Facial Melasma Research Articles

Comparative evaluation of intralesional platelet rich plasma versus tranexamic acid (50mg/ml) in the treatment of facial melasma

: Melasma is a recalcitrant hyperpigmentary condition. The pathogenesis of melasma is complex and not fully understood. Although many treatment modalities have been tried for melasma but no modality is considered as gold standard.: This study aimed to compare efficacy of intralesional platelet rich plasma with tranexamic acid (50mg/ml) in the treatment of facial melasma.: Total 64 patients were enrolled in the current study from July 2023 to March 2024. In group A, 31 patients were treated with intralesional PRP and in group B, 33 patients were treated with intralesional TXA (50mg/ml). Intralesional injections were given every 4 weekly till lesions resolve or a maximum of 6 sessions followed by monthly follow up for 3 months. Grade of clinical improvement was measured by percentage reduction in mMASI score at baseline, at every session and at follow up. Patient satisfaction score was assessed using a five-point Likert scale at the end of the study.: In the PRP group, 64.52% patients showed moderate to good response whereas in the TXA group, 72.72% patients showed good to very good response. Only 41.94% patients were satisfied in group A while 81.81% patients were satisfied with their recovery after treatment in group B.: TXA was effective in all types of melasma. PRP was significantly effective only in female patients whereas TXA was significantly effecacious in both male and female patients. We suggest monthly therapy with intralesional TXA at a higher dosage of 50 mg/ml as an efficient and time-saving treatment modality over intralesional PRP.

Melasma: A Clinical and Epidemiological Single-Group Observational Study in the Greek Population.

Melasma is a common acquired disorder of melanogenesis that predominately affects women and presents as hyperpigmented skin lesions mainly located on the face. The study aims to investigate the epidemiologic characteristics and hormonal profiles in melasma patients. One hundred fifty patients were enrolled in this study in a tertiary care hospital. Clinical patterns, pigment depth, disease severity, underlying conditions, and heredity were recorded. Endocrinologic profile and vitamin D levels were assessed. On clinical examination, the condition indicated a centrofacial localization in 74% of the patients. Extra facial melasma was noticed in 10 patients who had centrofacial melasma to begin with. Wood's lamp examination showed the dermal type as the most common. A family history of melasma was noted in 38% of the patients. Melasma Area and Severity Index (MASI) score ranged from 0.3 to 10.8, with a mean score of 4.12 ± 2.06. Pregnancy-induced melasma was reported in 36.1% of the patients. In 17.4% of women, melasma was related to using oral contraceptives. In 22% of patients, mild vitamin D deficiency was detected, while 21% had thyroid disorders. There is a strong correlation between family history and prevalence of melasma. Sun exposure is a major precipitating factor and should be carefully addressed in Mediterranean countries like Greece. However, other factors such as concomitant medication, multiple pregnancies, use of oral contraceptives, thyroid disorders and vitamin D deficiency might precipitate melasma.

532 nm Sub Pulsed Laser for Treating Melasma in Latin American Patients, Series of Cases

<i>Objective</i>: To analyze a series of cases treated with a 532 nm Sub Pulsed laser treatment for Melasma in Latin American Patients with Fitzpatrick type IV. <i>Background</i>: Melasma is a common, acquired, symmetrical hypermelanosis that presents as light to dark brown macules on the face usually over the forehead and malar areas that negatively impact patient’s quality of life. Many laser treatments have been described without any consensus, however, targeting the vascular component has been gaining popularity daily but the adverse reactions such as transient post inflammatory hyperpigmentation or atrophic scars have been described for treating the superficial and deep vessels. We propose a new laser range in order to treat Melasma. <i>Methods</i>: This is an observational study with 20 patients, Fitzpatrick type IV diagnosed with facial melasma that were treated with one to two sessions of a Sub Pulsed 532 nm Laser with an interval of 11 to 30 days. Dermoscopy was performed in the patients before the laser in order to show the presence of multiple vessels and pigmentation in the patients, before and after pictures were taken with Quantificare Lifeviz to show the results after the laser without any other topical or oral treatment. This Study was reviewed and approved by the Ethics and Investigation Committee of Dermalaser KPW in Lima, Peru, adhering to the highest ethical standards and following the principles Outlined in the Helsinsky Declaration. Informed Consent was obtained from all participants, who also provided written authorization for the publication of the study results and accompanying images. <i>Results</i>: In this series of cases the Modified MASI Score describes an average of 90.9% improvement in Melasma severity after the laser sessions. The pictures taken with Quantificare Lifeviz in order to asses the vascular, pigmentary and basal pictures show significant improvement. No PIH (Post inflammatory Hyperpigmentation) or major adverse reaction were described in this study.

