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Zhang C, Song X, Ma C, Wang M, Deng H, Yuan M, Zhu W, Shen L, Li Y, Shi L. Hyaluronic acid dissolving microneedle patch loaded with tranexamic acid for melasma treatment. Int J Biol Macromol 2024; 270:132255. [PMID: 38729504 DOI: 10.1016/j.ijbiomac.2024.132255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/03/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024]
Abstract
Melasma is an acquired hypermelanotic condition characterized by the presence of irregular light-to-dark brown macules that primarily manifest on the sun-exposed areas of the skin, particularly the face. The management of melasma poses significant challenges, as it is often recalcitrant to treatment and tends to recur despite successful treatment. In this study, we explored a safe, easy, and effective melasma treatment strategy. A hyaluronic acid (HA)-based microneedle (MN) patch loaded with tranexamic acid (TXA) was designed to deliver the necessary medication for melasma treatment. The MN patch features uniform needles with adequate mechanical strength and effective penetration and solubility in the skin without cytotoxicity. Remarkably, these MNs substantially reduce the thickness of the epidermis of melasma mice, curtail melanin production, and diminish dopachrome tautomerase (DCT) expression.
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Affiliation(s)
- Cai Zhang
- The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Xuejiao Song
- The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Chuan Ma
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, China
| | - Minjia Wang
- The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hui Deng
- Department of Dermatology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Miaomiao Yuan
- Shanghai Key Laboratory of Pancreatic Diseases, Precision Research Center for Refractory Diseases in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wuyou Zhu
- Shanghai Foreign Language School Affiliated to Shanghai International Studies University, Shanghai, China
| | - Lingyue Shen
- Department of Oral & Maxillofacial-Head & Neck Oncology, Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yuzhen Li
- The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
| | - Leilei Shi
- Shanghai Key Laboratory of Pancreatic Diseases, Precision Research Center for Refractory Diseases in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Sarkar R, Handog EB, Das A, Bansal A, Macarayo MJ, Keshavmurthy V, Narayan V, Jagadeesan S, Pipo E, Ibaviosa GM, Podder I, Bansal S. Topical and Systemic Therapies in Melasma: A Systematic Review. Indian Dermatol Online J 2023; 14:769-781. [PMID: 38099013 PMCID: PMC10718129 DOI: 10.4103/idoj.idoj_490_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Melasma is an acquired disorder, which presents with well-demarcated, brown-colored hyperpigmented macules, commonly involving the sun-exposed areas such as the face. It is a chronic and distressing condition, affecting the patients' quality of life, and has been conventionally treated with "first-line" agents including hydroquinone (HQ) alone or as a part of a triple combination cream (TCC), while "second-line" options include chemical peels, and third line options include laser therapy. Materials and Methods A systematic search was performed for all topical and systemic treatments for melasma up till May 4, 2021, using the PubMed and EMBASE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The search terms "melasma" and "treatment" were used to search for the relevant articles on both these databases, and a total of 4020 articles were identified. After removing the duplicate entries and screening the titles, abstracts, and full-text articles, we identified 174 randomized controlled trials (RCTs) or controlled clinical trials. Results Based on our review, HQ, TCCs, sunscreens, kojic acid (KA), and azelaic acid receive grade A recommendation. Further large-scale studies are required to clearly establish the efficacy of topical vitamin C, resorcinol, and topical tranexamic acid (TXA). Several newer topical agents may play a role only as an add-on or second-line drugs or as maintenance therapy. Oral TXA has a strong recommendation, provided there are no contraindications. Procyanidins, Polypodium leucotomos (PL), and even synbiotics may be taken as adjuncts. Discussion Several newer topical and systemic agents with multimodal mechanisms of action have now become available, and the balance seems to be tipping in favor of these innovative modalities. However, it is worth mentioning that the choice of agent should be individualized and subject to availability in a particular country.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
| | - Evangeline B. Handog
- Department of Dermatology, Asian Hospital and Medical Center, Muntinlupa City, Metro Manila
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, India
| | - Anuva Bansal
- Department of Dermatology, BLK-MAX Super Speciality Hospital, New Delhi, Delhi, India
| | - Ma. Juliet Macarayo
- Department of Dermatology, Angeles University Foundation Medical Center, Angeles, Pampanga
