Hyperpigmentation Research Articles

Picosecond Alexandrite Laser With Diffractive Lens Array Combined With Long-Pulse Alexandrite Laser for the Treatment of Facial Photoaging in Chinese Women: A Retrospective Study.

Facial photoaging is a type of facial skin aging induced mainly by exogenous factors (ultraviolet radiation) and often manifests itself in the form of hyperpigmentation, telangiectasia, roughness, increase in fine lines/wrinkles, and enlarged pores. Recently, picosecond lasers have become an emerging option for the treatment of facial photoaging, and long-pulse alexandrite lasers (LPAL) have demonstrated promising potential in the treatment of photoaging-related symptoms. This study aimed to evaluate the efficacy and safety of picosecond alexandrite laser (PSAL) with diffractive lens array (DLA) combined with LPAL for facial photoaging. This is a retrospective study of 20 Chinese female patients with facial photoaging who received PSAL with DLA combined with LPAL during a 1-year period. All patients were treated every 4weeks for a total of three treatments. Objective indicators of facial photoaging and patient satisfaction were evaluated before each treatment, and pain scores and adverse effects were recorded after each treatment. Compared with baseline, patients showed significant differences in all facial photoaging indices (p<0.01). After receiving three treatments, there was a 20.1% decrease in the pigmentation index, a 23.9% decrease in the erythema index, a 34.5% decrease in the texture index, a 28.4% decrease in the fine lines index, a 56% decrease in the pore index, a 9.3% elevation and a 17.1% decrease in elasticity R2 and F4, respectively, and a 55% decrease in sebum content. The mean satisfaction score for the three treatments was 4.67 (3.33, 5.00), and the mean visual analogue scale (VAS) pain score was 7.00. No serious adverse effects such as post-inflammatory hyperpigmentation (PIH), hypopigmentation, or blistering were observed at the treatment site during the treatment period. PSAL with DLA combined with LPAL for the treatment of facial photoaging with significant efficacy, high patient satisfaction, and minimal adverse effects.

Assessing the inclusion of postinflammatory hyperpigmentation outcomes in acne vulgaris clinical trials

Assessing the inclusion of postinflammatory hyperpigmentation outcomes in acne vulgaris clinical trials

Managing neurofibromatosis type I and vision impairment in a resource-limited setting: a case study and multidisciplinary approach

Background: Neurofibromatosis type I (NF1) is a genetic disorder characterized by the development of multiple benign tumors along nerves in the skin, brain, and other parts of the body. It is associated with a range of clinical manifestations, including skin lesions, neurofibromas, and ocular abnormalities, which can significantly impact a patient’s quality of life. Management of NF1 is particularly challenging in resource-limited settings due to limited access to diagnostic and therapeutic resources. Clinical presentation: A 62-year-old woman with a known history of NF1 presented with progressive visual impairment. Her condition began in childhood with multiple hyperpigmented skin macules, which developed into numerous cutaneous tumors over time. Examination revealed numerous neurofibromas, café-au-lait spots, and axillary freckling. Significant visual impairment was caused by large fibromas on her eyelids. Histological analysis confirmed benign nerve tissue tumors. Clinical discussion: The management strategy in this resource-limited setting focused on regular monitoring, patient education, symptomatic treatment, and multidisciplinary care. Despite the limitations, the patient’s condition was managed effectively through these adapted strategies. The importance of genetic testing for confirmation and further management was noted but not performed due to resource constraints. Conclusion: This case highlights the complexities of managing NF1 in resource-limited settings, emphasizing the need for adaptable management approaches. Multidisciplinary care and patient education were crucial in improving the patient’s quality of life. This case underscores the importance of early diagnosis and intervention to prevent complications like visual impairment.

Oral Tranexamic Acid for Prevention and Treatment of Postinflammatory Hyperpigmentation.