Combined Efficacy of Q-Switched 785 nm Laser and Tranexamic Acid Cream in the Treatment of Melasma: A Prospective Clinical Study

Background and Objectives: Melasma, a hypermelanotic dermatologic condition that mainly affects women, poses challenges due to its complex etiology involving environmental and genetic factors. Its pathophysiology, marked by intricate histological changes, is not fully understood. This study explored the efficacy and safety of a new 785 nm picosecond laser in treating facial melasma. Materials and Methods: An 11-participant cohort, comprising women with Fitzpatrick phototypes II-III, underwent a treatment protocol with a new 785 nm picosecond laser. The clinical evaluation used the Global Aesthetic International Score (GAIS) and the Five-Point Likert Scale Questionnaire. The aim of the study was to understand the capacity of the 785 nm wavelength laser to interact with both the pigmentary and vascular components of melasma. Results: The GAIS outcomes revealed excellent (18.2%), good (54.5%), poor (18.2%), and no results (9.1%). The Likert Scale responses varied from very satisfied (18.2%) to slightly satisfied (9.1%). Clinical images at three months demonstrated resolution of melasma with no adverse events. Conclusions: This non-invasive procedure showed positive outcomes and high patient tolerance, emphasizing its potential in melasma management. However, in order to fully understand the interactions of pigmentary and vascular components with the 785 nm wavelength laser, further research is required. The small cohort represents a limitation for this study, therefore studies that include a larger number of patients are needed to assess the effectiveness of this laser treatment for facial melasma.

Tyrosinase Inhibition and Antimelanogenic Effects of Resorcinol-Containing Compounds.

Tyrosinases (TYRs) are copper-containing metalloenzymes present in a large diversity of species. In human, hTYR is responsible for pivotal steps in melanogenesis, catalysing the oxidation of l-tyrosine to l-DOPA and further to dopaquinone. While numerous TYR inhibitors have been reported, polyphenolic compounds tend to dominate the literature. However, many of these compounds, particularly monophenols and catechols, have been identified as alternative substrates rather than true inhibitors, given their structural similarity to natural substrates. Resorcinol-containing compounds have emerged as promising candidates to address this challenge, as the meta-dihydroxy moiety in resorcinol demonstrates resistance to TYR-mediated oxidation, while retaining the favourable interactions with copper ions provided by the hydroxy groups. Although their precise mechanism of action remains debated, resorcinol derivatives have yielded some of the most active compounds against isolated mushroom and human TYRs, as well as clinically used dermocosmetic agents like rucinol and thiamidol, which exhibited very promising effects in patients with facial melasma. This review outlines the development of resorcinol-containing TYR inhibitors, categorized by scaffold type, ranging from simple alkyl analogues to intricate synthetic derivatives. Mechanistic insights about the resorcinol-TYR interaction are also presented and debated.

A Comparative Study of Efficacy between Oral Tranexamic Acid with Fluocinolone-Based Triple Combination Cream Versus Fluocinolone-Based Triple Combination Cream Alone in Melasma