| | | | | | - Soumya Jagadeesan
- Department of Dermatology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Eugenio Pipo
- Department of Dermatology, Northside Doctors Hospital, Ilocos Sur, Philippines
| | | | - Indrashis Podder
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kamarhati, Kolkata, West Bengal, India
| | - Shivani Bansal
- Department of Dermatology, All India Institute of Medical Sciences, Bathinda, Punjab, India
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Bhattacharjee R, Hanumanthu V, Thakur V, Bishnoi A, Vinay K, Kumar A, Parsad D, Kumaran MS. A randomized, open-label study to compare two different dosing regimens of oral tranexamic acid in treatment of moderate to severe facial melasma. Arch Dermatol Res 2023; 315:1831-1836. [PMID: 36757440 DOI: 10.1007/s00403-023-02549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/04/2023] [Accepted: 01/22/2023] [Indexed: 02/10/2023]
Abstract
Oral tranexamic acid (TXA) demonstrates promising results in melasma management. However, no clear consensus on the dosing and duration of maintenance doses of TXA therapy in melasma exists. In this study, we intend to evaluate and compare the efficacy of two different TXA dosing regimens in patients with melasma using the mMASI score. This was a randomized, open-label study wherein 50 patients (age > 18 years) with moderate to severe melasma were randomized into group A (250 mg TXA twice a day) and group B (500 mg TXA twice a day). Treatment was administered for 12 weeks and later followed up 4-weekly for next 12 weeks. The primary outcome measure was proportion of patients achieving 75% reduction in modified Melasma area and severity index (mMASI-75) at 12 weeks from baseline, reduction in mMASI and melasma quality of life (MelasQOL) score at 12 and 24 weeks. To assess the rate of relapse by end of 12 weeks post-treatment. Among 50 patients, proportion of patients achieving mMASI-75 at 12 weeks were 20% and 25% in group A and B, respectively (p-0.71). Both groups showed a significant reduction in mean mMASI (4.8 ± 2.2 in group A and 6.8 ± 3.4 in group B; p-0.02) at 12 weeks of treatment. mMASI remained stable after 12 weeks of follow-up and was 4.9 ± 2.43 and 4.93 ± 2.85 in group A and B, respectively (p-0.97). The mean percentage reduction in MelasQOL in group A and B were 41.8 ± 15.3 and 29.5 ± 21.5, respectively (p-0.03). No adverse effects were observed in both groups. Relapse rates was very less and comparable between both groups. Thus, we conclude that both dosing regimens showed comparable efficacy in terms of mMASI reduction at 12-weeks and the improvement achieved was well maintained even after 12-weeks of discontinuing treatment with very few patients relapsed. Hence, lower doses of TXA are equally effective and safe compared to higher doses and not all patients might require tapering or dosing maintenance.
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Affiliation(s)
- Rajsmita Bhattacharjee
- Department of Dermatology, Venereology and Leprology, Dr. B.R Ambedkar State Institute of Medical Science, Mohali, Punjab, 160055, India
| | - Vinod Hanumanthu
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Vishal Thakur
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Ashok Kumar
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
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Ferreira AM, da Silva Sena I, Curti J, de Souza AA, Dos Santos Lima PC, Rodrigues ABL, da Silva Ramos R, de Souza Pinheiro WB, Ferreira IM, Carvalho JCT. Trichoderma asperellum Extract Isolated from Brazil Nuts ( Bertholletia excelsa BONPL): In Vivo and In Silico Studies on Melanogenesis in Zebrafish. Microorganisms 2023; 11:microorganisms11041089. [PMID: 37110512 PMCID: PMC10146319 DOI: 10.3390/microorganisms11041089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Endophytic fungi are those that present part of their life cycle in healthy tissues of different plant hosts in symbiosis without causing harm. At the same time, fungus-plant symbiosis makes it possible for microorganisms to synthesize their own bioactive secondary metabolites while in the stationary stage. To accomplish this, the endophytic fungus Trichoderma asperellum was isolated from Bertholletia excelsa (Brazil nut) almonds. The fungus was cultivated and extracted with ethyl acetate, obtaining AM07Ac. Then, using HPTLC (High-performance thin-layer chromatography) and nuclear magnetic resonance (1H NMR), β-amyrin, kaempferol, and brucine were identified as major compounds. Further in vivo assays in zebrafish demonstrated the activity of AM07Ac on melanogenesis by producing a concentration-response inhibitory effect, which, through an in silico study, proved to be related to the noted major compounds known to inhibit tyrosinase activity. The inhibition of tyrosinase prevents melanin accumulation in skin. Therefore, these results imply the importance of investigating microorganisms and their pharmacological activities, in particular the endophytic fungus Trichoderma asperellum as a generator of active metabolites for melanogenesis modulation.
