Non-alcoholic fatty liver and lipid profile status in patients with melasma: A case-control study

Prevention of Melasma During Pregnancy: Risk Factors and Photoprotection-Focused Strategies

Melasma is a benign but emotionally distressing skin condition that reduces patients' quality of life, with prevalence rates during pregnancy ranging from 36.4% to 75%. Troublingly, up to 30% of cases are reported to persist after delivery, even ten years later. And recurrence and aggravation are common in subsequent pregnancies. This review examines the risk factors and mechanisms associated with melasma during pregnancy and summarized corresponding preventive strategies. We emphasize the critical role of photoprotection, including the use of sunscreens from the first trimester, in reducing the incidence of melasma.

Plasma Metabolomics Indicates Potential Biomarkers and Abnormal Metabolic Pathways in Female Melasma Patients

BACKGROUND

Melasma is a common and chronic pigmentary disorder with complex pathogenesis, and the relationship between melasma and metabolic syndrome remains elusive. Thus, metabolomics might contribute to the early detection of potential metabolic abnormalities in individuals with melasma.

OBJECTIVE

The present study aims to analyze changes in plasma metabolites of female melasma patients and identify disease markers as well as explore potential therapeutic targets.

METHODS

Plasma samples from 20 female patients with melasma and 21 healthy female controls that were comparable in terms of age and body mass index were collected for untargeted metabolomics investigations. Ultra-high performance liquid chromatography-mass spectrometry was used to analyze metabolites in the plasma. Metabolic pathway analyses were employed to identify significantly differentially expressed metabolites in melasma patients. Receiver operating characteristic curves were constructed, and correlation analyses were performed using the modified Melasma Area and Severity Index and oxidative stress levels.

RESULTS

In contrast to healthy subjects, melasma patients showed significant alterations in 125 plasma metabolites, including amino acids, lipids, and carbohydrate-related metabolites. KEGG pathway analysis suggested that primary pathways associated with the development of melasma include tryptophan metabolism, as well as the biosynthesis of phenylalanine, tyrosine, and tryptophan. Importantly, based on receiver operating characteristic curves and correlation analyses, several metabolites were identified as robust biomarkers for melasma.

CONCLUSION

Collectively, this study identified significant changes in plasma metabolites in melasma patients, providing new insights into the pathogenesis of melasma and opening novel therapeutic avenues.

Evaluation of Efficacy and Safety of Low-Fluence Q-Switched 1064-nm Laser in Infra-orbital Hyperpigmentation Based on Biometric Parameters

Introduction: Dark circles and wrinkles under the eyes are common cosmetic problems, caused by various conditions, especially aging and overproduction of melanin in the epidermis or dermis of the skin. Iin addition to the application of topical lightening agents, different types of lasers, especially the Q-Switched ND:YAG laser, have been used for the treatment of cutaneous hyperpigmentation. Because of a high prevalence of idiopathic eye dark circles (EDCs) or periorbital melanosis and a poor response to available therapies, we decided to evaluate the efficacy and safety of the Fractional QS 1064 nm ND:YAG Laser through a before-after trial. Methods: 18-65-year-old patients with skin Fitzpatrick phototype of I-V and without any usage of a topical or systemic therapeutic regimen (2-4 weeks before the trial) were enrolled in the study. Each patient was treated with 6 sessions of the Fractional QS 1064 nm ND:YAG Laser at 2-week intervals and assessed for response and possible side effects or recurrences through 4 outcome measures, including Visoface-based color and erythema, melanin index and lightness (Before the fourth and sixth sessions of the therapy; also 1 week and 3 months after finishing the trial). Results: The changes of Visoface-based color and erythema, the melanin pigment amount by the Mexameter (melanin index) and the degree of lightness by the Colorimeter of patients after 6 months of intervention were statistically significant (P<0.001). Conclusion: The fractional QS 1,064 nm ND:YAG Laser is an effective and safe therapy in EDCs since objective outcomes like the reduction of the melanin index and improving lightness and subjective ones like the reduction of darkness and erythema were confirmed.

