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Zhao Q, Gu N, Li Y, Wu X, Ouyang Q, Deng L, Ma H, Zhu Y, Fang F, Ye H, Wu K. Self-assembled gel microneedle formed by MS deep eutectic solvent as a transdermal delivery system for hyperpigmentation treatment. Mater Today Bio 2024; 26:101090. [PMID: 38800564 PMCID: PMC11127278 DOI: 10.1016/j.mtbio.2024.101090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
Hyperpigmentation (HP) is an unfavorable skin disease that typically caused by injury, inflammation, or photoaging and leads to numerous physical and psychological issues in patients. Recently, development and application of natural whitening substances, particularly compound curcumin (CUR), is one of the most prevalent treatments for HP. However, it is still a formidable challenge to improve the percutaneous delivery of CUR due to its inadequate solubility in water and excellent barrier function of skin. To overcome the limitations of conventional delivery and increase the percutaneous absorption of CUR, the efficient delivery of CUR is urgently required. Herein, we developed a new malic acid-sorbitol deep eutectic solvent (MS/DES) gel microneedle loaded with CUR as a transdermal delivery system for HP treatment. The MS/DES gel produces three-dimensional (3D) network structure by self-assembly of hydrogen bond interactions, which conferred the CUR-MS/DES-GMN with sufficient mechanical properties to successfully penetrate skin tissue while also helping to enhance the drug's release rate. The CUR-MS/DES-GMN exhibit high biocompatibility and mechanical property in vivo of mice. The zebrafish experiments also show that CUR-MS/DES gel has significant effect of anti-pigmentation. Therefore, the designed CUR-MS/DES-GMN system provides a novel strategy for HP treatment based on self-assembly of naturally molecules.
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Affiliation(s)
- Qi Zhao
- The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524003, China
- The Marine Biomedical Research Institute of Guangdong Zhanjiang, School of Ocean and Tropical Medicine, Guangdong Medical University, Zhanjiang, 524023, China
- Guangdong (Zhanjiang) Provincial Laboratory of Southern Marine Science and Engineering, Zhanjiang, 524023, China
| | - Na Gu
- The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524003, China
- The Marine Biomedical Research Institute of Guangdong Zhanjiang, School of Ocean and Tropical Medicine, Guangdong Medical University, Zhanjiang, 524023, China
- Guangdong (Zhanjiang) Provincial Laboratory of Southern Marine Science and Engineering, Zhanjiang, 524023, China
| | - Yier Li
- The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524003, China
- The Marine Biomedical Research Institute of Guangdong Zhanjiang, School of Ocean and Tropical Medicine, Guangdong Medical University, Zhanjiang, 524023, China
- Guangdong (Zhanjiang) Provincial Laboratory of Southern Marine Science and Engineering, Zhanjiang, 524023, China
| | - Xia Wu
- The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524003, China
- The Marine Biomedical Research Institute of Guangdong Zhanjiang, School of Ocean and Tropical Medicine, Guangdong Medical University, Zhanjiang, 524023, China
- Guangdong (Zhanjiang) Provincial Laboratory of Southern Marine Science and Engineering, Zhanjiang, 524023, China
| | - Qianqian Ouyang
- The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524003, China
- The Marine Biomedical Research Institute of Guangdong Zhanjiang, School of Ocean and Tropical Medicine, Guangdong Medical University, Zhanjiang, 524023, China
- Guangdong (Zhanjiang) Provincial Laboratory of Southern Marine Science and Engineering, Zhanjiang, 524023, China
| | - Luming Deng
- The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524003, China
- The Marine Biomedical Research Institute of Guangdong Zhanjiang, School of Ocean and Tropical Medicine, Guangdong Medical University, Zhanjiang, 524023, China
- Guangdong (Zhanjiang) Provincial Laboratory of Southern Marine Science and Engineering, Zhanjiang, 524023, China
| | - Hui Ma
- The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524003, China
- The Marine Biomedical Research Institute of Guangdong Zhanjiang, School of Ocean and Tropical Medicine, Guangdong Medical University, Zhanjiang, 524023, China
- Guangdong (Zhanjiang) Provincial Laboratory of Southern Marine Science and Engineering, Zhanjiang, 524023, China
| | - Yuzhen Zhu
- The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524003, China
- The Marine Biomedical Research Institute of Guangdong Zhanjiang, School of Ocean and Tropical Medicine, Guangdong Medical University, Zhanjiang, 524023, China
- Guangdong (Zhanjiang) Provincial Laboratory of Southern Marine Science and Engineering, Zhanjiang, 524023, China
| | - Fang Fang
- The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524003, China
| | - Hua Ye
- The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524003, China
- The Marine Biomedical Research Institute of Guangdong Zhanjiang, School of Ocean and Tropical Medicine, Guangdong Medical University, Zhanjiang, 524023, China
- Guangdong (Zhanjiang) Provincial Laboratory of Southern Marine Science and Engineering, Zhanjiang, 524023, China
| | - Kefeng Wu
- The Second Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524003, China
- The Marine Biomedical Research Institute of Guangdong Zhanjiang, School of Ocean and Tropical Medicine, Guangdong Medical University, Zhanjiang, 524023, China
- Guangdong (Zhanjiang) Provincial Laboratory of Southern Marine Science and Engineering, Zhanjiang, 524023, China