Introduction: Melasma is an acquired, chronic, recurrent hyper-pigmentary disorder characterized by symmetric light-brown to bluish-gray macules and patches with irregular, sharp borders. The term “melasma” is derived from the Greek word “melas,” meaning black, while “chloasma” refers to its occurrence during pregnancy, derived from “chloazein,” meaning green. Clinically, melasma predominantly affects the face, including the forehead, cheeks, temples, upper lip, chin, and nose. Methods: This cross-sectional study was conducted on 60 clinically diagnosed cases of melasma attending the Skin and VD outpatient department of Combined Military Hospital (CMH), Dhaka, Bangladesh from January 2020 to June 2020. Result: Ages of the patient at onset of melasma, in majority (56.67%) cases were between 20-25 years and 90% study population was female. Most (56.67%) of the patients were housewife. Regarding the distribution of melasma 50% were found malar, 46.67% centro-facial and 3.33% mandibular. By 12 weeks, Group A's mean MASI score further reduced to 6.995 ± 6.056, and Group B's score decreased significantly to 2.19 ± 2.378. The P value of 0.00 confirms a statistically significant difference between the groups at 12 weeks. Conclusion: In conclusion, our study demonstrates that oral tranexamic acid in combination with fluocinolone-based triple combination cream is significantly more effective in treating facial melasma than the cream alone.

Evaluation of Micro-Needling Followed by Metformin Solution versus Micro-Needling Followed by Tranexamic Acid Solution in Treatment of Melasma: A Comparative Split Face Study

Abstract Background Melasma is a common acquired pigmentary disorder that manifests as symmetric hyperpigmented macules and patches on the face, more frequently affecting women of reproductive age. Various underling risk factors have been implicated in the etiology of melasma including; Genetic factors, pregnancy, oral contraceptives, endocrine dysfunction, hormone treatments, cosmetic contact sensitivity and exposure to ultraviolet (UV) light. Management of melasma is a frustrating experience both for the treating doctors and patients because of its recurrent and often recalcitrant nature. Numerous therapeutic modalities have been tried for this condition such as hydroquinone, kligman’s formula (hydroquinone + steroid + tretinoin), kojic acid, azelaic acid, arbutin, ascorbic acid, chemical peels, lasers, tranexamic acid, rucinol, oligopeptides, silymarin, orchid extracts, and various botanical extracts with variable success rates. Objectives Our aim was to assess and compare the therapeutic effects of topical metformin solution 30% with microneedling versus topical tranexamic acid (4mg\ml) solution with microneedling in treating patients with facial melasma. Patients and Methods This is a split-face study included 35 patients with facial melasma. The patients recruited from the Outpatient Dermatology Clinic at Ain Shams University Hospitals. Topical metformin 30% solution with microneedling sessions were done for the right side of the face (4sessions - two weeks apart), and topical tranexamic acid solution (4mg/ml) with microneedling on the left side of the face (4 sessions – two weeks apart). The patients were followed up for 3 months. The response of treatment was evaluated by Hemi MASI score and Antera 3D camera. Results Our study revealed that both microneedling followed by topical metformin solution and microneedling followed by topical TXA solution were efficient in treatment of facial melasma as shown by significant decrease in h-MASI score and average melanin level assessed by Antera camera. Although statistically insignificant, the percentage of change in h- MASI score was more evident with TXA treatment than metformin treatment. The side effects were limited and transient in the form of erythema, burning sensation, and xerosis. The main problem with either treatment was the high relapse rate. Conclusion Both metformin and tranexamic acid applied topically following microneedling sessions led to statistically significant improvement of melasma according to Hemi MASI scores. Topical metformin appears to be a promising therapeutic option in the treatment of melasma without serious adverse effects.

Therapeutic efficiency and safety assessment of intradermal platelet-rich plasma combined with oral tranexamic acid in patients with facial melasma.

