders, exerting a significant emotional and psychosocial burden on patients. The persistent and recurring nature of melasma complicates its management in routine clinical practice. This comprehensive review outlines a stepwise, practical approach encompassing diagnostic, preventive and therapeutic strategies for the management of melasma. A thorough exploration of aggravating and exacerbating factors, including sun exposure, hormonal imbalances, photosensitizing medication and cosmetics, is essential for a holistic assessment of the disease. With an emphasis on consistent and effective photoprotection, initial topical treatment modalities target the melanin production and/or the transfer of melanosomes to keratinocytes. Topical tyrosine inhibitors emerge as the first choice for reducing and preventing hyperpigmentation, with compounds such as thiamidol or tranexamic acid (TXA) being preferred for their safety profile over hydroquinone (HQ), kojic acid and arbutin. Combination with chemical peels can further enhance the therapeutic efficacy, even in cases with resistant melasma. In more severe cases, laser- and light-based interventions may be considered, but with the caveat of the likelihood of recurrence within 3-6 months. Assisted TXA delivery, via either fractional non-ablative laser or microneedling techniques, can further improve clinical outcomes. In conclusion, an optimal melasma management strategy is a multimodal approach, which includes effective photoprotection and a mix of different topical treatments targeting melanin synthesis, the anti-inflammatory environment, senescence and vascularity. Complementary procedures, such as chemical peels, and laser, light-based or microneedling procedures, with or without TXA, can further expedite melanin clearance in more severely affected instances. Individual discussions with patients regarding treatment expectations, recurrence likelihood and potential side effects are paramount to a comprehensive and successful therapeutic journey.

Vitamin D and wound healing: Assessing skin barrier function and implications for chloasma treatment.

Chloasma, which is distinguished by irregularities in the pigmentation of skin, poses substantial challenge in the field of dermatology. The regulatory influence of vitamin D on the functions of skin cells implies that it may have the capacity to effectively treat chloasma and promote wound healing. To assess the efficacy of vitamin D in chloasma treatment and its impact on the function of skin barrier during the process of wound healing. The research spanned from April 2022 to September 2023, in Shanghai, China, examined 480 individuals who had been diagnosed with chloasma. A double-blind, placebo-controlled clinical trial was utilized to evaluate effectiveness of topical vitamin D3 in treatment of chloasma. Concurrently, randomized control trial investigated the effects of ingested vitamin D3 supplements on the process of wound healing. Transepidermal water loss (TEWL), chloasma severity score changes, wound size reduction and skin hydration levels were critical performance indicators. Statistically, the severity scores of chloasma decreased significantly in the vitamin D treatment group at 3 and 6 months compared with the placebo (p < 0.05). The Vitamin D group exhibited superior wound healing outcomes, including more substantial reduction in lesion size and enhanced skin barrier function, as evidenced by increased skin hydration and decreased TEWL (p < 0.05). Vitamin D substantially mitigated the severity of chloasma and has beneficial effect on wound healing and integrity of the skin barrier. Based on the results obtained, vitamin D exhibited promise as a therapeutic intervention in the field of dermatology, specifically in treatment of chloasma and promotion of wound recovery.

Photobiomodulation for melasma treatment: Integrative review and state of the art.

PURPOSE: Photobiomodulation therapy (PBM) is a versatile technique for treating skin diseases. Melasma, a chronic hyperpigmentation condition, has recently been associated with vascular features and dermal photoaging and poses significant management challenges. We review the recent literature on melasma etiology and the evidence supporting PBM as a therapeutic modality for melasma treatment. METHODS: We conducted a comprehensive literature search in three different databases from May to August 2023, focusing on studies published in the past 10 years. The inclusion criteria comprised full-text studies investigating low-power lasers and/or light-emitting diodes (LEDs) in in vitro or in vivo models, as well as clinical trials. We excluded studies discussing alternative melasma therapies or lacking experimental data. We identified additional studies by searching the reference lists of the selected articles. RESULTS: We identified nine relevant studies. Clinical studies, in agreement with in vitro experiments and animal models, suggest that PBM effectively reduces melasma-associated hyperpigmentation. Specific wavelengths (red: 630 nm; amber: 585 and 590 nm; infrared: 830 and 850 nm) at radiant exposures between 1 and 20 J/cm2 exert modulatory effects on tyrosinase activity, gene expression, and protein synthesis of melanocytic pathway components, and thus significantly reduce the melanin content. Additionally, PBM is effective in improving the dermal structure and reducing erythema and neovascularization, features recently identified as pathological components of melasma. CONCLUSION: PBM emerges as a promising, contemporary, and non-invasive procedure for treating melasma. Beyond its role in inhibiting melanogenesis, PBM shows potential in reducing erythema and vascularization and improving dermal conditions. However, robust and well-designed clinical trials are needed to determine optimal light parameters and to evaluate the effects of PBM on melasma thoroughly.

