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Pazyar N, Raeispour M, Yaghoobi R, Seyedtabib M. Evaluation of the effectiveness of microneedling with tranexamic acid in comparison with microneedling with vitamin C in the treatment of melasma: A prospective and single-blind clinical trial. Health Sci Rep 2023; 6:e1636. [PMID: 37867785 PMCID: PMC10588557 DOI: 10.1002/hsr2.1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/06/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023] Open
Abstract
Background and Aims Melasma is a common skin condition. Microneedling acts as a dermal delivery system that facilitates the penetration of lightening agents such as vitamin C and tranexamic acid (TXA) into the deeper layers of the skin. Therefore, this study aimed to compare the effectiveness of microneedling with TXA with microneedling and vitamin C in treating melasma. Methods In patients with melasma, microneedling was performed at 2-3 mm depth. During that, TXA and vitamin C were poured on the skin of each side of the face, and then each ampoule was soaked for 15 min. This method was performed three times in 2-week intervals, and the results were compared by measuring the Melasma Area and Severity Index (MASI) score before, during, and 2 months after the completion of the treatment. Results The average MASI score in the baseline in the TXA group was 4.61, and in the vitamin C group was 4.58. The average MASI score in the patients treated with TXA in the last treatment session was 2.40, and the group treated with vitamin C was 2.44. The study results showed that the treatment was effective in both groups based on MASI score. Although there was a difference between the responses of the two groups, it was not significant. Conclusion Microneedling with vitamin C and TXA is a safe and effective treatment option without side effects for treating melasma.
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Affiliation(s)
- Nader Pazyar
- Department of Dermatology, School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Maryam Raeispour
- School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Reza Yaghoobi
- Department of Dermatology, School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Maryam Seyedtabib
- Department of Biostatistics and Epidemiology, School of Public HealthAhvaz Jundishapur University of Medical SciencesAhvazIran
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Qaiyyum IA, Nawab M, Kazmi MH. A randomized controlled clinical trial to evaluate safety and efficacy of a Unani formulation in the management of Kalaf (Melasma). JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2023; 20:233-240. [PMID: 34582636 DOI: 10.1515/jcim-2021-0353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Kalaf (Melasma) is an acquired facial hypermelanism. It has direct impact on patient's quality of life and leads to development of various personality disorders. Lack of effective treatment and recurrences have drawn the attention of researcher to find alternative treatment. This study aimed to evaluate safety and efficacy of a topical Unani formulation in the management of melasma. METHODS We conducted a prospective randomized controlled clinical study on the participants diagnosed with melasma. The participants (n=72) randomized into test (n=36) and control (n=36) groups. Sixty participants (n=30 in each group) completed the duration of therapy. The participants of the test group were treated with a classical Unani formulation and control group with hydroquinone 4%. The primary end point was change in mean MASI score and secondary end point was improvement in quality of life after eight weeks of treatment. RESULTS The Unani formulation reduced 40.5% mean MASI score (17.31 ± 9.58 to 10.28 ± 5.92) in comparison to 32% reduction in mean MASI score (20.58 ± 9.49 to 13.92 ± 7.38) in the control group after eight weeks of treatment. When comparing with baseline the difference in MASI score was found statistically significant in both groups (p<0.05). On intergroup comparison, the change in MASI score between both groups was not statistically significant (p>0.05). In addition, MQOL and DQLI also improved significantly in both groups. CONCLUSIONS This study concluded that the Unani formulation and the control drug were equally effective and safer in the management of melasma.
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Affiliation(s)
- Ifra Abdul Qaiyyum
- Department of Moalajat (Medicine), National Research Institute of Unani Medicine for Skin Disorders, Hyderabad, Telangana, India
| | - Mohammad Nawab
- Department of Moalajat (Medicine), National Research Institute of Unani Medicine for Skin Disorders, Hyderabad, Telangana, India
| | - Munawwar Husain Kazmi
- Department of Ilmul Advia (Pharmacology), National Research Institute of Unani Medicine for Skin Disorders, Hyderabad, India
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Rutnin S, Suchonwanit P, Kositkuljorn C, Pomsoong C, Korpaisarn S, Arunakul J, Rattananukrom T. Characterizing Dermatological Conditions in the Transgender Population: A Cross-Sectional Study. Transgend Health 2023; 8:89-99. [PMID: 36824384 PMCID: PMC9942180 DOI: 10.1089/trgh.2021.0105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aimed to demonstrate the effects of gender-affirming hormone therapy (GAHT) and gender-affirming procedures on the skin in transgender individuals. Methods We conducted a cross-sectional study among transgender people. Skin conditions related to GAHT were assessed, including acne (using the Investigator's Global Assessment, IGA), postacne sequelae, melasma, hypertrichosis in androgen-sensitive areas (HAAs) in transgender men (TM) and hirsutism in transgender women (TW) (using the modified Ferriman-Gallwey score, mFG score), and hair loss (using the Hamilton-Norwood and Ludwig scale) at baseline, 6 months after GAHT, and the day on which the questionnaire was completed. Dermatological problems after gender-affirming procedures were evaluated. Results A total of 159 patients, including 134 TM and 25 TW, were eligible to participate. The median duration of GAHT was 23 and 36 months in TM and TW, respectively. In TM, the median IGA score of facial acne increased from 1 at baseline to 3 after 6 months and decreased to 2 after 2 years of GAHT. The mFG score indicated HAA in all TMs after testosterone treatment. A total of 88.1% of TM had no hair loss before hormone therapy. However, after 2 years of GAHT, 76.1% of TM developed male pattern hair loss (MPHL), and 26.1% of them had moderate-to-severe MPHL. In TW, the median IGA and mFG scores decreased after 3 years of hormone therapy, and the proportion of female pattern hair loss (FPHL) in TW increased to 16% after GAHT. In both groups, the most common skin complication after gender-affirming surgery was hypertrophic scarring. Conclusions GAHT in TM resulted in acne and MPHL, whereas GAHT in TW caused melasma and FPHL.