Postinflammatory hyperpigmentation (PIH) is a skin disorder characterized by hyperpigmentation resulting from heightened inflammation and/or damage to the basement membrane, melanocytes, and keratinocytes, leading to abnormal and excessive pigment deposition. Oral tranexamic acid (TXA), originally used as an antifibrinolytic for managing excessive bleeding, has garnered attention for its demonstrated safety and efficacy in treating melasma. There is a growing body of evidence regarding the use of TXA in the treatment of PIH. To review the mechanism of action of oral TXA in treating PIH and examine the use of oral TXA in preventing and/or treating PIH associated with laser-based and light-based treatments in individuals with skin color. Review of relevant articles from 2000 to present found in the Cochrane Library, PubMed, Embase, and Google Scholar, regarding the use of oral TXA in the treatment of PIH. Studies reviewed investigated the efficacy of oral tranexamic acid (TXA) in treating postinflammatory hyperpigmentation (PIH) and use in preventing PIH when used in conjunction with other treatments. All studies demonstrated significant improvement in PIH without significant adverse effects and side effects. Oral tranexamic acid is emerging as a safe and effective treatment in the prevention and treatment of postinflammatory hyperpigmentation.

Melasma removal using Q-Switched Neodymium-doped Yttrium Aluminium Garnet laser toning and high-intensity focussed ultrasound.

To evaluate the effectiveness of combining high-intensity focussed ultrasound and a Q-switched neodymium-doped yttrium aluminium garnet 1064nm low-fluence toning laser in the treatment of melasma. The experimental study was conducted from November 2020 to August 2021 at the medical physics laboratory, College of Medicine, Mustansiriyah University, Baghdad, Iraq, and comprised individuals of either gender aged >25 years having mixed form melasma in malar and forehead areas. Each participant received high-intensity focussed ultrasound treatment on the right side. After 2 weeks, Q-switched neodymium-doped yttrium aluminium garnet 1064nm low-fluence toning laser was applied to the melasma patches 4 times at one-week intervals. Melasma area and severity index scores were noted at baseline and at each visit for each patient. Visual analogue scale was used for objective evaluation. After the 4 laser sessions, all the patients completed a 3-month follow-up. Data was analysed using SPSS 24. Of the 25 subjects, 15(60%) were females and 10(40%) were males. The overall mean age was 41.6±8.46 years (range: 22-60 years). There was a significant improvement with high-intensity focussed ultrasound (p<0.05). In the 3rd laser session, there was a significant difference in melasma area and severity index score of 2.48 for the right side and 3.12 for the left side (p<0.05). In the 4th session, there was a significant difference in melasma area and severity index score of 1.68 for the right side and 2 for the left side (p<0.05). No post-inflammatory hyperpigmentation or rebound was noted. High-intensity focussed ultrasound combined with toning laser was more effective than Q-switched neodymium-doped yttrium aluminium garnet 1064nm low-fluence laser alone in removing difficult melasma from the malar area in the 2nd, 3rd and 4th sessions, and from the forehead in the 3d and 4th sessions.

Penentuan Kadar Flavonoid dan Kandungan Fitokimia Ekstrak Kulit Bawang Merah (Allium cepa L) dengan Berbantukan Microwave sebagai Potensi Bahan Aktif Tabir Surya

The skin serves as a protective barrier against dust and ultraviolet (UV) radiation. Excessive UV exposure is associated with accelerated skin aging, erythema, hyperpigmentation, and carcinogenesis. This study aimed to quantify flavonoid concentrations and characterize phytochemical constituents in shallot skin extracts for their potential as active ingredients in sunscreen formulations. Shallot skin was subjected to microwave assisted extraction using 70% ethanol as the solvent. Phytochemical screening revealed the presence of flavonoids, tannins, saponins, and alkaloids in the extract. Flavonoid content was determined via UV-Vis spectrophotometry, yielding 36.33 mgQE/g. The high flavonoid concentration observed in shallot skin extract suggests its potential efficacy as an active ingredient in sunscreen formulations.

Carotenoids from cyanobacteria modulate iNOS and inhibit the production of inflammatory mediators: Promising agents for the treatment of inflammatory conditions

Cyanobacteria are green multiproduct refineries of increasing interest for different industrial prospects. In this work, eleven cyanobacteria strains isolated from the Cape Verde archipelago were explored for their biotechnological applications in the field of inflammation. A biorefinery approach was employed to produce carotenoid-targeted extracts, further profiled by HPLC-PDA and explored for their ability to i) scavenge important physiological free radicals of oxygen (superoxide anion radical, O2•-) and nitrogen (nitric oxide, •NO) involved in the inflammatory process ii) slow-down post-inflammatory hyperpigmentation and iii) modulate the activity of inflammatory cytokine-producing enzymes, in enzymatic and cell systems comprising RAW 264.7 cells. The studied strains turned out to be important carotenoid producers (70.47–186.71 μg mg−1dry extract), mainly represented by β-carotene and zeaxanthin. The targeted-extracts stood-out for their potential to slow-down the inflammatory process through a multitarget approach: scavenging •NO and O2•-, reducing inflammatory cytokines production through lipoxygenase inhibition, and modulating the inducible nitric oxide synthase in LPS-stimulated RAW 264.7 cells, with strains of the order Nodosilineales revealing to be worth of further biotechnological exploitation.