Comparison of the efficacy and safety of intralesional injection of tranexamic acid and the topical application of Kligman combination drug in the treatment of macular amyloidosis

Macular amyloidosis (MA) is a common form of cutaneous amyloidosis that manifests as dark spots consisting of brown pigments with a rippled pattern on the skin, and the treatment of this condition is highly challenging. The aim of this study was to compare the efficacy and safety of intralesional injection of tranexamic acid (TXA) and topical application of Kligman combination drug in the treatment of macular amyloidosis. In this double-blind clinical trial, a total of 43 patients, who were diagnosed with MA, were treated with two different methods of intralesional injection of tranexamic acid and topical application of Kligman combination drug. Both therapeutic methods were effective in improving MA and significantly reduced hyperpigmentation of the treated areas, but tranexamic acid was significantly more effective than the Kligman combination drug. Significantly, greater improvements were observed in the group of patients treated with tranexamic acid. In the tranexamic acid treatment group, ΔE was reduced from 11.39 in the first session to 8.53 in the third session, and in the Kligman treatment group, it was reduced from 8.79 in the first session to 6.32 in the third session (p < 0.05). In addition, the pruritus score in patients treated with topical tranexamic acid injection was lower compared to the patients treated with the topical application of the Kligman combination drug. The results of this study demonstrated the significant positive effects of both treatment methods, but in terms of reducing melanin content, intralesional injection of tranexamic acid was a more effective method. Both treatments considered safe for MA. In tranexamic acid group, patients logically experienced a tolerable pain during injection but they significantly had significantly lower local pruritic discomfort during study. So, based on the positive findings of this study we suggest to use tranexamic acid in combination with other effective therapeutic methods for treatment of MA especially use of its topically applied form in combination with non-aggressive needling that results in better drug delivery without the experience of injection pain. Selection of the best administration route of tranexamic acid for hyperpigmented lesions depends on the each patient characteristic and their previous theraputic results that may vary case by case.

Comparison of efficacy and safety of tranexamic acid mesotherapy versus oral tranexamic acid in patients with melasma undergoing Q-switched fractional 1064-nm Nd:YAG laser: A blinded RCT and follow-up

BACKGROUND

Melasma is a common hyperpigmentation disorder. This study aimed to compare the efficacy of Nd-Yag fractional 1064 plus microinjection of tranexamic acid versus Nd-Yag fractional 1064 plus oral tranexamic acid in patients with melasma.

MATERIALS AND METHODS

This is a prospective, randomized study with a sample size of 40 patients, 20 in each treatment arm, which was done six times with 2-week intervals. Twenty patients were administered localized microinjections (4 mg/ml) of tranexamic acid and Q-switched 1064 laser every 2 weeks in one arm, while in the other arm, 20 were given oral tranexamic acid 250 mg three times a day and Q-switched 1064 laser every 2 weeks per visit.

RESULTS

Twenty-one patients with mean SD 40.52+-4.95 y/o were treated with oral tranexamic acid, and 20 patients with 43.3+-5.87 y/o treated with microinjection of tranexamic acid were analyzed. There was no statistically significant difference between the two groups in terms of demographic and clinical characteristics at the baseline (p > 0.05). The patients MASI score and ∆E decrease over the study period in both treatments significantly (p < 0.001). However, patient's MASI score (p = 0.99) and ∆E (p = 0.53) did not differ significant between the two group over the time. Satisfaction (p = 0.41) and complication during the study period (p = 0.09) were not significantly different between the two group.

CONCLUSION

The combination treatment method can be a viable option for Middle Eastern patients having melasma disorder, and tranexamic acid appears to be an effective and safe treatment for melasma, irrespective of its route of administration. Tranexamic acid can increase the permeability locally by non-invasive methods such as microneedling which is less painful than microinjection and can also increase patient satisfaction. Although the oral method is more tolerable for the patient, it may have systemic side effects, and its combination with Q-switch laser increases its effect regardless of the type of prescription. Therefore, it is recommended to use of this drug topically (cream or lotion) by non-invasive methods like microneedling to reduce pain and laser treatment in future studies.