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Affiliation(s)
- Suthinee Rutnin
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaninan Kositkuljorn
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Cherrin Pomsoong
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sira Korpaisarn
- Divisions of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jiraporn Arunakul
- Division of Child and Adolescent Health, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Rattananukrom
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Address correspondence to: Teerapong Rattananukrom, MD, MSc, Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand,
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Decrypting the Potential of Nanotechnology-Based Approaches as Cutting-Edge for Management of Hyperpigmentation Disorder. MOLECULES (BASEL, SWITZERLAND) 2022; 28:molecules28010220. [PMID: 36615414 PMCID: PMC9822493 DOI: 10.3390/molecules28010220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
The abundant synthesis and accretion of melanin inside skin can be caused by activation of melanogenic enzymes or increase in number of melanocytes. Melasma is defined as hyperpigmented bright or dark brown spots which are symmetrically distributed and have serrated and irregular borders. The three general categories of pigmentation pattern include centro facial pattern, malar pattern, and mandibular pattern. Exposure to UV rays, heat, use of cosmetics and photosensitizing drugs, female sex hormonal therapies, aberrant production of melanocyte stimulating hormone, and increasing aesthetic demands are factors which cause the development of melasma disease. This review gives a brief overview regarding the Fitzpatrick skin phototype classification system, life cycle of melanin, mechanism of action of anti-hyperpigmenting drugs, and existing pharmacotherapy strategies for the treatment of melasma. The objectives of this review are focused on role of cutting-edge nanotechnology-based strategies, such as lipid-based nanocarriers, i.e., lipid nanoparticles, microemulsions, nanoemulsions, liposomes, ethosomes, niosomes, transfersomes, aspasomes, invasomes penetration-enhancing vesicles; inorganic nanocarriers, i.e., gold nanoparticles and fullerenes; and polymer-based nanocarriers i.e., polymeric nanoparticles, polymerosomes, and polymeric micelles for the management of hyperpigmentation.
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Manuskiatti W, Yan C, Gulfan MCB, Techapichetvanich T, Wanitphakdeedecha R. Combination of a 755-nm picosecond laser and hydroquinone 2% cream versus hydroquinone 2% cream alone for the treatment of melasma: A randomized, split-face, and controlled trial. Lasers Surg Med 2022; 54:1245-1250. [PMID: 36345697 DOI: 10.1002/lsm.23615] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/16/2022] [Accepted: 10/08/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND While combined laser and topical treatments are currently a common approach to melasma treatment, data on the efficacy and safety of this combined therapy remain scarce, with studies showing varied results. OBJECTIVE To compare the efficacy and safety of hydroquinone (HQ) cream alone versus HQ cream combined with 755-nm picosecond (PS) laser in the treatment of melasma. METHOD Twenty subjects presenting with mixed-type melasma were enrolled in the study. All patients were instructed to apply 2% HQ cream to both sides of the face for 4 weeks. Randomly assigned hemifaces of all patients thereafter received 5 biweekly PS laser treatments. Objective (measurement of average melanin content and melanin index) and subjective (grading of modified melasma area and severity index [mMASI] score and global percentage of pigment clearance) assessments of melasma clearance, and occurrence of adverse effects were evaluated at 1-, 3-, and 6-months after the final laser treatment. RESULTS mMASI scores were significantly improved from baseline for both sides (p = 0.006 HQ alone, p < 0.001 HQ + PS laser), with no statistically significant difference when comparing HQ alone versus HQ + PS laser. Objective assessments (measurements of average melanin content and melanin index) of melasma clearance corresponded to the clinical evaluation using mMASI score. Mild postinflammatory hyperpigmentation was observed in 15% of the patients on the laser-treated side, while no adverse effects were reported on the HQ monotherapy side. CONCLUSIONS Adjunctive treatment with a 755-nm PS laser does not provide additional benefit to topical HQ in the treatment of melasma. ClinicalTrail.gov PRS. number: NCT04597203.
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Affiliation(s)
- Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chadakan Yan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Thanya Techapichetvanich
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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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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Lee J, Kwon KH. Skin problems of Korean military personnel changes in the use of cosmetics and differences in preference according to different characteristics: Focused on comparison pre- and post-enlistment. Health Sci Rep 2021; 4:e368. [PMID: 34541332 PMCID: PMC8439427 DOI: 10.1002/hsr2.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/28/2021] [Accepted: 08/02/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Recently, men's interest and participation in cosmetology have increased, and the number of "grooming" men who are exorbitantly investing in fashion and looks has increased, further increasing the growth potential of men's cosmetics. OBJECTIVES The purpose of this study was to analyze the skin diseases of men in their 20s and 30s in Korea, focusing on the comparison before and after enlistment, and to study the changes in cosmetic use and the difference in cosmetic preference according to the military service problem of Korean men. METHODS We enrolled 450 people, after excluding 50 dishonest respondents. Statistical data processing collected with the data analysis method were analyzed using the Statistical Package for Social Science (SPSS) WIN25.0 statistical package program through data coding and cleaning. RESULTS A total of 217 (48.2%) people preferred the cosmetic type of skin/lotion preferred by the private sector, and the cosmetic type required by the military was a complex skin lotion (48.2%) with 216 people (48.2%). All-in-one products were the most common products. The P-value was P < .001 or more. CONCLUSION The results of this comprehensive study indicated skin problems of Korean military personnel changes in the use of cosmetics and differences in preference according to different characteristics focused on comparison pre- and post-enlistment was assessed.
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Affiliation(s)
- Jinkyung Lee
- Division of Beauty Arts Care, Department of Practical Arts, Graduate School of Culture and ArtsDongguk UniversitySeoulSouth Korea
- Daily Beauty UnitAmorepacific Co.SeoulSouth Korea
| | - Ki Han Kwon
- Division of Beauty Arts Care, Department of Practical Arts, Graduate School of Culture and ArtsDongguk UniversitySeoulSouth Korea
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Sthalekar B, Agarwal M, Sharma V, Patil CY, Desai M. Prospective Study of Growth Factor Concentrate Therapy for Treatment of Melasma. Indian Dermatol Online J 2021; 12:549-554. [PMID: 34430458 PMCID: PMC8354406 DOI: 10.4103/idoj.idoj_750_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/13/2020] [Accepted: 02/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Melasma is a common acquired pigmentary skin disorder. Currently, there are various treatment options available but none is effective universally. Objective: Assess the role of Yuskin®, a growth factor concentrate (GFC) therapy, a modified platelet rich plasma (PRP) technique for the treatment of melasma. Materials and Methods: Subjects of Fitzpatrick skin type IV–V, of either gender, more than equal to 18 years of age, with a clinical diagnosis of melasma were enrolled in the study. Total three sessions of GFC monotherapy were given with one-month interval (day 0, day 30, and day 60) and follow up of subjects was done at day 90 for the final clinical assessment. Results: Out of 40 subjects enrolled, 30 subjects completed three GFC sessions and 26, completed day 90 follow-up. Statistically significant decrease in the mean mMASI scores was observed at all visits compared to baseline (P < 0.005 for each visit). Totally, 66.7% of severe melasma subjects showed improvement to mild to moderate category. Significant improvement in mean mMASI score was seen in subjects who had mild to moderate melasma at baseline (P < 0.05). Overall, aesthetic improvement was reported in 88.5% of subjects. Side effects reported were mild such as injection site pain, erythema, oedema and bruising, and resolved spontaneously within a few hours to few days of onset. Conclusion: Significant improvement in melasma was observed with GFC monotherapy, which needs further confirmation in larger randomized controlled studies. Overall, it was well tolerated. Thus, GFC therapy can be a safe, effective, and new option in the armamentarium of melasma management.