The effects of supramolecular nicotinamide combined with supramolecular salicylic acid on chloasma.

OBJECTIVE: To observe the efficacy and safety of supramolecular salicylic acid monotherapy and supramolecular nicotinamide in the treatment of chloasma. METHODS: A total of 28 female patients with chloasma diagnosed in the dermatology outpatient department of our hospital were randomly divided into an experimental group and a control group, with 14 cases in each group. All patients were treated with 30% supramolecular salicylic acid every 2 weeks, for a total of 8 treatments. The experimental group was treated with 10% supramolecular nicotinamide once in the morning and once in the evening, and the control group was a blank control. Before each exfoliation treatment, subjects were photographed with a VISIA skin detector, and skin image analysis and modified melasma area and severity index (MASI) score were performed. RESULTS: According to the MMASI decrease rate (%) before and after treatment, the effective rate of the experimental group was 64.29%, and the effective rate of the control group was 14.29%. The results of the GriffithS10 and VISIA were improved. During the whole treatment, there was one mild adverse reaction in both groups. CONCLUSION: Salicylic acid stripping combined with nicotinamide in the treatment of chloasma is safe and effective, can improve skin conditions, and can be widely applied in clinical practice.

Clinical evaluation of a topical Unani pharmacopoeial formulation Tila-e-Kalf in the management of melasma (Kalf): A randomized controlled clinical trial.

Objective: Melasma is a chronic, acquired, symmetrical hyper melanosis of skin, characterized by irregular light to dark brown patches on sun-exposed areas, with a significant effect on psychological health; melasma is termed as Kalf in Unani medicine. Conventional treatments have transitory results and often carry adverse effects like skin irritation, scarring, etc. This study was planned to evaluate the safety and efficacy of a Unani pharmacopoeial formulation Tila-e-Kalf, comprising of lentil (Lens culinaris), bitter almond (Prunus amygdalus), and fig (Ficus carica), and to compare its efficacy with standard drug hydroquinone in patients of melasma. Materials and Methods: This was an 8-week open-label, standard controlled, randomized clinical study conducted on patients of epidermal melasma. The test group received Tila-e-Kalf while the control group received hydroquinone 4% cream for local application once daily. Efficacy was assessed by MASI (Melasma Area Severity Index), DLQI (Dermatology Life Quality Index), and PGA (Physician Global Assessment) and colored photographs. Results: Mean MASI score decreased from10.65±0.85 to 7.07±0.74 in the test group (p<0.0001) and from 11.28±1.24 to 7.76±0.9 (p<0.0001) the in control group. Similar improvement was noticed in other parameters also. A large number of patients in the control group reported mild burning, itching, dryness, and skin rashes, while only one patient in the test group reported mild itching. Conclusion: Tila-e-Kalf as a topical depigmenting agent was found equally effective with better tolerability and safety as compared to hydroquinone.

Melasma in people with darker skin types: a scoping review protocol on prevalence, treatment options for melasma and impact on quality of life.