Platelet-Rich Plasma Injection Combined With Q-Switched Ruby Laser in the Treatment of Periorbital Hyperpigmentation.

Periorbital hyperpigmentation is a prevalent skin condition that represents a large quantity of cases seen in cosmetic dermatology. Patients tend to be left with pigmentation after Q-switched ruby laser treatment, especially the perioribital area. The study is conducted to compare the effect of PRP injection combined with laser therapy versus laser alone for periorbital hyperpigmentation treatment. In this single-center, case-control study, 30 patients with periorbital hyperpigmentation were allocated to receive PRP injection injection after Q-switched ruby laser or Q-switched ruby laser only, followed by a 12-week and 24-week follow-up visit. Visual analogue scale, Sadick tear trough rating scale, and patients' self-evaluation were used to evaluate the therapeutic effect. The combined group achieved a better improvement in long-term effect and had effect on facial rejuvenation. Patient satisfaction was higher in the combined group. Erythema and mild pain were the most common adverse reactions of both groups. Combining with PRP injection can improve the therapeutic effect of Q-switched ruby laser in treating periorbital hyperpigmentation and lessen the risk of post-inflammatory hyperpigmentation, indicating a new option for POH treatment.

Inhibitory Effects of Polyphenols from Equisetum ramosissimum and Moringa peregrina Extracts on Staphylococcus aureus, Collagenase, and Tyrosinase Enzymes: In vitro Studies

Background: Skin problems caused by oxidative stress lead to the activation of collagenase and tyrosinase enzymes, contributing to skin aging, discoloration, and infections. Equisetum ramosissimum and Moringa peregrina were assessed for their potential uses in treating various skin conditions. Objective: The present research aimed to investigate the positive effects of polyphenols in Equisetum ramosissimum and Moringa peregrina extracts as potential cosmetic products for the treatment of different skin conditions. Methods: Total phenolic and flavonoid contents, antioxidants, and anti-collagenase and anti-tyrosinase activities of plant extract mixtures (PEM) at different ratios of (M. peregrina: E. ramosissimum) were determined using standard procedures. Inhibitory effects of PEM against acne-causing Staphylococcus aureus (ATCC 29213) were evaluated using the diameter (cm) of the inhibition zone method. A cream formulation containing PEM was developed and characterized for stability and potential skin irritation in rats using standard procedures. Results: The PEM at a ratio of (2:1) showed the highest total phenolic and flavonoid content (150.15 ± 2.8 mg/g, equivalent to gallic acid, and 41.5 ± 1.2 mg/g, equivalent to quercetin, respectively). Antioxidant activities for PEM (2:1) were also optimal, as determined by the DPPH and ABTS methods (IC50 = 7.06 ± 0.12 µg/mL and 53.29 ± 3.3 µg/mL, respectively). Furthermore, PEM (2:1) exhibited superior inhibitory activities against collagenase and tyrosinase enzymes (IC50 = 32.4 ± 1.19 µg/mL and 8.4 ± 1.19 µg/mL, respectively). Antimicrobial activity of PEM (2:1) tested on S. aureus showed the largest zone of growth inhibition (2.8 cm) at a concentration of 60 mg/mL. Studies on the PEM (2:1) cream formulation revealed that it remained stable under room conditions. Skin irritation tests on rats showed no signs of oedema or erythema after treatment. Conclusion: The PEM with a ratio of (2:1) demonstrated optimal activity as an oxidative stress-neutralizing agent, inhibitor of enzymes responsible for skin aging and hyperpigmentation, and antibacterial agent. The cream formulation containing PEM exhibited physical stability and no detectable risk of skin irritation throughout the research procedures.

Modulation of Melanocyte in Melasma Patients After Picosecond Laser Treatment.