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Affiliation(s)
| | - Madhuri Agarwal
- Department of Dermatology, Yavana Aesthetics Clinic, Mumbai, Maharashtra, India
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Manuskiatti W, Yan C, Tantrapornpong P, Cembrano KAG, Techapichetvanich T, Wanitphakdeedecha R. A Prospective, Split-Face, Randomized Study Comparing a 755-nm Picosecond Laser With and Without Diffractive Lens Array in the Treatment of Melasma in Asians. Lasers Surg Med 2020; 53:95-103. [PMID: 32865858 DOI: 10.1002/lsm.23312] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Treatment of melasma with lasers remains a challenge due to its limited clinical efficacy in addition to high rates of recurrence and side effects. Recently, picosecond lasers have shown favorable results in treatment of benign pigmented lesions. To compare the efficacy and safety of using a 755-nm picosecond laser for the treatment of melasma in a split-face manner, having one side treated with a fractionated beam (diffractive lens array [DLA] coupling) and with a full-beam (flat optics) on the other side. STUDY DESIGN/MATERIALS AND METHODS Eighteen subjects presenting with mixed-type melasma were enrolled. Each patient was randomly treated with a 755-nm picosecond laser coupled with DLA on one side of the face and without DLA (flat optics) on the other side. The laser was delivered through an 8-mm spot size with an average fluence of 0.4 J/cm2 at 2.5 Hz for a total of two passes without pulse overlapping. All subjects received five monthly treatments. Subjective (clinical evaluation) and objective (color readings) assessments on the degree of pigment clearance and adverse effects were obtained at 1-, 3-, and 6-month after the final treatment. RESULTS At 6 months after the last treatment, physician-rating scores were 1.50 ± 0.76 and 1.50 ± 0.65 of the DLA and flat-optics sides, respectively. Pigment clearance significantly improved from 1 to 6 months after the treatment on each side (P = 0.019 on DLA and P = 0.023 on flat-optics sides). No statistically significant differences in physician-rating scores between the two treatment techniques were observed at all follow-up visits. Objective assessments of melasma clearance corresponded to the clinical evaluation. However, the full-beam (flat optics) provided lower incidence of pos-tinflammatory hyperpigmentation than the fractioned one. CONCLUSIONS A 755-nm picosecond laser is safe and effective for the treatment of melasma in dark-skinned individuals. The use of DLA does not provide additional benefit over the flat optics in clearing pigmentation. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chadakan Yan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ploypailin Tantrapornpong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kathryn Anne G Cembrano
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thanya Techapichetvanich
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Sastrini Sekarnesia I, Sitohang IBS, Agustin T, Wisnu W, Hoemardani ASD. A comparison of serum zinc levels in melasma and non-melasma patients: a preliminary study of thyroid dysfunction. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Chowdhary B, Mahajan VK, Mehta KS, Chauhan PS, Sharma V, Sharma A, Vashist S, Kumar P. Therapeutic efficacy and safety of oral tranexamic acid 250 mg once a day versus 500 mg twice a day: a comparative study. Arch Dermatol Res 2020; 313:109-117. [PMID: 32356007 DOI: 10.1007/s00403-020-02078-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 04/02/2020] [Accepted: 04/17/2020] [Indexed: 01/19/2023]
Abstract
Oral tranexamic acid (TXA) 250 mg twice daily has been used effectively for 4 weeks to 6 months to treat melasma. As relapses are frequent on discontinuation, a minimum effective dose of TXA that can be used safely for long time remains unknown. We compared the efficacy of oral TXA 250 mg once daily and 500 mg twice daily given for 16 weeks in 132 (m:f 23:109) adults with melasma. 42 patients in Group-A (TXA 250 mg/d) and 46 patients in Group-B (TXA 500 mg twice/d) completed the study. They were followed up at 4-week interval for percentage reduction in baseline Melasma Area Severity Index (MASI) and at 24 and 28 weeks for relapse. Therapeutic response, for both as per-protocol and intention-to-treat analysis, was scored as very good (> 75% reduction), good (51-75% reduction), moderate (25-50% reduction), mild (< 25% reduction) or no improvement. Reduction in mean MASI score at 4 weeks was not statistically significant in Group-A but it decreased significantly 8 weeks onwards and was comparable with that in Group-B. The relapse rate was higher in Group-B (10.8%) than Group-A (4.7%) at the end of 28 weeks. Oligomenorrhoea and abdominal discomfort in few patients did not necessitate treatment discontinuation. TXA 500 mg twice daily showed early reduction in mean MASI score compared to 250 mg given once daily with comparable safety and therapeutic efficacy at 16 weeks. Open-label cross-sectional design, no control arm, small number of patients in each group, MASI score being subjective assessment tool, short duration of treatment and follow-up are study limitations.