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Liao X, Cheng F, Jiang Y. Efficacy and safety of mesotherapy with tranexamic acid versus vitamin C in the treatment of melasma: A meta-analysis and systemic review. J Cosmet Dermatol 2024. [PMID: 38693699 DOI: 10.1111/jocd.16353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND The exact pathogenesis of melasma is not yet known, and its treatment remains challenging. Mesotherapy with tranexamic acid (TXA) and vitamin C was both reported to have certain effects on melasma. In spite of that several articles have compared the efficacy and safety of the two drugs on melasma, most of them were clinical study with small sample size. AIMS To evaluate the efficacy and safety of mesotherapy with TXA versus vitamin C in treating melasma through meta-analysis and systemic review. METHODS The authors searched PubMed, Web of Science, Springer, and ScienceDirect for studies that compared mesotherapy with TXA versus vitamin C as a treatment for melasma. Primary outcomes were change in melasma area and severity index (MASI) before and after the treatment. RESULTS Finally, five studies with a total of 127 patients were included in the systematic review. There was no statistic difference in the change in MASI score between the TXA and vitamin C groups (mean difference, 0.16; 95% CI, -0.79 to 1.11). CONCLUSIONS Mesotherapy with both TXA and vitamin C is safe and effective in the treatment of melasma.
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Affiliation(s)
- Xin Liao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. China
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. China
| | - Fengrui Cheng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. China
| | - Yunlan Jiang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. China
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Xiao Y, Zhou L, Tao W, Yang X, Li J, Wang R, Zhao Y, Peng C, Zhang C. Preparation of paeoniflorin-glycyrrhizic acid complex transethosome gel and its preventive and therapeutic effects on melasma. Eur J Pharm Sci 2024; 192:106664. [PMID: 38061662 DOI: 10.1016/j.ejps.2023.106664] [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: 07/25/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023]
Abstract
Paeoniflorin (PF) and glycyrrhizic acid (GL) have skin beautifying effects of anti-inflammation, anti-oxidation, inhibition of melanin formation, and reduction of skin pigmentation. To improve the transdermal permeability of PF and GL in transdermal drug delivery system (TDDS) and enhance their anti-melasma efficacy, PF-GL transethosome (PF-GL-TE) was prepared by ethanol injection method, and finally gelled with carbomer-940 to form PF-GL-TE gel. Consequently, the obtained PF-GL-TE is small and uniform, with an average particle size and a PDI value of about 167.9 nm and 0.102. PF-GL-TE gel showed sustained release behavior and high transdermal permeability in vitro release and transdermal tests. Meanwhile, PF-GL-TE gel played significant preventive effects on melasma induced by progesterone injection and ultraviolet radiation B (UVB) irradiation. According to the results of H&E staining and Masson staining of rat skin, PF-GL-TE gel can alleviate the skin inflammation of and reduce the loss of collagen fibers of back skin in the melasma model rats. Compared with the PF-GL mixture gel, PF-GL-TE gel significantly attenuated the oxidative damage of liver and skin by increasing the activity of SOD and reducing the content of MDA. The results of Western blot showed that PF-GL-TE gel might down-regulate melanin-related proteins expressions of MITF/TYR/TRP1 and TRP2 to prevent and treat melasma. These findings indicate that PF-GL-TE gel is an effective TDDS for delivering PF and GL into the skin, providing a promising preparation for effective prevention and treatment of melasma.
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Affiliation(s)
- Yaoyao Xiao
- Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Anhui Provincial Department of Education, Engineering Technology Research Center of Modern Pharmaceutical Preparation, China; Anhui Genuine Chinese Medicinal Materials Quality Improvement Innovation Collaborative Center, Hefei 230012, China; Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei 230012, China; Anhui Key Laboratory of Compound Chinese Materia Medica, Hefei 230012, China
| | - Lele Zhou
- Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Anhui Provincial Department of Education, Engineering Technology Research Center of Modern Pharmaceutical Preparation, China; Anhui Genuine Chinese Medicinal Materials Quality Improvement Innovation Collaborative Center, Hefei 230012, China; Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei 230012, China; Anhui Key Laboratory of Compound Chinese Materia Medica, Hefei 230012, China
| | - Wenkang Tao
- Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Anhui Provincial Department of Education, Engineering Technology Research Center of Modern Pharmaceutical Preparation, China; Anhui Genuine Chinese Medicinal Materials Quality Improvement Innovation Collaborative Center, Hefei 230012, China; Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei 230012, China; Anhui Key Laboratory of Compound Chinese Materia Medica, Hefei 230012, China
| | - Xuan Yang
- Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Anhui Provincial Department of Education, Engineering Technology Research Center of Modern Pharmaceutical Preparation, China; Anhui Genuine Chinese Medicinal Materials Quality Improvement Innovation Collaborative Center, Hefei 230012, China; Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei 230012, China; Anhui Key Laboratory of Compound Chinese Materia Medica, Hefei 230012, China
| | - Junying Li
- Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Anhui Provincial Department of Education, Engineering Technology Research Center of Modern Pharmaceutical Preparation, China; Anhui Genuine Chinese Medicinal Materials Quality Improvement Innovation Collaborative Center, Hefei 230012, China; Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei 230012, China; Anhui Key Laboratory of Compound Chinese Materia Medica, Hefei 230012, China
| | - Rulin Wang
- Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Anhui Provincial Department of Education, Engineering Technology Research Center of Modern Pharmaceutical Preparation, China; Anhui Genuine Chinese Medicinal Materials Quality Improvement Innovation Collaborative Center, Hefei 230012, China; Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei 230012, China; Anhui Key Laboratory of Compound Chinese Materia Medica, Hefei 230012, China
| | - Yanan Zhao
- Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230000, China.
