Abstract
Objectives: To evaluate the efficacy of an oral supplement containing carotenoids as an adjunct to a topical cosmetic lightening cream for the treatment of melasma. Methods: 44 subjects with melasma were recruited into a double-blinded, randomized, placebo controlled trial over 84 days at the Singapore National Skin Centre, to receive either an oral dietary supplement containing carotenoids or a placebo. All were prescribed a commercially available cream. Patients were assessed at onset, day 54 and day 84 by the Modified Melasma area and Severity Index (mMASI), photographic documentation, melanin and erythema indexes using a Mexameter®. Results: 44 patients completed the study. The median mMASI score fell significantly in both groups (both p<0.001). There was a greater decrease seen in those who received the oral supplement group (-2.1 vs -1.8, p <0.379). The erythema score showed significant improvements in both groups, with greater improvement in the group on the oral supplement, compared to placebo (median difference = -30, p =0.018, vs median difference = -20, p =0.020). Conclusion: Oral supplements containing carotenoids are potential adjuncts in melasma treatment. 1.5 Limitations: Small sample size and short study duration limit the observations noted in this study. Further larger-scale studies are required.
Highlights
Melasma is a prominent skin problem, especially amongst dark skin individuals, presenting with varying degrees of hyperpigmentation on sun-exposed areas of the skin [1]
Chemical peels are often added as second line therapy whilst laser therapies are reserved for patients who are refractory to conventional therapies, as they could cause paradoxical worsening of melisma [9,10,11,12,13]
Carotenoids are known photoprotectants and beta-carotene supplements have been used for protection against ultraviolet (UV) light-induced erythema despite the fact that they would color the skin in orange
Summary
Melasma is a prominent skin problem, especially amongst dark skin individuals, presenting with varying degrees of hyperpigmentation on sun-exposed areas of the skin [1]. Exposure to ultraviolet (UV) radiation is regarded to be the most important factor in the pathogenesis of melasma, hormonal factors (pregnancy, oral contraceptives) and ethnicity have been implicated [4]. Treatment is challenging and the topical treatment of melasma mainly aims at photoprotection as well as disrupting the enzymatic processes of pigment production within melanocytes [4]. First line therapy includes topicals like tyrosinase inhibitors such as hydroquinone, kojic acid, as well as other topicals such as retinoids, topical corticosteroids and azelates [5]. Chemical peels are often added as second line therapy whilst laser therapies are reserved for patients who are refractory to conventional therapies, as they could cause paradoxical worsening of melisma [9,10,11,12,13]
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