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Affiliation(s)
- Bhumika Chowdhary
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), 176001, Himachal Pradesh, India
| | - Vikram K Mahajan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), 176001, Himachal Pradesh, India.
| | - Karaninder S Mehta
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), 176001, Himachal Pradesh, India
| | - Pushpinder S Chauhan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), 176001, Himachal Pradesh, India
| | - Vikas Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), 176001, Himachal Pradesh, India
| | - Anuj Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), 176001, Himachal Pradesh, India
| | - Sanket Vashist
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), 176001, Himachal Pradesh, India
| | - Prabal Kumar
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), 176001, Himachal Pradesh, India
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Ismail ESA, Patsatsi A, Abd El-Maged WM, Nada EEDAEA. Efficacy of microneedling with topical vitamin C in the treatment of melasma. J Cosmet Dermatol 2019; 18:1342-1347. [PMID: 30770637 DOI: 10.1111/jocd.12878] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 12/01/2018] [Accepted: 01/03/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Despite the wide therapeutic options available for the treatment of melasma, including many active topical medications, technologies with lights and peelings, clinical control of this disorder is extremely challenging. OBJECTIVES To evaluate the effect of microneedling with topical vitamin C in the treatment of melasma. METHODS Thirty female patients with melasma received six sessions of microneedling with addition of topical vitamin C every two weeks. At each session, photos were taken and Melasma Area and Severity Index (MASI) score was calculated to assess the clinical improvement. RESULTS Mean age of the eligible patients was 33.2 ± 5.77 years. About 50% of cases were of Fitzpatrick skin type III. All patients showed improvement at the end of the sessions. Mean MASI score in the first session was 8.61 ± 4.45 and there was a gradual decline in its value till it reached a mean of 5.75 ± 4.16 in the last session (P < 0.0001). CONCLUSION Microneedling with topical vitamin C is an effective and safe treatment option for epidermal melasma especially in Fitzpatrick skin phototypes I-III.
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Affiliation(s)
- Esraa Salah Ali Ismail
- Faculty of Medicine, Department of Dermatology, Sohag University, Sohag University Hospital, Sohag, Egypt
| | - Aikaterini Patsatsi
- Faculty of Medicine, 2nd Department of Dermatology, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
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Prevalence of pigmentary disorders: A cross-sectional study in public hospitals in Durban, South Africa. Int J Womens Dermatol 2019; 5:345-348. [PMID: 31909155 PMCID: PMC6938902 DOI: 10.1016/j.ijwd.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/23/2019] [Accepted: 07/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background Pigmentary disorders are common in patients with skin of color and one of the top five most common dermatologic diagnoses in individuals of African descent. Little is known about the spectrum of pigmentary disorders in South Africa’s second largest province, KwaZulu Natal. Objective This study aimed to determine the profile of pigmentary disorders in patients at five outpatient public hospital skin clinics in Durban, South Africa. Methods We collected data related to age, sex, ethnicity, and skin dyspigmentation diagnosis in a cross-sectional descriptive study of all dermatology patients at five public hospitals in Durban, South Africa between January 1 and March 31, 2015. The diagnosis was made on the basis of clinical grounds, supported by relevant laboratory investigations or histopathology where necessary. Only data relating to patients’ first visit were recorded and captured using a Microsoft Excel 2007 spreadsheet. Results A total of 304 patients, the majority of whom were African women (n = 230; 75.8%), were included in the study. The three most common pigmentary diagnoses included vitiligo, postinflammatory hyperpigmentation, and melasma. Conclusion Dyschromias are the third most common dermatologic diagnosis in Durban, KwaZulu-Natal province, South Africa. The most common subtypes of pigmentary disorders include (in order of frequency) vitiligo, postinflammatory hyperpigmentation, and melasma.
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Sarkar R, Jagadeesan S, Basavapura Madegowda S, Verma S, Hassan I, Bhat Y, Minni K, Jha A, Das A, Jain G, Arya L, Mandlewala Z, Bagadia J, Garg V. Clinical and epidemiologic features of melasma: a multicentric cross‐sectional study from India. Int J Dermatol 2019; 58:1305-1310. [DOI: 10.1111/ijd.14541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/03/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology Maulana Azad Medical College New Delhi Delhi India
| | - Soumya Jagadeesan
- Department of Dermatology Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi Kerala India
| | | | - Sonali Verma
- Department of Dermatology Maulana Azad Medical College and Hospital New Delhi Delhi India
| | - Iffat Hassan
- Department of Dermatology Sexually Transmitted Diseases & Leprosy Government Medical College Srinagar (University of Kashmir) Srinagar Jammu & Kashmir India
| | - Yasmeen Bhat
- Department of Dermatology Sexually Transmitted Diseases & Leprosy Government Medical College Srinagar (University of Kashmir) Srinagar Jammu & Kashmir India
| | | | - Abhijeet Jha
- Department of Skin and Venereal diseases Patna Medical College and Hospital Patna Bihar India
| | - Anupam Das
- KPC Medical College and Hospital Kolkata West Bengal India
| | - Geraldine Jain
- Punarnawah LASER & Aesthetic Centre Jaipur Rajasthan India
| | - Latika Arya
- L A Skin & Aesthetic Clinic Defence Colony New Delhi Delhi India
| | | | | | - Vijay Garg
- Department of Dermatology Maulana Azad Medical College New Delhi Delhi India
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15
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Cario M. How hormones may modulate human skin pigmentation in melasma: An in vitro perspective. Exp Dermatol 2019; 28:709-718. [PMID: 30883945 DOI: 10.1111/exd.13915] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/05/2019] [Accepted: 03/07/2019] [Indexed: 12/16/2022]
Abstract
Melasma is a common acquired hyperpigmentary disorder occurring primarily in photo-exposed areas and mainly affecting women of childbearing age. To decipher the role of sex hormones in melasma, this viewpoint reviews the effects of sex hormones on cutaneous cells cultured in monolayers, in coculture, in 3D models and explants in the presence or the absence of UV. The data show that sex steroid hormones, especially oestrogen, can modulate in vitro pigmentation by stimulating melanocytes and keratinocyte pro-pigmentary factors, but not via fibroblast or mast cell activation. In vitro data suggest that oestrogen acts on endothelial cell count, which may in turn increase endothelin-1 concentrations. However, data on explants revealed that sex steroid even at doses observed during pregnancy cannot induce melanogenesis alone nor melanosome transfer but that it acts in synergy with UVB. In conclusion, we hypothesize that in predisposed persons, sex steroid hormones initiate hyperpigmentation in melasma by amplifying the effects of UV on melanogenesis via direct effects on melanocytes or indirect effects via keratinocytes and on the transfer of melanosomes. They also help to sustain hyperpigmentation by increasing the number of blood vessels and, in turn, the level of endothelin-1.