BACKGROUND: Melasma is one of the most encountered dermatoses in dermatology and skin care clinics. It is a challenging chronic, recurrent condition associated with hyperpigmentation. Its aetiology is poorly understood. Melasma affects all races and gender but is more prevalent in women with darker skin types. Being a facial lesion, melasma has a severe impact on quality of life due to its disfigurement. While many modalities of treatment for melasma exists, unfortunately, effectiveness and safety remain a huge concern. Treatment modalities are variable and often unsatisfactory. The objective of this scoping review is to systemically map available evidence from literature regarding melasma on people with darker skin types, garner insight as to how melasma affects the quality of life and begin to investigate and gain understanding on effectiveness of different treatments used for melasma. METHODS: A scoping review guided by Arksey and O'Malley's framework, the enhancements and recommendations of Levac, Colquhoun and O'Brien, Daudt and associates and the 2015 Johanna Briggs Institute's guidelines will be conducted. Systematic electronic searches of databases and search engines will include Scopus, PubMed, CINAHL Complete, Cochrane, Science Direct, and Web of Science which will be conducted to attain published peer-reviewed articles of all study designs excluding reviews and grey literature. All literature that meets the inclusion criteria, research question and sub-question will be included in this review. All the retrieved literature will be exported to an Endnote X20 library. Quality appraisal of the included articles will be conducted using the mixed methods appraisal tool (MMAT) 2018 version. DISCUSSION: We anticipate mapping relevant literature on the melasma, investigating the effectiveness of treatment options of melasma as well as evaluating its association with quality of life in people with darker skin types. This study is likely to reveal research gaps, which could guide future implementation research on melasma treatment interventions. SYSTEMATIC REVIEW REGISTRATION: This protocol has been registered a priori with OSF and is accessible on this link: https://osf.io/ru3jc/ .

Effectiveness of laser and topical tranexamic acid combination therapy in melasma: An updated systematic review and meta-analysis of randomized controlled trials.

Melasma is a chronic relapsing skin condition. Laser therapy is a new advancement in treatment. Whether the topical application of tranexamic acid (TXA) increases the efficacy of laser therapy in melasma is still under debate. With recent studies yielding different results, it was imperative to compile all the available literature systematically. This meta-analysis investigates the effectiveness of a combination therapy of laser plus TXA acid for treating melasma. PubMed/MEDLINE, Cochrane Central, Google Scholar, Scopus, and the International Clinical Trials registry were systematically searched for article retrieval. Screening per PRISMA guidelines was undertaken by two independent reviewers using the Covidance database. Melasma area of severity index (MASI)/modified MASI was used as the clinical improvement outcomes. A total of nine studies that described the combined use of topical tranexamic acid with laser therapy were included for meta-analysis. These studies employed various types of lasers along with topical TXA. The results showed that the combination of both laser therapy and topical TXA significantly decreased the MASI score (P < 0.0001). Subgroup analyses revealed that fractional CO2 laser among the laser types and monthly laser plus twice daily topical TXA were most effective in decreasing the MASI/mMASI score. The meta-analysis found that combining topical tranexamic acid and laser therapy is an effective and safer treatment option for treatment-resistant melasma. Furthermore, monthly fractional CO2 laser and daily application of topical tranexamic acid showed high effectiveness and safety.

Risk factors of striae gravidarum and chloasma melasma and their effects on quality of life.

OBJECTIVE: This study aims to determine the risk factors associated with striae gravidarum (SG) and chloasma melasma (CM) and their effects on the quality of life. METHODS: This descriptive and cross-sectional study was carried out in Turkey with 1000 pregnant women at 36 weeks of gestation and above. Personal information form, Quality of Life (SF36) Scale, Skindex-29 Scale, and MelasQoL-TR questionnaire were applied to pregnant women. Besides, skin types of pregnant women were determined using Fitzpatrick Skin Type Classification. Davey's score was used to determine the severity of SG. RESULTS: In the study, the prevalence of SG was found as 67.9% (n = 679), and the prevalence of CM 23.5% (n = 235). There was a significant relationship between young age, low education level, high BMI before pregnancy, history of SG in her previous pregnancy, family history of SG, and development of SG in pregnant women (p = 0.001). There was a significant relationship between CM in her previous pregnancy and family history of CM and development of CM (p = 0.001). The quality of life of pregnant women with SG was found to be lower than without SG (p < 0.001). The quality of life of pregnant women with CM was found to be lower than without CM (p < 0.001). CONCLUSIONS: As a result, in the study, it was determined that young age, low education level, high BMI, history of SG in previous pregnancy, and family history of SG were risk factors for SG. The risk factors of CM, on the other hand, were found as the history of CM in the previous pregnancy and the family. It was identified that SG and CM have adverse effects on the quality of life.