| | - Can Peng
- Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Anhui Provincial Department of Education, Engineering Technology Research Center of Modern Pharmaceutical Preparation, China; Anhui Genuine Chinese Medicinal Materials Quality Improvement Innovation Collaborative Center, Hefei 230012, China; Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei 230012, China; Anhui Key Laboratory of Compound Chinese Materia Medica, Hefei 230012, China.
| | - Caiyun Zhang
- Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Center for Xin'an Medicine and Modernization of Traditional Chinese Medicine of IHM, School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Anhui Provincial Department of Education, Engineering Technology Research Center of Modern Pharmaceutical Preparation, China; Anhui Genuine Chinese Medicinal Materials Quality Improvement Innovation Collaborative Center, Hefei 230012, China; Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei 230012, China; Anhui Key Laboratory of Compound Chinese Materia Medica, Hefei 230012, China.
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Mpofana N, Paulse M, Gqaleni N, Makgobole MU, Pillay P, Hussein A, Dlova NC. The Effect of Melasma on the Quality of Life in People with Darker Skin Types Living in Durban, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7068. [PMID: 37998299 PMCID: PMC10671852 DOI: 10.3390/ijerph20227068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
Melasma is a common skin disorder of acquired hyperpigmentation that appears commonly on the face. Although asymptomatic, melasma causes psychosocial and emotional distress. This study aimed to assess melasma's severity on people with darker skin types, evaluate the effects of melasma on the quality of life (QoL), and establish QoL predictors in affected individuals. This was a cross-sectional analytic study that enrolled 150 patients from three private dermatology clinics in Durban, South Africa who were diagnosed with melasma. The severity of melasma alongside QoL were measured using a melasma area and severity index (MASI) score and melasma quality of life scale (MELASQoL), respectively. The associations among factors and QoL were explored using multivariable methods and stepwise regression analysis. p-values less than 0.05 were considered significant. Enrolled patients were predominantly females (95%), of which 76% were of black African ethnicity, 9% were of Indian ethnicity, and 15% had mixed ancestry, with an average age of 47.30 years. Family history revealed that 61% had no prior melasma cases, while 39% had affected relatives, most commonly mothers (41%). The cheeks were the most common site for melasma. MASI score of Masi (β = 0.209, t = 2.628, p < 0.001), the involvement of cheeks (β = -0.268, t = -3.405, p < 0.001), level of education (β = -0.159, t = -2.029, p = 0.044), and being menopausal (β = -0.161, t = -2.027, p = 0.045) were found to be predictors of QoL. A regression model was created to forecast MELASQoL using these four predictors. This equation's significance lies in its ability to enable the remote assessment of MELASQoL based on these four variables. It offers a valuable tool for researchers and medical professionals to quantitatively and objectively evaluate the impact of melasma on an individual's quality of life.