Melasma is a chronic, acquired hypermelanosis that primarily affects the face. Platelet-rich plasma (PRP) and tranexamic acid (TXA) are promising treatments for melasma. However, only a few randomized clinical trials have examined the efficacy and safety of combining these therapies for melasma. We aimed to compare the efficacy and safety of combining PRP and oral TXA with those of PRP alone in the treatment of facial melasma. A randomized controlled trial was conducted at Walailak University Hospital, Nakhon Si Thammarat, Thailand, between March and September 2023. Participants with mixed-type melasma were randomly allocated in a 1:1 ratio to either group A (PRP injection alone without placebo) or group B (PRP injection with oral TXA). Therapeutic efficacy and safety assessments were performed over a 12-week follow-up period. The study included 26 participants (mean age: 45.9 years, standard deviation (±SD): 5.0) who were predominantly female (84.6%). In group A, the modified Melasma Area and Severity Index (mMASI) scores significantly decreased from a median of 4.30 interquartile range (IQR): 4.10) to 3.60 (IQR: 3.10) between week 0 and week 12, respectively. In group B, the median mMASI decreased from 6.40 (IQR: 7.80) to 3.60 (IQR: 3.70) over the same period. The median change in mMASI scores in group B (2.90, IQR: 2.40) was significantly larger than in group A (0.90, IQR: 0.60) (p < 0.001, U = 160.50). However, there were no significant differences in the physicians' global assessment (PGA), melasma quality of life scale (MelasQoL) or patient satisfaction during follow-up. Four patients (15.4%) experienced transient erythema and swelling. In group B, 1 participant (7.7%) experienced transient mild gastrointestinal discomfort after receiving oral TXA. The combination of intradermal PRP injection and oral TXA is effective for melasma, even in patients with poor prognostic treatment response factors. No serious adverse reactions were observed in either group.

A collagen biostimulator improves photoaging pigmentation

AbstractPhotoaging pigmentation conditions such as senile lentigo and melasma show epidermal melanogenic activity and dermal abnormalities, including collagen degradation. A dermal rejuvenation strategy with skin‐lightening therapy directly acting on melanocytes is suggested for photoaging pigmentation. This study investigates whether collagen biostimulation can result in skin lightening of photoaging skin. A split‐face clinical trial was conducted, involving 40 subjects with facial melasma and senile lentigo. Subjects received a poly‐DL‐lactic acid (PDLLA) treatment on one side of their face, whereas the contralateral side received a treatment of normal saline as a control. Assessments were scheduled every month after completing treatments for up to 3 months. Pigmentation was evaluated using the L* value as measured with a chromameter and by investigator global assessment scores (IGA). Subjects reported different outcomes in terms of overall skin quality, including pigmentation, wrinkles and elasticity. Skin biopsies were obtained before the treatment and 4 weeks after completing the treatment. Fontana‐Masson, Masson‐Trichrome and Verhoeff‐van Gieson staining, and fibroblast‐specific protein 1 (FSP1) immunostaining were conducted. The PDLLA treatment demonstrated significant improvements in the L* values and IGA scores from 8 weeks after the subject completed their treatments. These improvements were sustained over a 12‐week assessment period. The subjects reported substantial reductions in both pigmentation and wrinkle severity and elasticity throughout the assessment period. Fontana‐Masson staining showed a marked decrease in pigmentation upon a PDLLA injection compared to the baseline values. Increased immunogenicity of FSP1 and increases in collagen and elastic fibre staining were observed. This study demonstrated remarkable improvements in photoaging pigmentation along with collagen production with a collagen biostimulator. Thus, collagen biostimulators represent a promising therapeutic approach for addressing photoaging signs associated with melasma and senile lentigo. (ClinicalTrials.gov Identifier: NCT05913102).

755-nm picosecond laser plus topical 20% azelaic acid compared to topical 20% azelaic acid alone for the treatment of melasma: a randomized, split-face and controlled trial.

Melasma remains a refractory skin condition that needs to be actively explored. Azelaic acid has been used for decades as a topical agent to improve melasma through multiple mechanisms, however, there is a lack of research on its combination with laser therapy. This study evaluated the effectiveness of isolated treatment with topical 20% azelaic acid and its combination with 755-nm picosecond laser in facial melasma patients. A randomized, evaluator-blinded, controlled study was conducted on 30 subjects with facial melasma in a single center from October 2021 to April 2022. All subjects received topical 20% azelaic acid cream (AA) for 24 weeks, and after 4 weeks, a hemiface was randomly assigned to receive 755-nm picosecond (PS) laser therapy once every 4 weeks for 3 treatments. Treatment efficacy was determined by mMASI score evaluations, dermoscopic assessment, reflectance confocal microscopy (RCM) assessments and patient's satisfaction assessments (PSA). Treatment with 20% azelaic acid, with or without picosecond laser therapy, significantly reduced the hemi-mMASI score (P < 0.0001) and resulted in higher patient satisfaction. Improvements in dermoscopic and RCM assessments were observed in both sides of the face over time, with no difference between the two sides. RCM exhibited better dentritic cell improvement in the combined treatment side. No patients had serious adverse effects at the end of treatment or during the follow-up period. The additional use of picosecond laser therapy showed no clinical difference except for subtle differences detected by RCM assessments.The study was registered in the Chinese Clinical Trial Registry (ChiCTR2100051294; 18 September 2021).