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Affiliation(s)
- Adriana Maciel Ferreira
- Research Laboratory of Drugs, Department of Biological and Health Sciences, Federal University of Amapá, Rod. JK, km 02, Macapá 68902-280, Brazil
| | - Iracirema da Silva Sena
- Laboratory of Biocatalysis and Applied Organic Synthesis, Department of Exact Sciences, Chemistry Course, Federal University of Amapá, Rod. JK, km 02, Macapá 68902-280, Brazil
| | - Jhone Curti
- Research Laboratory of Drugs, Department of Biological and Health Sciences, Federal University of Amapá, Rod. JK, km 02, Macapá 68902-280, Brazil
| | - Agerdânio Andrade de Souza
- Research Laboratory of Drugs, Department of Biological and Health Sciences, Federal University of Amapá, Rod. JK, km 02, Macapá 68902-280, Brazil
| | - Paulo Cesar Dos Santos Lima
- Research Laboratory of Drugs, Department of Biological and Health Sciences, Federal University of Amapá, Rod. JK, km 02, Macapá 68902-280, Brazil
| | - Alex Bruno Lobato Rodrigues
- Laboratory of Biocatalysis and Applied Organic Synthesis, Department of Exact Sciences, Chemistry Course, Federal University of Amapá, Rod. JK, km 02, Macapá 68902-280, Brazil
| | - Ryan da Silva Ramos
- Laboratory of Biocatalysis and Applied Organic Synthesis, Department of Exact Sciences, Chemistry Course, Federal University of Amapá, Rod. JK, km 02, Macapá 68902-280, Brazil
| | - Wandson Braamcamp de Souza Pinheiro
- Central Extraction Laboratory, Graduate Program in Chemistry, Federal University of Pará, R. Augusto Corrêa, Guamá, 01, Belém 66075-110, Brazil
| | - Irlon Maciel Ferreira
- Laboratory of Biocatalysis and Applied Organic Synthesis, Department of Exact Sciences, Chemistry Course, Federal University of Amapá, Rod. JK, km 02, Macapá 68902-280, Brazil
| | - José Carlos Tavares Carvalho
- Research Laboratory of Drugs, Department of Biological and Health Sciences, Federal University of Amapá, Rod. JK, km 02, Macapá 68902-280, Brazil
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Jia Z, Tian K, Zhong Y, Wang X, Gao S, Xu W, Li K, Wu L. Effectiveness of combination therapy of broadband light and intradermal injection of tranexamic acid in the treatment of chloasma. J Cosmet Dermatol 2023; 22:1536-1544. [PMID: 36718828 DOI: 10.1111/jocd.15632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of broadband light (BBL) combined with intradermal injection of tranexamic acid for treating melasma. METHODS 120 women with melasma admitted to our hospital from January 2021 to April 2022 were randomly categorized into the following groups: control group, treated with 250 mg tranexamic acid given orally twice daily, except during menstruation; group I, treated with BBL (Sciton, Inc., USA) monthly; group II, received intradermal injections of tranexamic acid monthly; and group III, treated with BBL with intradermal injection of tranexamic acid monthly. Treatment in each group lasted three months. The MASI (Melasma Area Severity Index) and VISIA (Canfield VISIA Complexion Analysis) were used for evaluation. RESULTS After treatment course, MASI scores and VISIA brown spot and red zone ranking improved in all four groups (p < 0.05). The decrease in MASI scores and improvement rates of VISIA brown spot and red zone rankings were not significantly different among the control group, group I, and group II; however, the decreased MASI scores and improvement rates of VISIA brown spot and red zone rankings were significantly higher in group III than in the other three groups (p < 0.05). CONCLUSION The effect of BBL combined with the intradermal injection of TA in the treatment of melasma is remarkable. This combination therapy can be an alternative and effective treatment for managing melasma.