Clinical effect of radiofrequency introduction of tranexamic acid combined with Q-switched laser in the treatment of moderate to severe melasma / 中华医学美学美容杂志

Objective:To observe the clinical effect of tranexamic acid radiofrequency introduction combined with Q-switched laser comprehensive treatment of moderate to severe melasma.Methods:From December 2019 to September 2021, ninety-six female patients with melasma [age 24-59 years old, average age (37.8±6.0) years old] were admitted to the Plastic and Aesthetic Department of the First Affiliated Hospital of Henan University of Chinese Medicine. They were divided into the Q-switched laser group and the combined group by random number table method, with 48 cases respectively. The Q-switched laser group received Q-switched laser therapy, while the combined group received tranexamic acid radiofrequency introduction combined with Q-switched laser comprehensive therapy. The melasma area and severity index (MASI) scores were compared between the two groups before and after treatment. The clinical efficacy, adverse reactions and recurrence rates of the two groups were compared.Results:The MASI scores of the Q-switched laser group and the combined treatment group were (28.28±1.24) points and (28.52±4.25) points respectively before treatment, and (13.38±7.96) points and (9.11±5.48) points respectively after treatment. The MASI scores of the two groups were decreased after treatment, which of the combined group was lower than that of the Q-switched laser group ( t=3.06, P<0.05). The total clinical effective rate of the combination group (93.75%) was higher than that of the Q-switched laser group (79.17%) (χ 2=4.36, P<0.05). The incidence rate of hyperpigmentation (2.08%) and recurrence rate (2.08%) of the combination group were lower than those of the Q-switched laser group (14.58%, 16.67%) (χ 2=6.01, P<0.05). Conclusions:Tranexamic acid radiofrequency introduction combined with Q-switched laser comprehensive treatment can improve skin lesions and clinical efficacy in patients with moderate to severe melasma, and reduce pigmentation and recurrence.

Efficacy of external treatment of integrated traditional Chinese and Western medicine on chloasma / 中华医学美学美容杂志

Objective:To explore the efficacy of external treatment of integrated traditional Chinese and Western medicine on melanized type complicated with vascularized type of chloasma.Methods:A total of 82 patients (aged 26-50 years, with an average age of 44.5 years) with melanized type complicated with vascularized type of chloasma were selected, and randomly divided into groups: 28 cases in the traditional Chinese medicine control group were treated with traditional Chinese medicine pourmask combined with surrounded facial acupuncture; 26 cases in Western medicine control group underwent wet compress with 0.5% tranexamic acid solution. In the integrated Chinese traditional and Western medicine treatment group, 28 cases were treated with 2 regimens. After 8 weeks, MASI score was carried out, and vascular hyperplasia in skin lesions was observed by polari-light skin scope.Results:After treatment, the MASI scores in the three groups were all decreased, and the decreasing rate of MASI scores from high to low was as follows: Integrated Chinese traditional and Western medicine treatment group (8.60±4.53) > TCM control group (6.26±3.20) > Western medicine control group (4.39±2.11). After treatment, the vascular hyperplasia scores in the three groups were all decreased, and the value of vascular hyperplasia in the integrated Chinese traditional and Western medicine treatment group (2.57±0.63) and Western medicine control group (1.55±0.51) was greater than that in TCM control group (0.96±0.51), but there was no significant difference between the integrated Chinese traditional and Western medicine treatment group and Western medicine control group.Conclusions:External treatment of integrated traditional Chinese and Western medicine is effective in the treatment of melanized type complicated with vascularized type of chloasma, and wet compress with tranexamic acid solution can inhibit vascular hyperplasia in patients with chloasma.

Topical Treatments for Melasma and Their Mechanism of Action.