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Affiliation(s)
- Nomakhosi Mpofana
- Dermatology Department, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban 4000, South Africa;
- Department of Somatology, Durban University of Technology, Durban 4000, South Africa;
| | - Michael Paulse
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa;
| | - Nceba Gqaleni
- Discipline of Traditional Medicine, University of KwaZulu-Natal, Durban 4000, South Africa;
- Faculty of Health Sciences, Durban University of Technology, Durban 4000, South Africa
| | | | - Pavitra Pillay
- Department of Biomedical and Clinical Technology, Durban University of Technology, Durban 4000, South Africa;
| | - Ahmed Hussein
- Department of Chemistry, Cape Peninsula University of Technology, Cape Town 8000, South Africa;
| | - Ncoza Cordelia Dlova
- Dermatology Department, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban 4000, South Africa;
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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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Albzea W, AlRashidi R, Alkandari D, Sadan M, Alkandari A, Alkanderi JJ, AlHajri MT, Almutairi SN, Alenzi A, Alanazi S, Al-Qurashi S, Alhajaji R, Al Shami A. Azelaic Acid Versus Hydroquinone for Managing Patients With Melasma: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cureus 2023; 15:e41796. [PMID: 37457606 PMCID: PMC10339666 DOI: 10.7759/cureus.41796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/18/2023] Open
Abstract
Melasma, a commonly acquired hyperpigmentation skin condition, is usually treated with topical agents as the first line of management. This systematic review and meta-analysis aimed to assess the efficacy and safety of azelaic acid versus hydroquinone in treating melasma patients. We conducted a comprehensive search across four online databases (PubMed, Scopus, Web of Science, and Cochrane Library) from the time of their creation until May 28, 2023. We considered randomized controlled studies comparing hydroquinone with azelaic acid for the treatment of melasma patients. We used the Cochrane Risk of Bias tool 2 to evaluate the risk of bias. The mean difference (MD) for continuous variables and the risk ratio (RR) for categorical variables, with a 95% confidence interval (CI) were pooled. Six studies were included, with a total of 673 patients with melasma. The azelaic acid had a lower mean change in melasma area severity index (MASI) than the hydroquinone group [MD= -1.23, 95% CI (-2.05, -0.40), P=0.004]. No difference was observed regarding the improvement via the objective response scale, the reduction in pigmentation, or the adverse events reported. However, despite not being statistically significantly different, there was a trend towards having more good responses in the azelaic acid group. Azelaic acid may be better than hydroquinone in reducing melasma severity (measured by MASI). However, larger studies with long-term follow-up are needed to validate these findings.
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Affiliation(s)
- Wardah Albzea
- Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Rahf AlRashidi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Danah Alkandari
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Moudhi Sadan
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Abdulaziz Alkandari
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Jaber J Alkanderi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Maisem T AlHajri
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Saad N Almutairi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Athbi Alenzi
- Emergency Department, Adan Hospital, Al-Ahmadi, KWT
| | - Shahad Alanazi
- Pharmacology, College of Pharmacy, Alqassim University, Alqassim, SAU
| | - Safenaz Al-Qurashi
- Family Medicine, Al-Awali Primary Health Care, Ministry of Health, Makkah, SAU
| | - Raghad Alhajaji
- Public Health Department, Makkah Health Affairs, Ministry of Health, Makkah, SAU
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Nazli EC, Avcı C, Akarsu S. The effect of patient characteristics on illness perception and sun protection behaviors in melasma. J Cosmet Dermatol 2022; 21:7107-7115. [PMID: 36136352 DOI: 10.1111/jocd.15401] [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: 08/09/2022] [Accepted: 09/16/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND/AIM Melasma, a significant cosmetic problem, has been accepted by some authors as a photoaging illness in recent times. There is no published study evaluating the effects of the clinical and sociodemographic findings on illness perception and sun protection behaviors (SPBs) in patients with melasma. PATIENTS/METHODS Sociodemographic data, personal characteristics, and clinical features of 150 patients with melasma were recorded in this cross-sectional study. They were analyzed for their SPBs in three groups as "never," "rarely/sometimes," and "often/always." Patients completed the Melasma Quality of Life (QoL) Scale and Revised-Illness Perception Questionnaire. RESULTS Melasma patients with higher clinical severity and Qol scores, lower education level, concomitant chronic illness, and a history of previous melasma treatment thought more frequently that melasma had negative serious consequences. Majority of the patients blamed sun exposure as the cause of the melasma. However, SPBs were more frequent only in patients with higher socioeconomic and educational levels, a previous history of melasma treatment, and evaluating their disease as a chronic condition. Neither Qol nor clinical severity score had a significant effect on sun exposure causal attribution or SPBs. No significant effect of patients' perception of melasma was determined on the use of sunscreen or protective hat. CONCLUSION Being aware of the factors affecting the perception of melasma and QoL of patients might be helpful in making persistent individual recommendations for the regulation of SPBs.
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Affiliation(s)
- Ecem Cantürk Nazli
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey
| | - Ceylan Avcı
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey
| | - Sevgi Akarsu
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey
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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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Seetan K, Shatanawi M, Ali A, Khamees A, Alsheikh A, Alawneh A, Al-Shami M, Al-Shar'e H. Disease characteristics, determinants, and perception of use of sunscreen and sun-protective behaviors among patients of color with melasma: A cross-sectional study. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022; 38:495-500. [PMID: 35108414 DOI: 10.1111/phpp.12779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/28/2021] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Melasma is an acquired state of hyperpigmentation that most commonly affects the face. The use of sunscreen is essential in melasma treatment. We sought to investigate patients' perspectives and behaviors toward sunscreen usage. METHODS A cross-sectional hospital-based study targeted 418 melasma patients from May 2019 to May 2021. Data regarding socio-demographic characteristics and the knowledge, attitude, and behavior toward sunscreen and sun exposure were collected and analyzed. Furthermore, a complete clinical assessment was done. RESULTS The mean age of the patients was 35.4 ± 8.6 years. Melasma distribution was mostly centro-facial (49.8%). The mean duration of the disease was 22.3 ± 11.6 months, with a mean Melasma Area and Severity Index (MASI) score of 18.6 ± 8.9. Only 170 patients believed that sun exposure played a role in their disease. Skin darkening was the most recognized effect of sun exposure by 92.9% of participants. 58.6% reported using sunscreen with a higher female predominance (p < .001), while males reported more broad-spectrum sunscreen usage (p < .001). The reason that was reported the most behind not using sunscreen was the high cost (94%). CONCLUSIONS Our study showed a sound level of knowledge regarding the effects of sun exposure, and sunscreen advantages and disadvantages, with relatively inadequate translation into their attitudes and practices regarding sun-protective behaviors. The use of sunscreen among the patients was average in numbers with a higher female predominance.