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Affiliation(s)
- Muriel Cario
- Inserm 1035, Bordeaux, France
- Univ. Bordeaux, Bordeaux, France
- Aquiderm, Bordeaux, France
- National reference center for rare skin Diseases, Bordeaux Hospital, Bordeaux, France
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16
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A comparative study between two topical treatments (tranexamic acid and flutamide) in the treatment of patients with melasma. JOURNAL OF THE EGYPTIAN WOMENʼS DERMATOLOGIC SOCIETY 2018. [DOI: 10.1097/01.ewx.0000546169.90015.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sarkar R, Gokhale N, Godse K, Ailawadi P, Arya L, Sarma N, Torsekar RG, Somani VK, Arora P, Majid I, Ravichandran G, Singh M, Aurangabadkar S, Arsiwala S, Sonthalia S, Salim T, Shah S. Medical Management of Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group. Indian J Dermatol 2017; 62:558-577. [PMID: 29263529 PMCID: PMC5724303 DOI: 10.4103/ijd.ijd_489_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Melasma is one of the most common hyperpigmentary disorders found mainly in women and dark-skinned patients. Sunlight, hormones, pregnancy, and genetics remain the most implicated in the causation of melasma. Although rather recalcitrant to treatment, topical agents such as hydroquinone, modified Kligman's Regime, azelaic acid, kojic acid, Vitamin C, and arbutin still remain the mainstay of therapy with sun protection being a cornerstone of therapy. There are several new botanical and non botanical agents and upcoming oral therapies for the future. There is a lack of therapeutic guidelines, more so in the Indian setup. The article discusses available evidence and brings forward a suggested treatment algorithm by experts from Pigmentary Disorders Society (PDS) in a collaborative discussion called South Asian Pigmentary Forum (SPF).
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Affiliation(s)
- Rashmi Sarkar
- Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Narendra Gokhale
- Consultant Dermatologist, Sklinic Skin Clinic, Indore, Madhya Pradesh, India
| | - Kiran Godse
- Dermatology, D Y Patil Hospital, Mumbai, Maharashtra, India
| | - Pallavi Ailawadi
- Dermatology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Latika Arya
- Consultant Dermatologist, L A Skin and Aesthetic Clinic, New Delhi, India
| | - Nilendu Sarma
- Dermatology, Dr B. C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - R G Torsekar
- Consultant Dermatologist, Fortis Hospital, Mumbai, Maharashtra, India
| | - V K Somani
- Consultant Dermatologist, Skintrendz, Himayat Nagar, Hyderabad, India
| | - Pooja Arora
- Dermatology, Dr RML Hospital and PGIMER, New Delhi, India
| | - Imran Majid
- Dermatology, Govt Medical College, Srinagar, Jammu and Kashmir, India
| | - G Ravichandran
- Senior Consultant and Coordinator, Dermatology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Mohan Singh
- Consultant Dermatologist, Mohan Skin Diseases Hospital, Phagwara, Punjab, India
| | | | - Shehnaz Arsiwala
- Consultant Dermatologist, Saifee Hospital, Prince Aly Khan Hospital, Mumbai, Maharashtra, India
| | - Sidharth Sonthalia
- Consultant Dermatologist, Skinnocence: The Skin Clinic, Gurgaon, Haryana, India
| | - T Salim
- Consultant Dermatologist, Cutis institute of Dermatology and Aesthetic Sciences, Calicut, Kerala, India
| | - Swapnil Shah
- Consultant Dermatologist, Solapur, Maharashtra, India
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Gupta M, Mahajan VK. Clinical profile of 300 men with facial hypermelanosis. J Dermatol Case Rep 2017; 11:20-24. [PMID: 29367869 DOI: 10.3315/jdcr.2017.1244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 03/01/2017] [Indexed: 01/19/2023]
Abstract
Background Facial hypermelanosis is a significant cause of cosmetic disfigurement, social embarrassment and psychological morbidity affecting quality of life. Objective To study clinicoepidemlogic patterns of facial hypermelanoses among men. Material and Methods Medical records of all adult males presenting with facial hypermelanoses were analyzed for this retrospective cross sectional study for demographic details, duration, cosmetic usage, sun exposure, drug intake, infections, systemic or cutaneous diseases, and family history of hypermelanotic dermatosis. Laboratory investigations and skin biopsy were performed when deemed necessary. Results These were 300 Indian men aged 18 to 74 (mean 37.35) years with 121 (40.3%) individuals aged 31-50 years. Various patterns of melasma in 230 (76.7%) patients were the major cause of facial hypermelanosis. Periorbital hypermelanosis was observed in 32 (10.7%), freckles and lentigens in 26 (8.7%), acanthosis nigricans in 12 (4%) and lichen planus pigmentosus in 10 (3.3%), pigmented cosmetic contact dermatitis in 7, and nevus of Ota in 6 persons. The 71 (30.8%) patients with melasma had a history of frequent sun exposure, 9 (3.9%) patients had systemic comorbidities. Family history of periorbital melanosis was present in 7 (21.8%), personal or family history of atopy in 5 (15.6%) patients. Acanthosis nigricans was associated with obesity in 9 (75%) of patients and with diabetes mellitus in 4 (33.3%) cases. Conclusions Melasma, periorbital hypermelanosis, acanthosis nigricans and lichen planus pigmentosus remain the predominant causes for facial hypermelanosis in men.
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Affiliation(s)
- Mrinal Gupta
- Department of Dermatology, Venereology & Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda)-176001 (Himachal Pradesh), India
| | - Vikram K Mahajan
- Department of Dermatology, Venereology & Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda)-176001 (Himachal Pradesh), India
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Rostami Mogaddam M, Safavi Ardabili N, Iranparvar Alamdari M, Maleki N, Aghabalaei Danesh M. Evaluation of the serum zinc level in adult patients with melasma: Is there a relationship with serum zinc deficiency and melasma? J Cosmet Dermatol 2017; 17:417-422. [PMID: 29131489 DOI: 10.1111/jocd.12392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Melasma is a common acquired hypermelanosis of sun-exposed skin, particularly on the face, which presents as symmetric, light- to gray-brown-colored macules and patches. There are several studies of serum zinc levels in cutaneous disorders. So far, no studies have been carried out to assess the serum zinc level in patients with melasma. The aim of this study is to determine the serum zinc level in patients with melasma compared to healthy subjects. MATERIALS AND METHODS A total of 118 patients with melasma and 118 healthy controls were enrolled in this prospective cross-sectional study. The two groups were matched for age and sex. Atomic absorption spectrophotometry was used to measure serum zinc levels. The statistical analysis was performed using SPSS software. RESULTS The mean serum level of zinc in melasma patients and controls was 77.4±23.2 μg/dL and 82.2±23.9 μg/dL, respectively (P-value=.0001). Serum zinc deficiency was found in 45.8% and 23.7% of melasma patients and control subjects, respectively. A positive family history of melasma in first-degree relatives was present in 46 (39%) of the cases, and a history of taking oral contraceptive pill was found in 95 (81%) of women with melasma. The aggravating factors for melasma were stated as: sun exposure (11.1%), pregnancy (15.3%), nutrition (2.5%), oral contraceptive pills (18.6%), and emotional stress (5.9%). The malar and centrofacial patterns were seen in 3.4% and 72% of cases, respectively, whereas 24.6% of the patients had both centrofacial distribution and malar distribution, and there was no patient with mandibular pattern. Among patients with melasma, 20.3% had thyroid dysfunction, while in the control subjects, 8.4% had thyroid dysfunction (P=.001). CONCLUSION There is a significant relationship between low levels of zinc and melasma. Zinc deficiency may be involved in the pathogenesis of melasma. Also, treatment with oral zinc supplements can be tried in these patients to see the outcome. However, to make recommendations on screening for zinc deficiency in patients with melasma, future research of good methodological quality is needed.