Objective: We conducted a review of topical agents currently used in melasma, discussing their mechanism of action, efficacy, safety, and tolerability, with an update on newer treatments. Methods: A systematic review from PubMed database was performed, using PRISMA guidelines. The search was limited to English and Spanish studies that were double or single blinded, prospective, controlled or randomized clinical trials, reviews of literature, and meta-analysis studies. Results: 348 studies were analyzed; 80 papers met inclusion criteria. Triple combination (TC) therapy and hydroquinone (HQ) are still the most well-studied agents with strong evidence-based recommendation. TC therapy remains the gold standard of care based on efficacy and patient tolerability. Evidence has shown ascorbic acid, azelaic acid, glycolic acid, kojic acid, salicylic acid, and niacinamide to be effective as adjuvant therapies with minimal side effects. Tranexamic acid (TA) and cysteamine have become recent agents of interest due to their good tolerability, however more trials and studies are warranted. Less evidence exists for other topical agents, such as linoleic acid, mulberry extract oil, rucinol, 2% undecylenoyl phenylalanine, and epidermal growth factors agents. Limitations: Some studies discussed represented a low sample size, and there is an overall lack of recent studies with larger populations and long-term follow up. Conclusions: TC therapy continues to be the gold standard of care. Topical cysteamine and TA are newer options that can be incorporated as adjuvant and maintenance treatments into a patient's regimen. Cysteamine and topical TA have no known severe adverse effects. Evidence comparing other topical adjuvant treatments to HQ, maintains HQ as the gold standard of care.

Efficacy and Safety of Using Noninsulated Microneedle Radiofrequency Alone Versus in Combination with Polynucleotides for the Treatment of Melasma: A Pilot Study.

INTRODUCTION: This split-face, double-blind, randomized controlled study investigated the efficacy and safety of using a microneedling radiofrequency (RF) device with polynucleotides (PN) versus RF alone for the treatment of melasma. METHODS: Thirty adult participants with melasma (Fitzpatrick skin types III-V) received three treatments with an invasive, bipolar, pulsed-type microneedling RF device on both sides of the face. The treatment sessions occurred once every 2 weeks. The hemifaces of each participant were designated for treatment and control with PN and normal saline solution (NSS), applied after treatment with RF. Measurements were made of melanin index (MI), erythema index (EI), skin roughness (by the Antera 3D system), modified melasma area severity index (mMASI) for each hemiface, and patients' self-assessed improvement. These occurred at baseline and again following the final treatment (2 weeks and 1, 2, 3, and 6 months after). Mean values were obtained for MI, EI, skin roughness, and mMASI. A generalized estimating equation (GEE) was used to compare the obtained values for the outcome measures across all assessment points. RESULTS: All patients were women (mean age, 43.2 ± 7.0 years). Mixed melasma predominated (61.5%; n = 16), and the mean duration of melasma was 8.9 ± 6.5 years. Twenty-six participants were followed up to the 6-month assessment point. Significant improvements were observed from baseline in MI, skin roughness, and mMASI scores for both the PN and control sides at 6 months, with no statistically significant differences between sides. Patients' self-assessed improvement scores also showed a positive trend. Melasma recurrence was observed in three patients at 2, 3, and 4 months after the last treatment session (10% recurrence rate). CONCLUSIONS: The combination of an invasive, bipolar, pulsed-type microneedling RF with PN is not superior compared with microneedling RF alone in the treatment of melasma. Microneedling RF may be considered as safe and efficacious for the improvement of skin roughness, and as an adjunctive treatment option for melasma. CLINICAL TRIAL REGISTRATION: This study was registered on ClinicalTrials.gov and assigned NCT number TCTR20210804002.

A Comparative Study of Dermatoscopic Features of Melasma and Hori's Nevus in Asian Patients.

Background: Dermatoscopy is a noninvasive diagnostic tool for pigmented lesions. However, data regarding dermatoscopic features in melasma and Hori's nevus, which are commonly found in Asian populations, are still lacking. In addition, melasma coexisting with Hori's nevus presents a particular diagnostic challenge and they generally require different treatments. Objective: We sought to describe the dermatoscopic features of melasma and Hori's nevus and to establish diagnostic clues for each condition. Methods: Fifty patients with melasma and 46 patients with Hori's nevus were enrolled in the study. Dermatoscopic pictures were taken with Dermlite DL200 HR (3Gen, San Juan Capistrano, Califorinia) and evaluated by two blinded board-certified dermatologists. Results: The dermatoscopic features more prominently seen in melasma compared to Hori's nevus include light brown pigmentation (98% vs. 10.9%, P<0.001), regular pigment network (38% vs. 2.2%, P<0.001), irregular pigment network (98% vs. 63%, P<0.001), arcuate structure (68% vs. 13%, P<0.001), circles (48% vs. 10.9%, P<0.001), sparing of follicles and sweat gland openings (98% vs. 4.3%, P<0.001), and telangiectasias (52% vs. 19.6%, P=0.001). In contrast, the common features of Hori's nevus include blue-brown or grey pigmentation (63% vs. 0%, P=0.001) and speckled homogenous pattern (52.2% vs. 0%, P<0.001). Conclusion: Dermatoscopy is a useful diagnostic tool for distinguishing between melasma and Hori's nevus. In patients with coexistence of both conditions, dermatoscopy can be used to confirm the diagnosis and aid the proper treatment.