Sequential therapy with topical clobetasol for 14 days followed by hydroquinone versus hydroquinone alone in facial melasma treatment: a randomized, double-blind, controlled clinical trial.

Clobetasol has demonstrated remarkable results in treating melasma within a short time frame; however, its use is limited because of the risk of local side effects. To date, there is no controlled trial on sequential clobetasol/hydroquinone for melasma. This study aimed to investigate the tolerability and efficacy of 0.05% clobetasol followed by 4% hydroquinone (CLOB-HQ) in comparison to the isolated use of 4% hydroquinone (HQ). A double-blinded, randomized clinical trial involving 50 women with facial melasma was performed. They were directed to apply 0.05% clobetasol every night for 14 days, followed by 4% hydroquinone for 46 days (CLOB-HQ group), or the use of hydroquinone for 60 days (HQ group). Evaluations were carried out at inclusion, andafter 14 and 60 days of treatment, measuring modified Melasma Area and Severity Index (mMASI), Melasma Quality of Life scale (MELASQoL), and colorimetry. The Global Aesthetic Improvement Scale (GAIS) was assessed by a blinded evaluator. There was no difference in the main outcomes at D14 and D60 (P > 0.1). For CLOB-HQ, the mean (CI 95%) reduction in mMASI was 13.2% (5.1-21.3%) and 43.1% (32.2-54.0%) at D14 and D60, and for HQ, they were 10.6% (5.9-27.5%) and 44.8% (33.2-52.3%). The MELASQoL, colorimetric luminosity, and GAIS showed a progressive improvement for both groups despite no difference between them. No severe side effects were identified. No cases of telangiectasias, atrophy, or perioral dermatitis were associated with the use of CLOB. The sequential CLOB-HQ regimen was safe and well tolerated, even though its efficacy was not different from HQ after 14 or 60 days of treatment. Based on these findings, the use of clobetasol 14 days before hydroquinone is not advisable for the treatment of melasma.

Boldine: a narrative review of the bioactive compound with versatile biological and pharmacological potential.

Boldine is a plant-derived bioactive compound that has a beneficial impact on human health. Boldine is an aporphine alkaloid mainly obtained from the leaves and bark of the Chilean Boldo tree (Peumus boldus, Family: Monimiaceae). There are plenty of preclinical evidence supports that boldine exerts its beneficial effects against various diseases. Lumiskin™, a patented and marketed formulation by Revitol Skincare for skin brightening, contains Dicetyl boldine, a boldine derivative. All the available information on the Chilean boldo tree (P.boldus Molina) species was actualized by systematically searching the scientific databases (PubMed, SciFinder, Web of Science, Google Scholar, Scopus and others) and scientific literature. This article covers the recent advances in pharmacokinetic, toxicological, pharmacological/biological activities, and molecular mechanisms of the bioactive compound to understand health benefits of boldine better. Boldine exerts antioxidant, hepatoprotective, anti-atherosclerotic, anti-diabetic, analgesic, antipyretic, anti-inflammatory, anti-epileptic, neuroprotective, nephroprotective, anti-arthritis, anticancer and nootropic effects. Moreover, boldine exhibits its various pharmacological activities by altering antioxidant parameters (MDA, superoxide dismutase, glutathione), peroxynitrite, inflammatory markers apoptotic index, caspase-3, acetyl-cholinesterase, myeloperoxidase, TNF-α (Tumor necrosis factor-α), iNOS, Bcl-2-associated X protein (BAX), ACE-1(Angiotensin-converting enzyme-1), dopamine D2 receptors and nicotinic acetylcholine receptor. Boldine has the potential to modulate a variety of biological networks. Due to its versatile pharmacological effects reported in various experimental animals as well as in randomized clinical trials for the treatment of facial melasma and for treatment of urinary stone lithotripsy in children as a complementary phytotherapy; in the future, this compound might be developed as a novel drug for a different indication.