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Affiliation(s)
- Zou Jia
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Kai Tian
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuanyuan Zhong
- Department of Party and Administration Office, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoyun Wang
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Suyue Gao
- Department of Dermatology and Cosmetic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Wushuang Xu
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ke Li
- Department of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lijun Wu
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Konisky H, Balazic E, Jaller JA, Khanna U, Kobets K. Tranexamic acid in melasma: A focused review on drug administration routes. J Cosmet Dermatol 2023; 22:1197-1206. [PMID: 36606378 DOI: 10.1111/jocd.15589] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Melasma is a disorder of hyperpigmentation and vascularization often found in women between the ages of 20 and 40. The pathogenesis is unknown, but melasma often occurs in sun-exposed areas of the face, forearms, and back. Risk factors include family history, increased estrogen/progesterone, certain medications, and UV exposure. Melasma is typically treated with topical hydroquinone (HQ); however, it is often refractory to treatment. Tranexamic acid (TXA) is a plasmin inhibitor used off-label in the treatment of melasma. TXA can be administered orally, topically, or intralesionally. AIMS The purpose of this review is to characterize the wide variety of TXA delivery methods for melasma treatment and the efficacy of these methods compared with traditional treatments. PATIENTS/METHODS A comprehensive PubMed and Embase search was conducted in May 2022 using the phrases tranexamic acid and melasma. Forty-six articles were included in this review. RESULTS Oral, intralesional, and topical TXA is safe and effective treatments for melasma. They have been studied in a variety of randomized controlled trials and have been compared with several traditional treatments. Overall, MASI scores in patients using TXA in any form improved. CONCLUSIONS Oral TXA was found to be the most effective, especially in cases of refractory melasma; however, it caused GI upset and menstrual irregularities in many patients. The pro-thrombotic nature of this drug must be considered before safely prescribing to patients. Intralesional injections and microneedling with topical TXA were found to be effective alternatives to oral treatment. Lastly, topical TXA alone was found to be the least effective method but can be combined with other cosmeceuticals to improve outcomes. Topical TXA was also found to be better tolerated than hydroquinone, a traditional topical melasma treatment.
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Affiliation(s)
- Hailey Konisky
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Eliza Balazic
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Jose A Jaller
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Urmi Khanna
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Kseniya Kobets
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
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Cassiano DP, Espósito ACC, da Silva CN, Lima PB, Dias JAF, Hassun K, Miot LDB, Miot HA, Bagatin E. Update on Melasma-Part II: Treatment. Dermatol Ther (Heidelb) 2022; 12:1989-2012. [PMID: 35906506 PMCID: PMC9464276 DOI: 10.1007/s13555-022-00780-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/13/2022] [Indexed: 01/10/2023] Open
Abstract
Melasma is a prevalent chronic relapsing pigmentary disorder that affects photoexposed areas, especially in women of childbearing age. Although there is currently no curative treatment available for melasma, this manuscript critically reviews the knowledge regarding photoprotection, topical and oral therapies, and procedures such as peelings, laser, and microneedling that represent the main strategies for control and prevention of this disease. As the pathogenesis of melasma is not entirely understood, there are prospects for the development of new therapeutic strategies that might act on the pathways that promote sustained pigmentation rather than merely decreasing melanin synthesis and removing melanin from the epidermis.