Clinical Study of a Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser with Different Parameters in the Treatment of Chloasma: A Randomized-Controlled Trial.

Objective: To explore the clinical efficacy of a Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser with different parameters in the treatment of chloasma. Methods: In this study, 30 patients with chloasma, symmetrically distributed on the left and right sides of the face and who were treated with a Fayton Q-switched 1064 nm Nd:YAG laser, were recruited. The patients were randomly selected for the treatment of facial lesions on the left and right sides of the face using a spot diameter of 9 mm and an energy density of 0.8 J/cm2 on one side, and, on the opposite side, a spot diameter of 6 mm with an energy density of 1.2 J/cm2. The laser frequency was 5 Hz and treatment was conducted once every 7-10 days and repeated eight times as a course of treatment. At the end of the course of treatment, as well as 1, 3, and 6 months after treatment, front-facing images and 45° left- and right-side images were taken, respectively. The curative effect of the treatment was evaluated using the Melasma Area Severity Index (MASI) score. Results: The results of this study showed that the total effective rate of a Fayton Q-switched 1064 nm Nd:YAG laser in the treatment of chloasma was 60%. Conclusions: Using a Q-switched 1064 nm Nd:YAG laser represents a safe and effective approach for the treatment of chloasma. The therapeutic effects of the parameter sets, that is, a spot diameter of 9 mm and an energy density of 0.8 J/cm2, and a spot diameter of 6 mm with an energy density of 1.2 J/cm2, were similar. The treatment time and average effective times of the latter were relatively shortened. Clinical Trial Registration number researchregistry6799.

Dermal Pathology in Melasma: An Update Review.

BACKGROUND: Melasma is a complex and multipathophysiological condition that is challenging to treat. The roles of each element in the dermis were highlighted in this recent year due to targeting it with emerging therapies. Although some studies have demonstrated abnormal findings in the dermis of melasma lesions, there are no integrated data regarding these findings. PURPOSE: This article aims to discuss each finding in the dermis of melasma lesions and to provide some ideas about treatment options. METHODS: An Internet search was completed using the MEDLINE, Embase, Scopus, and Google Scholar databases for relevant literature through June 2021 and reference lists of respective articles. Only the articles published in English language were included. RESULTS: Several studies have focused on the dermal changes in melasma. Common findings included basement membrane disruption, pendulous melanocytes, marked solar elastosis, increased melanophages, increased mast cells, and neovascularization. In addition, each of them had the specified mechanism that may relate with the others. CONCLUSION: Several changes in the dermis of melasma lesion may be connected with pathological changes in the epidermis. This may serve as a potential target treatment for melasma, which requires a multimodal approach.

Efficacy of long-pulsed 1 064-nm Nd:YAG laser combined with a topical emulsion containing Camellia reticulata and Radix Notoginseng in the treatment of melasma / 中华皮肤科杂志