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20
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Colomb L, Flament F, Wagle A, Agrawal D. In vivo
evaluation of some biophysical parameters of the facial skin of Indian women. Part I: variability with age and geographical locations. Int J Cosmet Sci 2017; 40:50-57. [DOI: 10.1111/ics.12431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 07/07/2017] [Indexed: 01/22/2023]
Affiliation(s)
- L. Colomb
- L'Oréal Research and Innovation; 188, Rue Paul Hochart 94550 Paris France
| | - F. Flament
- L'Oréal Research and Innovation; 188, Rue Paul Hochart 94550 Paris France
| | - A. Wagle
- L'Oréal Research and Innovation; 7th Floor, Universal Majestic, Ghatkopar - Mankhurd Link Road Chembur Mumbai - 400 071 India
| | - D. Agrawal
- L'Oréal Research and Innovation; 7th Floor, Universal Majestic, Ghatkopar - Mankhurd Link Road Chembur Mumbai - 400 071 India
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22
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Uyanikoglu H, Aksoy M. Quality of life in patients with melasma in Turkish women. Dermatol Reports 2017; 9:7340. [PMID: 29430289 PMCID: PMC5806155 DOI: 10.4081/dr.2017.7340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Mustafa Aksoy
- Department of Dermatology, Harran University Medical Faculty, Sanliurfa, Turkey
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23
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Handa S, De D, Khullar G, Radotra BD, Sachdeva N. The clinicoaetiological, hormonal and histopathological characteristics of melasma in men. Clin Exp Dermatol 2017; 43:36-41. [DOI: 10.1111/ced.13234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2017] [Indexed: 11/29/2022]
Affiliation(s)
- S. Handa
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - D. De
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - G. Khullar
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - B. D. Radotra
- Department of Histopathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - N. Sachdeva
- Department of Endocrinology; Postgraduate Institute of Medical Education and Research; Chandigarh India
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24
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Ogbechie-Godec OA, Elbuluk N. Melasma: an Up-to-Date Comprehensive Review. Dermatol Ther (Heidelb) 2017; 7:305-318. [PMID: 28726212 PMCID: PMC5574745 DOI: 10.1007/s13555-017-0194-1] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 01/12/2023] Open
Abstract
Melasma is a common acquired condition of symmetric hyperpigmentation, typically occurring on the face, with higher prevalence in females and darker skin types. Multiple etiologies, including light exposure, hormonal influences, and family history, have been implicated in the pathogenesis of this disorder. Overall prevalence ranges widely at 1-50%, since values are typically calculated within a specific ethnic population within a geographic region. Histologically, melasma can display increased epidermal and/or dermal pigmentation, enlarged melanocytes, increased melanosomes, solar elastosis, dermal blood vessels, and, occasionally, perivascular lymphohistiocytic infiltrates. Various topical, oral, and procedural therapies have been successfully used to treat melasma. Traditional topical therapies including hydroquinone, tretinoin, corticosteroids, and triple combination creams; however, other synthetic and natural topical compounds have also shown varying efficacies. Promising oral therapies for melasma include tranexamic acid, Polypodium leucotomos, and glutathione. Procedures, including chemical peels, microneedling, radiofrequency, and lasers, are also often used as primary or adjunctive treatments for melasma. Notably, combination therapies within or across treatment modalities generally result in better efficacies than monotherapies. This review serves as a comprehensive update on the current understanding of the epidemiology, pathogenesis, clinical and histologic features of melasma, as well as treatments for this common, yet therapeutically challenging, condition.
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Affiliation(s)
| | - Nada Elbuluk
- Ronald O. Perelman Department of Dermatology, New York University, New York, NY, USA.
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25
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Choubey V, Sarkar R, Garg V, Kaushik S, Ghunawat S, Sonthalia S. Role of oxidative stress in melasma: a prospective study on serum and blood markers of oxidative stress in melasma patients. Int J Dermatol 2017; 56:939-943. [PMID: 28681382 DOI: 10.1111/ijd.13695] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Melasma is a common pigmentary disorder presenting in the dermatological clinic. Many factors have been implicated in the pathogenesis, however, the cause still remains elusive. Recently the effect of oxidative damage has been proposed in the etiopathogenesis of melasma. This study was undertaken to evaluate the role of oxidative stress in patients with melasma. MATERIAL AND METHODS Fifty patients with melasma, age 18 years of age and older, and an equal number of age and sex-matched controls were included in the study. Baseline severity assessment using the modified Melasma Area and Severity Index (modified MASI score) was done in all patients. Serum malondialdehyde, blood superoxide dismutase, and blood glutathione peroxidase levels were measured in cases and controls group and results were compared. RESULT The serum levels of malondialdehyde, superoxide dismutase, and blood glutathione were significantly higher among the cases compared to controls. The difference in the serum concentrations was significant between the two groups (P < 0.01). A positive correlation was found between these enzyme levels and severity of melasma (modified MASI score); however, this correlation was statistically significant with serum malondialdehyde only. The level of oxidative stress among the male and female melasma patients was not statistically different. CONCLUSION Oxidative stress was found to be increased in cases of melasma compared to the control group in this study. This substantiates the role of oxidative stress in etiopathogenesis of melasma; however, further studies are required to reach a definitive conclusion.