Melasma is a therapeutically challenging hyperpigmented skin condition. Currently, there is a lack of invivo observation regarding changes in melanin and dendritic melanocytes after laser treatment. To investigate alterations in melanin and melanocytes in melasma before and after laser treatment using optical coherence tomography (OCT). Eight female melasma patients were enrolled in Taiwan. Based on the baseline OCT scans, the patients were categorized into either epidermal-type or mixed-type melasma and were assigned different treatment protocols accordingly. Sequential OCT images were collected from melasma lesions and normal skin at baseline, Week 4 and Week 8. After 8 weeks of laser treatment, the mean Melasma Area Severity Index (MASI) score improved from 10.92 to 6.30. Results from OCT showed no significant changes in the normalized density, area, or intensity of melanin in both lesional and normal skin. At baseline, the mean length of dendritic melanocytes in the affected skin was 15% longer than those in normal skin; at Week 8, the mean length of lesional dendritic melanocytes became the same as those in normal skin. Additionally, the mean width of dendritic melanocytes decreased from being 4% wider to only 2% wider than those in normal skin. After 8 weeks of treatment, an improvement of MASI score was noted, mainly attributable to a reduction in lesional area. OCT showed no notable change regarding melanin, but a decrease in length and width of dendritic melanocytes was noted in the lesional skin of melasma patients.

Rheumatological manifestations of H syndrome.

H syndrome (HS) is a rare autosomal recessive genodermatosis characterised by cutaneous hyperpigmentation, hypertrichosis, sclerodermatous thickening, and multisystemic involvement. It results from mutations in the SLC29A3 gene encoding the human equilibrative nucleoside transporter 3, leading to impaired histiocyte apoptosis and unchecked proliferation. We report the case of a 24-year-old Moroccan male who had a history of insulin-dependent diabetes mellitus. He developed hyperpigmented skin patches with hypertrichosis and induration. Musculoskeletal findings included bilateral hallux valgus, pes planus, reducible flexion contractures of the proximal interphalangeal joints, and restricted ankle dorsiflexion. Additional findings consist of lymphadenopathy, hepatomegaly, hypogonadism, and ophthalmic manifestations. Investigations showed elevated sedimentation rate, anaemia, and osteopaenia. Ankle ultrasound revealed calcaneal enthesopathy and subcutaneous infiltration. In reporting this case, we aim to highlight the significant rheumatological involvement that can arise in patients with H syndrome and explore potential treatment options to improve the musculoskeletal findings.

Energy-based methods and nanocarrier-based approaches for melasma treatment

Melasma is a chronic disease caused by excessive melanin production in the skin, affecting the quality of life, especially in women. As a kind of skin hyperpigmentation, it can be caused by sun exposure, genetics, hormones, drugs, or inflammation. Melasma treatment can be effective when the product penetrates well into the skin. As an essential skin barrier, the stratum corneum displays a significant role in topical and transdermal drug delivery. In this regard, numerous strategies have been developed to increase the skin permeability and efficiency of drugs. This review explores energy-based methods and nanocarrier-based approaches for melasma treatment, focusing on enhancing drug delivery to the viable epidermis and overcoming SC. Physical methods have some advantages like increasing the skin penetration and also some drawbacks, including frequent visits, high costs, and the need for advanced equipment and trained operators. Further, these methods are often combined with high energy and special technics. As an emerging physical-based method that could be used to treat patients with multiple medications, microneedle patch is drawing interest due to its ease of use, ability to pinpoint drug delivery, and fewer side effects. In addition, they can penetrate drug molecules into deeper layers of skin and provide more sustainable results compared to conventional methods. Nanocarrier-based systems like transferosome and ethosome (deformable liposomes) are also effective options for skin penetration and treating melasma and skin hyperpigmentation. Despite several benefits, such as high entrapment efficiency, good permeation, and increased bioavailability of drugs through the skin, their stability problems and limitations toward nanoparticle production on an industrial scale are the most significant drawbacks of this method. In the current review, we looked at the articles published between 2010 and August 2023 on energy-based methods and nanocarriers-based approaches have been used to treat melasma.

A case of familial progressive hyperpigmentation with or without hypopigmentation presenting with hypopigmented striae along the lines of Blaschko.