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Affiliation(s)
- Khaled Seetan
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Murad Shatanawi
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Amin Ali
- Department of Clinical Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Almu'atasim Khamees
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Ahmad Alsheikh
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Anas Alawneh
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Manar Al-Shami
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Hossam Al-Shar'e
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
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10
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Abstract
Melasma is a multifactorial dyschromia that results from exposure to external factors (such as solar radiation) and hormonal factors (such as sex hormones and pregnancy), as well as skin inflammation (such as contact dermatitis and esthetic procedures), in genetically predisposed individuals. Beyond hyperfunctional melanocytes, skin with melasma exhibits a series of structural and functional alterations in the epidermis, basement membrane, and upper dermis that interact to elicit and sustain a focal hypermelanogenic phenotype. Evolution in the knowledge of the genetic basis of melasma and the cutaneous response to solar radiation, as well as the roles of endocrine factors, antioxidant system, endothelium proliferation, fibroblast senescence, mast cell degranulation, autophagy deficits of the melanocyte, and the paracrine regulation of melanogenesis, will lead to the development of new treatments and preventive strategies. This review presents current knowledge on these aspects of the pathogenesis of melasma and discusses the effects of specific treatments and future research on these issues.
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11
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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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12
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Bosamiya SS, Jain SM. A Pilot Study to Compare Therapeutic Efficacy and Safety of Combined Treatment of Skin Microneedling and Depigmenting Cream versus Depigmenting Cream Alone in Facial Melasma at Tertiary Care Center. J Cutan Aesthet Surg 2021; 14:156-159. [PMID: 34566356 PMCID: PMC8423208 DOI: 10.4103/jcas.jcas_182_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Melasma is a commonly acquired, chronic, and relapsing disorder that results in symmetrical, brownish facial pigmentation. It is more common in women than in men, which generally starts between 20 and 40 years of age, and it can lead to considerable embarrassment and distress. Managing melasma is a difficult challenge that requires long-term treatment with a number of topical agents. Microneedling has been described as a new technique to enhance the drug’s transdermal penetration, and has also been reported to result in sustained long-term improvement of recalcitrant melasma. Aim: The aim of this article was to compare the therapeutic efficacy and safety of combined treatment of skin microneedling and depigmenting cream versus depigmenting cream alone in the treatment of melasma. Materials and Methods: A prospective study was conducted with a sample size of 40 patients, with twenty in each of the treatment arms; 20 patients were treated with combined skin needling and depigmenting cream and 20 with depigmenting cream alone. The outcome was evaluated periodically for up to 2 months using the modified Melasma Area and Severity Index (MASI) score. Results: Significant reduction was observed in modified MASI score in the combined treatment, with P value <0.05. Conclusion: Combining microneedling with Kligman’s regimen gives better results in melasma treatment compared to topical treatment alone.
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Affiliation(s)
- Sanjay S Bosamiya
- Department of Dermatology, Venereology, and Leprosy, Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, Gujarat, India
| | - Sonal M Jain
- Department of Dermatology, Venereology, and Leprosy, Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, Gujarat, India
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13
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Philipp-Dormston WG, Vila Echagüe A, Pérez Damonte SH, Riedel J, Filbry A, Warnke K, Lofrano C, Roggenkamp D, Nippel G. Thiamidol containing treatment regimens in facial hyperpigmentation: An international multi-centre approach consisting of a double-blind, controlled, split-face study and of an open-label, real-world study. Int J Cosmet Sci 2021; 42:377-387. [PMID: 32390164 PMCID: PMC7576892 DOI: 10.1111/ics.12626] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/27/2020] [Indexed: 12/13/2022]
Abstract
Objective Tyrosinase is the rate‐limiting enzyme in melanogenesis. Thiamidol is the most potent inhibitor of human tyrosinase out of 50 000 tested compounds. In clinical studies, it was shown to improve facial hyperpigmentation, post‐inflammatory hyperpigmentation and age spots significantly. To identify the optimal number of daily Thiamidol applications, we conducted a split‐face study comparing the efficacy and tolerability of four‐times with two‐times daily application. Subsequently, we evaluated the efficacy and tolerability of a typical face care regimen containing Thiamidol in a real‐world study. Methods The split‐face study was double‐blind, randomized, controlled, including two Thiamidol containing products (serum and day care SPF 30). The serum was applied twice daily on one half of the face and the day care SPF30 twice‐daily on the whole face. The real‐world study was open‐label, observational, including three Thiamidol containing products (day care SPF 30 in the morning, serum and night care in the evening). In both studies, subjects with mild‐to‐moderate facial hyperpigmentation applied the products over 12 weeks. Assessments included clinical and subjective grading of hyperpigmentation, skin condition, hemi‐/modified MASI, chromameter and clinical photography. Results In the split‐face study (n = 34), hyperpigmentation, skin roughness and hMASI improved all significantly (P < 0.001) versus baseline, with first visible results after two weeks of twice‐daily application. The four‐times daily application led to significant improvement versus the two‐times daily application. In the real‐world study (n = 83), all evaluated parameters, including skin condition and chromametry (n = 30), improved significantly (P < 0.001) in comparison with baseline and the corresponding preceding visits. The subjects judged the cosmetic properties of the products positively. In both studies, the products were well tolerated. Conclusion Four‐times daily Thiamidol improves facial hyperpigmentation significantly more than two‐times daily and is well tolerated by the subjects. The real‐world study with a typical face care regimen containing Thiamidol shows improvement of facial hyperpigmentation and confirms tolerability. Furthermore, the data provide evidence for the suitability of this three‐product Thiamidol regimen for day‐to‐day life.