Efficacy of oral 5 mg melatonin in the treatment of facial melasma in women: A double-blind, randomized, placebo-controlled clinical trial.

Efficacy of oral 5 mg melatonin in the treatment of facial melasma in women: A double-blind, randomized, placebo-controlled clinical trial.

Efficacy and Safety of Nicotinamide 10%, Associated with Magnesium Ascorbyl Phosphate 5% and Hyaluronic Acid 5%, Compared to Hydroquinone 4% in Women with Facial Melasma: A Randomized, Double-Blind, Controlled Clinical Trial.

Nicotinamide has demonstrated efficacy in the treatment of melasma. Topical antioxidants and humectants may enhance its performance. Currently, there is no controlled trial on the combination of 10% nicotinamide, 5% magnesium ascorbyl phosphate, and 5% hyaluronic acid, a dermo-cosmetic compound, in comparison to 4% hydroquinone for the treatment of melasma. This study aimed to explore the tolerability and efficacy of the association of the combined product versus hydroquinone. A randomized, double-blind trial involving women with facial melasma was conducted. Participants were instructed to apply the combined product (NIC group) twice daily or 4% hydroquinone for 60 days (HQ group) at night and placebo in the morning. Evaluations were performed at inclusion, after 14 and 60 days of treatment, measuring the modified Melasma Area and Severity Index (mMASI), Melasma Quality of Life Scale (MELASQoL), and colorimetric luminosity. The Global Aesthetic Improvement Scale (GAIS) was assessed by a blinded evaluator. Both interventions led to a progressive improvement in mMASI, MELASQoL, and GAIS, without a difference between them on D14 and D60 (p>0.2). For NIC, the mean reduction (95% CI) in mMASI was 16% (8-24%) on D14 and 32% (23-41%) on D60, while for HQ, it was 10% (7-24%) on D14 and 43% (34-52%) on D60. Reduction in colorimetric luminosity was greater in the HQ group at D60 (p=0.01). No serious side effects were identified. Of the initially included 50 patients, one was lost to follow-up in the HQ group on D60, and one withdrew consent from the NIC group, both unrelated to treatment. The association of 10% nicotinamide, 5% magnesium ascorbyl phosphate, and 5% hyaluronic acid was safe and well-tolerated, although its overall clinical efficacy was numerically inferior to 4% hydroquinone. This regimen can be considered for patients with poor tolerability to hydroquinone. #RBR-4mkfmr8.

Expression of Endothelin-1, Endothelin Receptor-A, and Endothelin Receptor-B in facial melasma compared to adjacent skin.

Although melasma is highly prevalent, its pathogenesis is not yet fully understood. In the skin, endothelin-1 (ET-1) is primarily produced by keratinocytes in response to UVB exposure, which is mediated by an increase in IL-1α or reactive oxygen species. ET-1 plays a role in melanogenesis by binding to specific receptor B (ERB) or receptor A (ERA). However, the expression of ET-1, ERA, and ERB in melasma has not been systematically investigated. The objective of this study was to evaluate the expression of ET-1, ERA, and ERB in facial melasma compared to the adjacent unaffected skin. Cross-sectional study, with 40 skin samples (20: facial melasma; 20: adjacent unaffected skin) from women with facial melasma without treatment for 30 days except for sunscreen. A triple staining immunofluorescence technique was performed for anti-vimentin, DAPI, plus one of the following antibodies: (a) anti-ET1, (b) anti-ERA; (c) anti-ERB. Interfollicular areas on the slides of each topography (melasma; unaffected skin) were photographed in triplicate under confocal laser microscopy. The mean staining intensities of the image histograms (0-255 pixels intensity) were estimated for different types of cells (suprabasal keratinocytes, basal layer, and upper dermis) and were blindly compared between topographies. The mean (SD) age of the participants was 44.9 (9.2). The expression of ET-1 was increased in the whole epidermis with melasma when compared to the adjacent skin, being 32.8% (CI95% 14.7%-52.6%) higher in the spinous layer (p=0.013), 30.4% (CI95% 13.7%-47.9%) higher in the basal layer (p=0.014), and 29.7% (CI95% 11.4%-49.7%) higher in the melanocytes (p=0.006). There was no noticeable expression of ET-1 within the cells on the upper dermis. Neither ERA nor ERB resulted in differential epidermal expression between melasma and unaffected skin (p≥0.1). ET-1 is expressed more intensely on the epidermis from the skin with facial melasma compared to the unaffected adjacent skin.

