Abstract
Background: Melasma is one of the most common causes of facial hyperpigmentation which causes cosmetic disfigurement and leads to psychological problems. Although various treatments are available for melasma, it remains a difficult condition to treat. Aim of the Work: to evaluate and compare the efficacy of intradermal injection of tranexamic acid, topical silymarin cream and glycolic acid peeling in treatment of melasma. Patients and Methods: Sixty female patients with melasma were divided into 3 groups: group A; 20 patients were treated with intradermal injection of tranexamic acid. Group B; 20 patients were treated with topical silymarin cream and group C; 20 patients were treated with glycolic acid peeling 50%. Dermoscopic examination and clinical assessment (according to the modified Melasma Area and Severity Index) were performed for all patients. Results: There was a statistically significant difference between the studied groups as regard the response to different therapeutic modalities with the best results in group C followed by group B then the least response was in group A. There was statistically significant difference between A and B, A and C; so group B and C showed better response than group A, while there was no statistically significant difference between groups B and C. Conclusion: Silymarin cream was a novel, effective and safe treatment modality for melasma especially in epidermal and mixed types in Fitzpatrick skin phototype III, IV and V as it showed a significant improvement of melasma lesion. It was as effective as 50% glycolic acid peeling in the treatment of melasma without post inflammatory hyperpigmentation that occurred by glycolic acid peeling.
Highlights
Melasma is a common disorder of hyperpigmentation that occurs most commonly in females during reproductive age
Silymarin cream was a novel, effective and safe treatment modality for melasma especially in epidermal and mixed types in Fitzpatrick skin phototype III, IV and V as it showed a significant improvement of melasma lesion
It was as effective as 50% glycolic acid peeling in the treatment of melasma without post inflammatory hyperpigmentation that occurred by glycolic acid peeling
Summary
Melasma is a common disorder of hyperpigmentation that occurs most commonly in females during reproductive age. It is most prevalent in darker-complexioned individuals [1]. Though benign, can be extremely psychologically distressing and has been shown to have a significant impact on quality of life, social and emotional wellbeing [2]. Silymarin has potent antioxidant properties, reduces and suppress harmful effects of solar ultraviolet radiation (UVR) [4]. Glycolic acid (GA) peels effect is derived from its chemexfoliating properties which depend on facilitating the removal of melanized keratinocytes, leading to melanin pigment loss and acceleration of skin turnover [5]. Melasma is one of the most common causes of facial hyperpigmentation which causes cosmetic disfigurement and leads to psychological problems. Various treatments are available for melasma, it remains a difficult condition to treat
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