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Affiliation(s)
- W G Philipp-Dormston
- Hautzentrum Köln, Schillingsrotter Str. 39-41, Köln, 50996, Germany.,Faculty of Health, University Witten/Herdecke, Witten, 58455, Germany
| | - A Vila Echagüe
- Centro de Referencia en Tratamiento Laser, Av. Del Libertador 662, Piso 17, depto. 42, Buenos Aires, Argentina
| | | | - J Riedel
- BDF Argentina, Av Triunvirato 2902, Buenos Aires, C1427 AAP CABA, Argentina
| | - A Filbry
- BDF Argentina, Av Triunvirato 2902, Buenos Aires, C1427 AAP CABA, Argentina
| | - K Warnke
- BDF Argentina, Av Triunvirato 2902, Buenos Aires, C1427 AAP CABA, Argentina
| | - C Lofrano
- Beiersdorf AG, Unnastrasse 48, Hamburg, 20245, Germany
| | - D Roggenkamp
- BDF Argentina, Av Triunvirato 2902, Buenos Aires, C1427 AAP CABA, Argentina
| | - G Nippel
- BDF Argentina, Av Triunvirato 2902, Buenos Aires, C1427 AAP CABA, Argentina
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14
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Dorgham NA, Hegazy RA, Sharobim AK, Dorgham DA. Efficacy and tolerability of chemical peeling as a single agent for melasma in dark‐skinned patients: A systematic review and meta‐analysis of comparative trials. J Cosmet Dermatol 2020; 19:2812-2819. [DOI: 10.1111/jocd.13725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Nevine A. Dorgham
- Dermatology Department Faculty of Medicine Cairo University Giza Egypt
| | - Rehab A. Hegazy
- Dermatology Department Faculty of Medicine Cairo University Giza Egypt
| | | | - Dina A. Dorgham
- Dermatology Department Faculty of Medicine Cairo University Giza Egypt
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15
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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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16
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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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Jusuf NK, Putra IB, Mahdalena M. Is There a Correlation between Severity of Melasma and Quality of Life? Open Access Maced J Med Sci 2019; 7:2615-2618. [PMID: 31777617 PMCID: PMC6876811 DOI: 10.3889/oamjms.2019.407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/13/2019] [Accepted: 07/14/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Melasma is a common chronic acquired hyper melanosis. It has significant impacts on appearance, psychosocial and emotional distress, hence reducing the quality of life of the affected patients. Melasma quality of life scale (MelasQoL) is a new quality of life (QoL) questionnaire consists of 10 questions, scored from 1 to 7, with higher index scores indicating poor QoL. The severity of melasma can be assessed by the Melasma Area and Severity Index (MASI) score. AIM: We aimed to determine the correlation between the severity of melasma (MASI score) and quality of life. MATERIAL AND METHODS: This was a cross-sectional analytic study involving 30 subjects with melasma. The diagnosis was made based on history, clinical features and by Wood’s lamp examination. MASI score was determined to assess the severity of melasma. Subjects answered 10 items of MelasQol questionnaire. All collected data were processed and statistically analysed by Spearman correlation test to determine the association of MASI score with MelasQoL. Association of quality of life with clinical pattern and depth of lesion were analysed by Mann Whitney test. RESULTS: There was no significant correlation between MASI score and MelasQoL (p = 0.797; r = 0.049). Likewise, there was no association of quality of life with clinical pattern type (p = 0.12) and depth of lesion (p = 0.92). CONCLUSION: There was no significant correlation between the MASI score and quality of life.