Evaluation of Micro-Needling Followed by Tranexamic Acid Cream versus Micro-Needling Followed by Tranexamic Acid Solution in Treatment of Melasma: A Comparative Split Face Study

Abstract Background Melasma is a common pigmentary disorder clinically characterized by symmetric light brown to bluish-gray macules and patches with irregular, sharp borders that affect cutaneous areas, particularly the face and neck. It is commonly identified in women of reproductive ages and more commonly described in darker-skinned patients with Fitzpatrick skin types IV to VI residing in high-intensity ultraviolet radiation worldwide. It causes significant cosmetic disfigurement, psychosocial stress, and embarrassment, affecting patients’ quality of life. Objectives To evaluate the efficacy and safety of microneedling followed by tranexamic acid (TXA) cream application versus microneedling followed by tranexamic acid solution in the treatment of facial melasma. Patients and Methods This prospective split-face comparative study included thirty female patients with different types of melasma, their ages ranged from 25 to 40 years. They were recruited from the Dermatology outpatient clinic of Ain Shams University Hospitals. All patients have been treated with TXA for 3 sessions; one session every month (the right side of the face was treated by microneedling followed by TXA 5 % cream while the left side of the face was treated by microneedling followed by TXA solution 5%). Additionally, the right side of the face was treated with TXA 5% cream, and the left side applied with placebo cream twice daily for 3 months. Assessment was done by Hemi Melasma Area and Severity Index score (Hemi -MASI), patients’ satisfaction score, clinical digital photography, dermoscopic examination and area percentage of melanin concentration assessed by histopathological examination. Results Our findings showed significant improvement in different types of melasma regarding Hemi MASI score, patients’ satisfaction score, and area percentage of melanin concentration assessed by histopathological examination by Fontana-Masson stain (FM) one month after 3rd treatment session in both sides of the face. However, a minor melasma recurrence was observed two months after 3rd treatment session on both sides of the face. Meanwhile, no significant difference was observed in the treatment response of microneedling followed by TXA cream versus microneedling followed by TXA solution one month after 1st and 2nd sessions regarding Hemi MASI score, while a significant difference was observed one month after the 3rd session. Conclusion Topical TXA appears to be a promising therapeutic option in the treatment of melasma without serious adverse effects. Topical TXA cream, which was applied twice daily by the patient combined with microneedling sessions with TXA cream, has better results in comparison with microneedling sessions with TXA solution with placebo cream.

The 675-nm wavelength for treating facial melasma.

Melasma is an acquired skin problem. It characterises sun-exposed areas, particularly on the face, with irregular borders and bilateral distribution. With this study, we want to strengthen the scientific literature regarding the use of a 675-nm laser device for the treatment of women and men with facial melasma pigmentary and vascular symptoms. Eighteen patients were treated for facial melasma. A total of three sessions at 30-day intervals were performed with a 675-nm laser device. A five-point Global Aesthetic Improvement Scale was used to separately assess the improvement of the patient's skin 3months after the last treatment (T1) compared to baseline (T0). The pain during treatment was measured using a Visual Analog Scale of 10 points. The non-ablative laser system used emits red light with a wavelength of 675nm through a 13×13mm scanning system. At T1 , a consistent improvement in the pigmentary and vascular components was visible. This is always combined with a considerable reduction in vascular expression. Our research shows that individuals with Fitzpatrick phototypes II to III can treat facial melasma with the 675-nm laser source system without risk. Due to its interaction with melanin, collagen and haemoglobin chromophores, as well as its excellent capacity to penetrate tissues with less heating, this system is promising in the treatment of pigmentary and vascular illnesses such as melasma. The great success of the technology we used came from the reduced levels of inflammation produced after the treatments and the low energy level implied.