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Affiliation(s)
- Vikrant Choubey
- Department of Dermatology, Venereology and Lepreology, Maulana Azad Medical College, New Delhi, India
| | - Rashmi Sarkar
- Department of Dermatology, Venereology and Lepreology, Maulana Azad Medical College, New Delhi, India
| | - Vijay Garg
- Department of Dermatology, Venereology and Lepreology, Maulana Azad Medical College, New Delhi, India
| | - Smita Kaushik
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
| | - Sneha Ghunawat
- Department of Dermatology, Venereology and Lepreology, Maulana Azad Medical College, New Delhi, India
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India E-mail:
| | - Pallavi Ailawadi
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Mazurek K, Pierzchała E. Comparison of efficacy of products containing azelaic acid in melasma treatment. J Cosmet Dermatol 2016; 15:269-82. [DOI: 10.1111/jocd.12217] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Klaudia Mazurek
- Department of Aesthetic Medicine; Chair of Cosmetology; School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec; Medical University of Silesia in Katowice; Katowice Poland
| | - Ewa Pierzchała
- Department of Aesthetic Medicine; Chair of Cosmetology; School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec; Medical University of Silesia in Katowice; Katowice Poland
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29
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Ogita A, Funasaka Y, Ansai SI, Kawana S, Saeki H. Melasma in a Male Patient due to Estrogen Therapy for Prostate Cancer. Ann Dermatol 2015; 27:763-4. [PMID: 26719650 PMCID: PMC4695433 DOI: 10.5021/ad.2015.27.6.763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 01/24/2015] [Accepted: 02/04/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Azusa Ogita
- Department of Dermatology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yoko Funasaka
- Department of Dermatology, Nippon Medical School Hospital, Tokyo, Japan
| | - Shin-Ichi Ansai
- Department of Dermatology, Nippon Medical School Hospital, Tokyo, Japan
| | - Seiji Kawana
- Department of Dermatology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School Hospital, Tokyo, Japan
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Ikino JK, Nunes DH, Silva VPMD, Fröde TS, Sens MM. Melasma and assessment of the quality of life in Brazilian women. An Bras Dermatol 2015; 90:196-200. [PMID: 25830989 PMCID: PMC4371668 DOI: 10.1590/abd1806-4841.20152771] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 02/18/2014] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Melasma is a chronic, acquired hyperpigmentation disease on sun-exposed areas
of the skin, which affects patients' quality of life. OBJECTIVE To assess the impact on the quality of life of women living in Florianópolis,
Brazil, through questionnaire (MelasQol), and investigate the clinical
aspects and risk factors for melasma, correlating them with the MelasQol
scores. METHODS This study was performed on 51 melasma patients cared for at the University
Hospital of the Universidade Federal de Santa Catarina. The variables
included were: age, gender, age of onset of melasma, Fitzpatrick phototype
(I-VI), duration and family history of melasma, onset of melasma during
pregnancy, use of hormonal contraceptive, thyroid disorder and distribution
of melasma. The MelasQoL questionnaire, validated for Brazilian Portuguese
(MelasQoL-BP), was applied. RESULTS The mean age was 38.43±6.75 years. All patients were women. The most common
Fitzpatrick skin phototypes were III (49.02%) and IV (33.33%). Melasma had a
mean age of onset of 29.18±7.05 years and a mean duration of 9.25±6.18
years. The majority of patients did not have familial history of melasma
(50.98%). Melasma onset was associated with pregnancy (45.10%). The
MelasQoL-BP analysis revealed significant emotional impact on patients, such
as feeling bothered (94.11%), frustrated and embarrassed (64.71%), and
depressed (52.94%) about their skin appearance, as well as unattractive
(78.43%). No social impact was observed (P>0.05). CONCLUSION Melasma has a strong emotional impact on quality of life, resulting
especially from feelings about skin appearance.
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Treatment of Melasma in Men With Low-Fluence Q-Switched Neodymium-Doped Yttrium–Aluminum–Garnet Laser Versus Combined Laser and Glycolic Acid Peeling. Dermatol Surg 2015; 41:457-65. [DOI: 10.1097/dss.0000000000000304] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Melasma is an acquired pigmentary disorder characterized by symmetrical hyperpigmented macules on the face. Its pathogenesis is complex and involves the interplay of various factors such as genetic predisposition, ultraviolet radiation, hormonal factors, and drugs. An insight into the pathogenesis is important to devise treatment modalities that accurately target the disease process and prevent relapses. Hydroquinone remains the gold standard of treatment though many newer drugs, especially plant extracts, have been developed in the last few years. In this article, we review the pathogenetic factors involved in melasma. We also describe the newer treatment options available and their efficacy. We carried out a PubMed search using the following terms “melasma, pathogenesis, etiology, diagnosis, treatment” and have included data of the last few years.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Pooja Arora
- Department of Dermatology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Vijay Kumar Garg
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Evidence-based treatment for melasma: expert opinion and a review. Dermatol Ther (Heidelb) 2014; 4:165-86. [PMID: 25269451 PMCID: PMC4257945 DOI: 10.1007/s13555-014-0064-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Melasma is one of the most common pigmentary disorders seen by dermatologists and often occurs among women with darker complexion (Fitzpatrick skin type IV–VI). Even though melasma is a widely recognized cause of significant cosmetic disfigurement worldwide and in India, there is a lack of systematic and clinically usable treatment algorithms and guidelines for melasma management. The present article outlines the epidemiology of melasma, reviews the various treatment options along with their mode of action, underscores the diagnostic dilemmas and quantification of illness, and weighs the evidence of currently available therapies. Methods A panel of eminent dermatologists was created and their expert opinion was sought to address lacunae in information to arrive at a working algorithm for optimizing outcome in Indian patients. A thorough literature search from recognized medical databases preceded the panel discussions. The discussions and consensus from the panel discussions were drafted and refined as evidence-based treatment for melasma. The deployment of this algorithm is expected to act as a basis for guiding and refining therapy in the future. Results It is recommended that photoprotection and modified Kligman’s formula can be used as a first-line therapy for up to 12 weeks. In most patients, maintenance therapy will be necessary with non-hydroquinone (HQ) products or fixed triple combination intermittently, twice a week or less often. Concomitant camouflage should be offered to the patient at any stage during therapy. Monthly follow-ups are recommended to assess the compliance, tolerance, and efficacy of therapy. Conclusion The key therapy recommended is fluorinated steroid containing 2–4% HQ-based triple combination for first line, with additional selective peels if required in second line. Lasers are a last resort. Electronic supplementary material The online version of this article (doi:10.1007/s13555-014-0064-z) contains supplementary material, which is available to authorized users.