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Affiliation(s)
- Nelva Karmila Jusuf
- Department of Dermatology and Venerology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Imam Budi Putra
- Department of Dermatology and Venerology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Mahdalena Mahdalena
- Department of Dermatology and Venerology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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18
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Suryaningsih BE, Sadewa AH, Wirohadidjojo YW, Soebono H. Association between heterozygote Val92Met MC1R gene polymorphisms with incidence of melasma: a study of Javanese women population in Yogyakarta. Clin Cosmet Investig Dermatol 2019; 12:489-495. [PMID: 31308719 PMCID: PMC6614830 DOI: 10.2147/ccid.s206115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/20/2019] [Indexed: 11/23/2022]
Abstract
Introduction: Melasma is an acquired hypermelanosis of the face. The pathogenesis of melasma is multifactorial and may be caused by interactions between genetics and the environment. Research has shown that skin pigmentation is regulated by the Melanocortin-1 Receptor gene (MC1R). In Japanese populations, Val92Met and Arg163Gln genotypes of MC1R gene polymorphisms are associated with freckles and lentigo solaris, because they have skin types II–III, but for Indonesians who are skin type IV, hyperpigmentation disorders are often melasma. Purpose: This study aimed to identify the association between Val92Met and Arg163Gln genotypes of MC1R gene polymorphisms with the incidence of melasma in a Javanese women population. Patients and methods: This study used unmatched case-control design, conducted by clinical examination and questionnaire. Data were analyzed with Chi-squared test and Odds Ratio (OR). Results: This study evaluated 158 Javanese women from 18–60 years old with 79 case and 79 control subjects. The genotype of Val92Met was found more common in melasma subjects than in non-melasma (p=0.005) with (OR2.53; 95% CI:1.21–5.29). By using a bivariate test we showed sun exposure and family history of melasma were risk factors for melasma (OR:1.99; 95% CI:1.04–3.78) and (OR:35.32; 95% CI:10.25–121.70). However, genotype of Arg163Gln was not a risk factor for the incidence of melasma (OR: 0.86; 95% CI:0.39–1.89). Conclusion: The findings showed Val92Met genotypes, sun exposure and family history were risk factors for melasma incidence. This is the first study on incidence of melasma in an Indonesian population and contributes to ongoing efforts to understand the mechanisms of melasma.
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Affiliation(s)
- Betty Ekawati Suryaningsih
- Department of Dermatovenereology, Faculty of Medicine Islamic Indonesia University, Yogyakarta, Indonesia.,Department of Dermatovenereology, Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ahmad Hamim Sadewa
- Department of Biochemistry, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Hardyanto Soebono
- Department of Dermatovenereology, Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, Indonesia
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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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20
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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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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: 131] [Impact Index Per Article: 18.7] [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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Schalka S, Steiner D, Ravelli FN, Steiner T, Terena AC, Marçon CR, Ayres EL, Addor FAS, Miot HA, Ponzio H, Duarte I, Neffá J, Cunha JAJD, Boza JC, Samorano LDP, Corrêa MDP, Maia M, Nasser N, Leite OMRR, Lopes OS, Oliveira PD, Meyer RLB, Cestari T, Reis VMSD, Rego VRPDA. Brazilian consensus on photoprotection. An Bras Dermatol 2015; 89:1-74. [PMID: 25761256 PMCID: PMC4365470 DOI: 10.1590/abd1806-4841.20143971] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/28/2014] [Indexed: 12/14/2022] Open
Abstract
Brazil is a country of continental dimensions with a large heterogeneity of climates
and massive mixing of the population. Almost the entire national territory is located
between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the
south certainly makes Brazil one of the countries of the world with greater extent of
land in proximity to the sun. The Brazilian coastline, where most of its population
lives, is more than 8,500 km long. Due to geographic characteristics and cultural
trends, Brazilians are among the peoples with the highest annual exposure to the sun.
Epidemiological data show a continuing increase in the incidence of non-melanoma and
melanoma skin cancers. Photoprotection can be understood as a set of measures aimed
at reducing sun exposure and at preventing the development of acute and chronic
actinic damage. Due to the peculiarities of Brazilian territory and culture, it would
not be advisable to replicate the concepts of photoprotection from other developed
countries, places with completely different climates and populations. Thus the
Brazilian Society of Dermatology has developed the Brazilian Consensus on
Photoprotection, the first official document on photoprotection developed in Brazil
for Brazilians, with recommendations on matters involving photoprotection.