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Affiliation(s)
| | - Ana Cláudia C. Espósito
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Campus de Rubião Jr., Botucatu, SP Brazil
| | - Carolina N. da Silva
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Campus de Rubião Jr., Botucatu, SP Brazil
| | - Paula B. Lima
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Campus de Rubião Jr., Botucatu, SP Brazil
| | - Joana A. F. Dias
- Departamento de Dermatologia, UNIFESP, São Paulo, SP Brazil
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Campus de Rubião Jr., Botucatu, SP Brazil
| | - Karime Hassun
- Departamento de Dermatologia, UNIFESP, São Paulo, SP Brazil
| | - Luciane D. B. Miot
- Departamento de Dermatologia, UNIFESP, São Paulo, SP Brazil
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Campus de Rubião Jr., Botucatu, SP Brazil
| | - Hélio A. Miot
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Campus de Rubião Jr., Botucatu, SP Brazil
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Mahajan VK, Patil A, Blicharz L, Kassir M, Konnikov N, Gold MH, Goldman MP, Galadari H, Goldust M. Medical therapies for Melasma. J Cosmet Dermatol 2022; 21:3707-3728. [PMID: 35854432 DOI: 10.1111/jocd.15242] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/11/2022] [Indexed: 01/19/2023]
Abstract
Melasma is a common malady affecting all races with a higher incidence in Hispanics, Middle Eastern, Asians and African origin females (Fitzpatrick skin phototypes III-V). Women are affected much more often than men. Melasma remains a significant cause of cosmetic morbidity and psychosocial embarrassment affecting quality of life necessitating effective and reliable treatment. Unfortunately, treatment remains unsatisfactory due to limited efficacy, adverse effects and relapses after stopping treatment. Although chemical peels, laser and light therapies and dermabrasion may have utility, the evidence available for their efficacy is limited and they often cause post inflammatory hyperpigmentation particularly in individuals with darker skin types. Medical therapies remain mainstay in the management of melasma. The triple combination, hydroquinone 4%, tretinoin 0.05% and fluocinolone acetonide 0.01% (Triluma, Galderma, Ft. Worth Texas, often modified incorporating different corticosteroids) remains the only US FDA approved treatment for melasma and is the gold standard due its demonstrated efficacy across ethnicities. Oral tranexamic acid alone or in combination with other modalities has also shown significant efficacy. Several cosmeceuticals and botanical extracts used as skin lightening agents have been demonstrated to be useful. Physical sunscreens containing zinc oxide, iron oxide, titanium dioxide, and silicones provide photoprotective and camouflage effect. We propose that a multimodality approach to the treatment of melasma is the most effective treatment approach. This review is focused on the medical therapies for melasma.
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Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology & Leprosy Dr. Rajendra Prasad Government Medical College Kangra, Tanda, India
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Leszek Blicharz
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Martin Kassir
- Founding director, Worldwide laser institute, Dallas, USA
| | | | - Michael H Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA
| | - Mitchel P Goldman
- Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA.,Department of Dermatology, University of California, San Diego, CA, USA
| | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Chiang PH, Lin YJ, Chiu YC, Chung WH, Ku CL, Ng CY. Feasibility of oral tranexamic acid for vitiligo patients with melasma. Dermatol Ther 2021; 34:e15047. [PMID: 34190390 DOI: 10.1111/dth.15047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/19/2021] [Accepted: 06/28/2021] [Indexed: 01/10/2023]
Abstract
Melasma and vitiligo are both common pigmentary disorders, and the treatment is challenging. Oral tranexamic acid (TA) is effective for refractory melasma; however, the feasibility of TA in vitiligo patients with melasma was not studied. To evaluate the treatment outcomes and adverse effects of oral TA in vitiligo patients with melasma. We conducted a retrospective analysis of vitiligo patients who received oral TA for melasma in a tertiary dermatologic center from January 2017 to August 2020. We enrolled 32 patients with concomitant vitiligo and melasma on the face. The mean duration of the improvement of melasma that patients reported is around 1.64 months of treatment. The first sign of repigmentation of the vitiligo lesions occurred at 1 month of treatment. 84.38% of the patients achieved a mild to good degree of improvement of melasma (0%-75% improvement), whereas 81.25% of the patients achieved a moderate to excellent degree of improvement of vitiligo (25%-100% improvement) via physician global assessments. No significant adverse event was noted. No patients experience vitiligo disease deterioration during TA treatment. Oral TA may be a feasible option for melasma in vitiligo patients.
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Affiliation(s)
- Pin-Hsuan Chiang
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Jr Lin
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yen-Chuan Chiu
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan.,Vitiligo Clinic and Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Lung Ku
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Chau Yee Ng
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan.,Vitiligo Clinic and Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
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