Efficacy and Safety of Topical Tranexamic Acid Alone or in Combination with Either Fractional Carbon Dioxide Laser or Microneedling for the Treatment of Melasma.

Tranexamic acid (TXA) is a promising treatment modality for melasma. Microneedling (MN) and fractional carbon dioxide (CO2) laser were reported to enhance TXA transepidermal delivery. To compare efficacy and safety of topical TXA alone or in combination with either fractional CO2 laser or MN for treatment of melasma. Thirty females with facial melasma were divided randomly into 3 equal groups after excluding pregnant and lactating women and those using oral contraceptives or other hormonal therapy. Patients of group A were treated with fractional CO2 laser and those of group B were treated with MN (4 sessions, 3 weeks apart for both) with immediate topical application of TXA 5% solution after sessions and daily application of 5% TXA cream for both groups. Patients of group C were treated by topical daily application of TXA 5% cream. Evaluation was done by modified melasma area and severity index scores (mMASI), patient satisfaction and dermoscopy. Statistically significant improvement of mMASI was reported in all studied groups with a significantly better improvement in patients of groups A and B than those of group C, meanwhile the difference between groups A and B was statistically insignificant. Topical TXA is a safe and fairly effective treatment modality for facial melasma. Combining TXA with either fractional CO2 laser or MN yielded significantly better improvement than when used alone. Fractional CO2 laser carries the risk of post-inflammatory hyperpigmentation in patients with skin types III and IV and requires meticulous patient selection.

Amber photobiomodulation versus tranexamic acid for the treatment of melasma: protocol for a double-blind, randomised controlled trial

IntroductionPhotobiomodulation (PBM) has been suggested as an alternative treatment for melasma. In vitro studies have shown PBM with amber light inhibits the tyrosinase enzyme, induces autophagy and reduces the melanin...

P70 A randomized open-label study to compare two different dosage regimens of oral tranexamic acid in treatment of moderate-to-severe facial melasma

Abstract Oral tranexamic acid (TXA) demonstrates promising results in melasma treatment; however, TXA dosing in melasma management has been a cause for persistent speculation. There is still no consensus to guide dosing, duration of TXA therapy and need for maintenance treatment. Our aim was to evaluate and compare the efficacy of two different TXA dosing regimens, 250 mg twice daily vs. 500 mg twice daily in patients with melasma using the modified Melasma Area and Severity Index (mMASI) score. This was a randomized open-label study involving 50 patients aged &amp;gt; 18 years with moderate-to-severe melasma. Patients were randomized into group A (oral TXA 250 mg twice daily) and group B (oral TXA 500 mg twice daily) for 12 weeks and later followed-up monthly to 24 weeks. The primary outcome measure was the proportion of patients achieving a 75% reduction in mMASI (mMASI-75) at 12 weeks from baseline, and a reduction in mMASI and Melasma Quality of Life (MelasQOL) score at 12 and 24 weeks. The proportion of patients achieving mMASI-75 at 12 weeks was 20% in group A and 25% in B (P = 0.71). Both groups showed a statistically significant reduction in mean (SD) mMASI [4.8 (2.2) in group A and 6.8 (3.4) in group B; P = 0.02] at 12 weeks. mMASI remained stable after 12 weeks and was 4.9 (2.43) and 4.92 (2.85) in groups A and B, respectively, at 24 weeks (P = 0.97). The mean (SD) percentage reduction rates in MelasQOL in groups A and B were 41.8 (15.3) and 29.5 (21.5), respectively (P = 0.03). No adverse effects were observed in either group. Both dosing regimens showed comparative efficacy in terms of mMASI reduction at 12 weeks. The improvements achieved were well maintained even after 12 weeks of discontinuing treatment. Hence, lower doses of TXA (i.e. 250 mg twice daily) are equally as effective and safe as higher doses (i.e. 500 mg twice daily). With regard to maintenance dosing, few patients relapsed; hence, not all patients will require tapering or dosing maintenance.