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Affiliation(s)
- Sérgio Schalka
- Photobiology Department, Sociedade Brasileira de Dermatologia, São Paulo, SP, Brazil
| | | | | | | | | | | | - Eloisa Leis Ayres
- Center of Dermatology Prof. Rene Garrido Neves, City Health Foundation, Rio de Janeiro, RJ, Brazil
| | | | | | - Humberto Ponzio
- Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ida Duarte
- Charity Hospital, Santa Casa de Misericórdia, São Paulo, SP, Brazil
| | - Jane Neffá
- Fluminense Federal University, Niterói, RJ, Brazil
| | | | | | | | | | - Marcus Maia
- Charity Hospital, Santa Casa de Misericórdia, São Paulo, SP, Brazil
| | - Nilton Nasser
- Federal University of Santa Catarina, Blumenau, SC, Brazil
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Handel AC, Miot LDB, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol 2015; 89:771-82. [PMID: 25184917 PMCID: PMC4155956 DOI: 10.1590/abd1806-4841.20143063] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 09/20/2013] [Indexed: 01/19/2023] Open
Abstract
Melasma is a chronic acquired hypermelanosis of the skin, characterized by irregular brown macules symmetrically distributed on sun-exposed areas of the body, particularly on the face. It is a common cause of demand for dermatological care that affects mainly women (especially during the menacme), and more pigmented phenotypes (Fitzpatrick skin types III-V). Due to its frequent facial involvement, the disease has an impact on the quality of life of patients. Its pathogeny is not yet completely understood, although there are some known triggering factors such as sun exposure, pregnancy, sexual hormones, inflammatory processes of the skin, use of cosmetics, steroids, and photosensitizing drugs. There is also a clear genetic predisposition, since over 40% of patients reported having relatives affected with the disease. In this manuscript, the authors discuss the main clinical and epidemiological aspects of melasma.
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Affiliation(s)
| | | | - Hélio Amante Miot
- Universidade Estadual Paulista "Julio de Mesquita Filho", Botucatu, SP, Brazil
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Handel A, Lima P, Tonolli V, Miot L, Miot H. Risk factors for facial melasma in women: a case–control study. Br J Dermatol 2014; 171:588-94. [DOI: 10.1111/bjd.13059] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A.C. Handel
- Department of Dermatology and Radiotherapy FMB‐UNESP Botucatu SP Brazil
| | - P.B. Lima
- Department of Dermatology and Radiotherapy FMB‐UNESP Botucatu SP Brazil
| | - V.M. Tonolli
- Department of Dermatology and Radiotherapy FMB‐UNESP Botucatu SP Brazil
| | - L.D.B. Miot
- Department of Dermatology and Radiotherapy FMB‐UNESP Botucatu SP Brazil
| | - H.A. Miot
- Department of Dermatology and Radiotherapy FMB‐UNESP Botucatu SP Brazil
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Prabha N, Mahajan VK, Mehta KS, Chauhan PS, Gupta M. Cosmetic contact sensitivity in patients with melasma: results of a pilot study. Dermatol Res Pract 2014; 2014:316219. [PMID: 25132846 PMCID: PMC4123589 DOI: 10.1155/2014/316219] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 06/29/2014] [Indexed: 01/19/2023] Open
Abstract
Background. Some of the patients with melasma perhaps have pigmented cosmetic dermatitis. However, cosmetic contact sensitivity in melasma remains poorly studied particularly in the Indian context. Objectives. To study cosmetic contact sensitivity in patients with melasma. Materials and Methods. 67 (F : M = 55 : 12) consecutive patients with melasma between 19 and 49 years of age were patch tested sequentially during January-December, 2012, with Indian Cosmetic and Fragrance Series, Indian Sunscreen Series, p-phenylenediamine, and patient's own cosmetic products. Results. 52 (78%) patients were in the age group of 20-40 years. The duration of melasma varied from 1 month to 20 years. Centrofacial, malar, and mandibular patterns were observed in 48 (72%), 18 (27%), and 1 (1%) patients, respectively. Indian Cosmetics and Fragrance Series elicited positive reactions in 29 (43.3%) patients. Cetrimide was the most common contact sensitizers eliciting positivity in 15 (52%) patients, followed by gallate mix in 9 (31%) patients and thiomersal in 7 (24%) patients. Only 2 of the 42 patients showed positive reaction from their own cosmetics while the other 5 patients had irritant reaction. Indian Sunscreen Series did not elicit any positive reaction. Conclusion. Cosmetics contact sensitivity appears as an important cause of melasma not associated with pregnancy, lactation, or hormone therapy.
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Affiliation(s)
- Neel Prabha
- Department of Dermatology, Venereology & Leprosy, Dr. R. P. Govt. Medical College, Kangra, Tanda, Himachal Pradesh 176001, India
| | - Vikram K. Mahajan
- Department of Dermatology, Venereology & Leprosy, Dr. R. P. Govt. Medical College, Kangra, Tanda, Himachal Pradesh 176001, India
| | - Karaninder S. Mehta
- Department of Dermatology, Venereology & Leprosy, Dr. R. P. Govt. Medical College, Kangra, Tanda, Himachal Pradesh 176001, India
| | - Pushpinder S. Chauhan
- Department of Dermatology, Venereology & Leprosy, Dr. R. P. Govt. Medical College, Kangra, Tanda, Himachal Pradesh 176001, India
| | - Mrinal Gupta
- Department of Dermatology, Venereology & Leprosy, Dr. R. P. Govt. Medical College, Kangra, Tanda, Himachal Pradesh 176001, India
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