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Cestari TF, Dantas LP, Boza JC. Acquired hyperpigmentations. An Bras Dermatol 2014; 89:11-25. [PMID: 24626644 PMCID: PMC3938350 DOI: 10.1590/abd1806-4841.20142353] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 03/25/2013] [Indexed: 01/15/2023] Open
Abstract
Cutaneous hyperpigmentations are frequent complaints, motivating around 8.5% of all
dermatological consultations in our country. They can be congenital, with different
patterns of inheritance, or acquired in consequence of skin problems, systemic
diseases or secondary to environmental factors. The vast majority of them are linked
to alterations on the pigment melanin, induced by different mechanisms. This review
will focus on the major acquired hyperpigmentations associated with increased
melanin, reviewing their mechanisms of action and possible preventive measures.
Particularly prominent aspects of diagnosis and therapy will be emphasized, with
focus on melasma, post-inflammatory hyperpigmentation, periorbital pigmentation,
dermatosis papulosa nigra, phytophotodermatoses, flagellate dermatosis, erythema
dyschromicum perstans, cervical poikiloderma (Poikiloderma of Civatte), acanthosis
nigricans, cutaneous amyloidosis and reticulated confluent dermatitis
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Affiliation(s)
- Tania Ferreira Cestari
- Rio Grande do Sul Federal University, Internal Medicine Department, Porto Alegre(RS), Brazil, PhD - Associate Professor at the Internal Medicine Department, at Rio Grande do Sul Federal University (UFRGS). Teaching Professor at the Child and Adolescent Health Sciences and the Surgical Post-Graduation Programs at Rio Grande do Sul Federal University (UFRGS). Chief of the Dermatology Department at Porto Alegre Clinics Hospital - Rio Grande do Sul Federal University (HCPA-UFRGS) - Porto Alegre (RS), Brazil
| | - Lia Pinheiro Dantas
- Rio Grande do Sul Federal University, Medical Sciences Post Graduation program, Porto AlegreRS, Brazil, MD, Dermatologist, MSc (in course) at the Medical Sciences Post Graduation program at Rio Grande do Sul Federal University (UFRGS) - Porto Alegre (RS), Brazil
| | - Juliana Catucci Boza
- Rio Grande do Sul Federal University, Child and Adolescent Health Sciences Post Graduation Program, Porto AlegreRS, Brazil, MD, Dermatologist, PhD (in course) at the Child and Adolescent Health Sciences Post Graduation Program at Rio Grande do Sul Federal University (UFRGS) - Porto Alegre (RS), Brazil
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Effect of 82% Lactic Acid in Treatment of Melasma. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:407142. [PMID: 27355080 PMCID: PMC4897467 DOI: 10.1155/2014/407142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/23/2014] [Accepted: 05/24/2014] [Indexed: 11/18/2022]
Abstract
Melasma is an acquired, chronic, and symmetrical hypermelanosis, characterized by brown patches of variable darkness on sun exposed areas of body. There are numerous modalities of treatment currently in use for this disease, of which the chemical peeling is very commonly used. Therefore, the present work was done to see the effect of 82% lactic acid peel in the treatment of melasma. A total number of 20 patients of either sex attending the OPD of dermatology department with clinically evident melasma were included in the study. 82% Lactic acid peel was applied on the face for 12 weeks in each patient. Patients were evaluated clinically and photographically at various intervals and in follow-up till 24 weeks. Assessment of patient satisfaction and side effects were also noted. All the subjects completed the study. Application of this peel for 12 weeks significantly decreased the melasma area severity index score and also melasma severity scale score. Patient and physician analogue scales also showed the improvement by the treatment. Regarding the adverse effects, burning sensation was the only side effect noted in our study. In conclusion, 82% lactic acid peel is well tolerated and can be used for the treatment of melasma.
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Hexsel D, Lacerda DA, Cavalcante AS, Filho CASM, Kalil CLPV, Ayres EL, Azulay-Abulafia L, Weber MB, Serra MS, Lopes NFP, Cestari TF. Epidemiology of melasma in Brazilian patients: a multicenter study. Int J Dermatol 2013; 53:440-4. [DOI: 10.1111/j.1365-4632.2012.05748.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Doris Hexsel
- Cosmetic Dermatology at the Department of Dermatology; Pontificia Universidade Catolica do Rio Grande do Sul; Porto Alegre RS
- Brazilian Center for Studies in Dermatology; Porto Alegre RS
| | - Davi A. Lacerda
- Hospital Local de Sapopemba e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; São Paulo SP
| | | | | | | | | | - Luna Azulay-Abulafia
- Dermatology Service; Santa Casa de Misericórdia do Rio de Janeiro; Rio de Janeiro RJ
| | - Magda B. Weber
- Department of Dermatology; Universidade Federal de Ciências da Saúde de Porto Alegre; RS
| | - Marcio S. Serra
- Department of Dermatology of the Gaffrèe & Guinle University Hospital; Universidade Federal do Estado do Rio de Janeiro; Rio de Janeiro RJ
| | | | - Tania F. Cestari
- Service of Dermatology; Hospital de Clinicas de Porto Alegre; UFRGS; Porto Alegre RS Brazil
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Abstract
Melasma is an acquired hypermelanosis that results in localized hyperpigmentation, commonly found on the face. This condition is much more common in women than men. There are some features of melasma in men that seem to differ from those seen in women. However, there is a paucity of data on this topic. The aim of this article is to review the etiology, clinical presentation, and treatment of melasma in men. It is important for dermatologists to understand some unique aspects of melasma in this group to provide appropriate care for patients who suffer from this frustrating condition.
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Affiliation(s)
- Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Jang YH, Sim JH, Kang HY, Kim YC, Lee ES. The histopathological characteristics of male melasma: Comparison with female melasma and lentigo. J Am Acad Dermatol 2012; 66:642-9. [DOI: 10.1016/j.jaad.2010.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 10/26/2010] [Accepted: 10/29/2010] [Indexed: 10/14/2022]
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Tamega ADA, Miot LDB, Bonfietti C, Gige TC, Marques MEA, Miot HA. Clinical patterns and epidemiological characteristics of facial melasma in Brazilian women. J Eur Acad Dermatol Venereol 2012; 27:151-6. [PMID: 22212073 DOI: 10.1111/j.1468-3083.2011.04430.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A de A Tamega
- Department of Dermatology, Sao Paulo State University, Botucatu Medical School, Unesp, Campus Universitário de Rubião, Botucatu, SP, Brazil
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Affiliation(s)
- Virendra N Sehgal
- Dermato Venereology Center, Sehgal Nursing Home, Panchwati, Delhi, India.
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