Objective:To evaluate the efficacy of long-pulsed 1 064-nm Nd:YAG laser combined with a topical emulsion containing Camellia reticulata and Radix Notoginseng in the treatment of melasma. Methods:A total of 80 patients with melasma were enrolled from Department of Dermatology, People′s Hospital of Ningxia Hui Autonomous Region from June 2019 to June 2020, and randomly and equally divided into control group and observation group by using a random number table: 40 patients in the control group were treated with long-pulsed 1 064-nm Nd:YAG laser once every 2 weeks for 6 sessions as a course of treatment; another 40 in the observation group were treated with the same laser therapy as the control group and a topical emulsion containing Camellia reticulata and Radix Notoginseng twice a day for 3 months as a course of treatment. Melasma area and severity index (MASI), clinical efficacy, patient satisfaction rate and safety were compared between the 2 groups before and/or after treatment. Results:After 4- and 8-week treatment, there was no significant difference in the MASI score between the observation group (14.57 ± 3.22 points, 10.00 ± 2.94 points, respectively) and control group (14.74 ± 3.11 points, 11.31 ± 3.00 points, respectively; both P>0.05). After 12-week treatment, the MASI score was significantly lower in the observation group (4.80 ± 2.78 points) than in the control group (7.07 ± 3.22 points, t = -3.38, P<0.01). After 3-month treatment, the response rate was significantly higher in the observation group (36 cases, 90%) than in the control group (31 cases, 77.5%; χ2 = 4.58, P < 0.001) ; however, there was no significant difference in the patient satisfaction rate between the observation group (87.5%) and control group (72.5%, χ2 = 7.26, P = 0.06). In addition, no significant difference in the occurrence of adverse reactions was observed between the observation group (5 cases, 12.5%) and control group (7 cases, 17.5%; P > 0.05) . Conclusion:Compared with the long-pulsed 1 064-nm Nd:YAG laser alone, the topical emulsion containing Camellia reticulata and Radix Notoginseng in combination with the long-pulsed 1 064-nm Nd:YAG laser is more effective for the treatment of melasma, with higher patient satisfaction and less adverse reactions.

Efficacy of topical cysteamine hydrochloride in treating melasma: a systematic review.

INTRODUCTION: Melasma remains a recurrent, chronic, therapeutically challenging, and psychologically burdening condition. Several different modalities and approaches have been utilized, and some with notable success to experimentally manage the condition. Cysteamines, with their depigmentation properties, have only recently been intensely studied. One such formulation is the topical 5% cysteamine hydrochloride, the structure of which is notably more stable and with a less foul odor than its prior counterparts. We, therefore, aimed to assess the efficacy of the mentioned formulation in the treatment of melasma. METHODS: The PubMed, SCOPUS, ISI Web of Science, and Embase, Cochrane, and Proquest databases were thoroughly searched for English studies evaluating the effects of the topical agent mentioned. RESULTS: Eight studies (five RCTs, two case reports, and one case series) were included after three rounds of screening, most of which were carried out in Iran. Statistical significance was noted when assessing decreased melanin content and satisfaction rates. CONCLUSIONS: It appears that the cysteamine cream could be comparably efficient in treating melasma while accompanied only by minor and transient adverse events. However, current evidence is limited by insufficient sample size, long-term follow-up, and only to epidermal melasma, highlighting the need for appropriately designed randomized controlled clinical trials to draw a conclusive image of the cysteamine's role in treating this recalcitrant condition.

Platelet-rich plasma is a promising therapy for melasma.

INTRODUCTION: Platelet-rich plasma (PRP) is an autologous blood product which has recently been used in multiple spheres of dermatology including facial rejuvenation, androgenetic alopecia, acne scars, and wound healing. Its use in melasma is comparatively an understudied topic. MATERIAL AND METHODS: An extensive systematic literature search of the PubMed electronic database and Cochrane central register of controlled trials was done using the keywords "platelet rich plasma" and "melasma" in the title. Relevant studies were selected and data were analyzed by two different authors. Four articles were excluded as they did not adhere to the inclusion criteria of this review and a total of 6 articles were reviewed.The relevant references of the included articles were also traced and included. DISCUSSION: These studies showed that PRP has been used effectively not only as an adjuvant therapy but also as a standalone treatment for melasma. PRP contains about 30 growth factors, transforming growth factor beta (TGF-ß) being one of the growth factors having a predominant role in treatment of melasma. TGF-ß decreases signal transduction of microphthalmia-induced transcription factor and thus decreases tyrosinase and tyrosinase-related proteins. In addition to this, PRP also has an additional benefit of inducing collagen synthesis thus improving the quality and texture of the skin. But there is a scarcity of data and large randomized controlled trials. This review is an effort to highlight and upscale the use of this excellent blood product for melasma which is quite a treatment refractory disorder.