Familial progressive hyperpigmentation with or without hypopigmentation (FPHH) is an autosomal dominant disorder characterized by widespread skin hyperpigmentation, café-au-lait spots, and hypopigmented circular macules, resulting from KITLG variants. KITLG, expressed by keratinocytes, binds to KIT on melanocytes, stimulating melanogenesis. Disturbances in the KITLG-KIT interaction result in diffuse hyperpigmentation in FPHH. However, the mechanisms behind hypopigmented macule formation remain unclear. This report presents a unique FPHH case in a patient with a novel KITLG mutation (Ser78Leu). Notably, the patient showed multiple hypopigmented macules and striae along the lines of Blaschko. Digital polymerase chain reaction analysis of the DNA from skin and blood tissues indicated a copy-neutral loss of heterozygosity at the KITLG locus, only in the hypopigmented macule. These findings suggest that the hypopigmented macules might result from revertant mosaicism. Conversely, café-au-lait spots do not follow the lines of Blaschko and can superimpose on the hypopigmented striae, indicating a distinct pathogenesis. This case contributes to the understanding of the genetic mechanisms in FPHH.

Correlation Between Coral Lesions and Skin Hyperpigmentation in Reef Fish on the Southwest Coast of Grenada, West Indies

Correlation Between Coral Lesions and Skin Hyperpigmentation in Reef Fish on the Southwest Coast of Grenada, West Indies

Topical Ascorbic Acid Mesotherapy with Microneedling versus Topical Tranexamic Acid Mesotherapy with Microneedling for Melasma: A Therapeutic Comparative Study

Background &amp; objectives: Melasma is a common skin hyperpigmentation syndrome that frequently includes reproductive-aged females, and numerous therapies with various consequences have been suggested. Thus, the objective was to compare the microneedling and mesotherapeutic effects of ascorbic acid versus tranexamic acid for melasma treatments. Methods: This interventional therapeutic prospective study was conducted on 40 patients with melasma at Khabat Consultation Center for Skin Diseases, Sulaimaniyah, Iraq, from March 2022 to August 2022. Sociodemographic data of patients were collected together with a family history of melasma using a well-designed questionnaire. Half of the patients were treated with ascorbic acid, while the rest were treated with tranexamic acid using a derma pen. Results: Highly significant reduction of MASI score were seen before and after treatment (p&lt;0.001) were seen in mean scores before and after treatments for both types of treatments (ascorbic acid and tranexamic acid). Moreover, ascorbic acid results in the highest mean score reduction in skin type III (p=0.746), while tranexamic acid results in the highest mean score in skin type IV (p&lt;0.05). Furthermore, the dermal melasma recorded the highest mean score, and the lowest level was observed in the epidermal melasma for both ascorbic acid and tranexamic acid groups. No significant difference was found between both studied groups in sociodemographic data and other studied variables (family history, skin type, previous treatment, and duration of melasma). Conclusions: Both types of therapy mesotherapy was effective in treating melasma; however, their potencies varied on different skin types and according to melasma types.

ADOLESCENTS KNOWLEDGE ON THE USE OF COSMETIC AND DERMATOLOGICAL PREPARATIONS IN THE TREATMENT OF ACNE VULGARIS

Acne vulgaris is a common, chronic, inflammatory disorder of the pilosebaceous unit that affects most teenagers with inflammatory lesions on the face and trunk. They are mainly caused by increased sebum production, hyperkeratinization of the follicle, inflammation, hormonal changes, misuse of cosmetic and dermatological preparations. This condition is more common in adolescents, but it also occurs in patients in their twenties and thirties too. These changes in the skin affect emotional stress and quality of life. Dermocosmetics play a special role in the care and treatment of acne-prone skin. A series of complementary dermocosmetics are available, which include products with cleansing, active, soothing and moisturizing properties. Dermocosmetics formulated with active substances can be used in acne monotherapy based on the effectiveness of specific active ingredients in alleviating acne symptoms without any adverse effects reported so far. Effective skincare serves not only as a preventative measure by addressing the underlying causes of acne, but also helps mitigate the negative effects of pharmacological therapy and helps manage complications such as scarring and post-inflammatory hyperpigmentation. This study aims the evaluation of the awareness of adolescents in relation to the treatment of acne and their knowledge about the use of cosmetic and dermatological preparations. Based on our results 40% of teenagers didn’t consult a dermatologist but used preparations that they see on social media and that their effectiveness was lower than 30%. 38% of the teenagers have used the therapy and the food regime that the dermatologist recommended which lead to a 75% effectiveness on treatment, 12% have used lotions recommended by their pharmacists and didn’t follow the food regime from which they had an effectiveness of only 42%. We also noticed that the patients who followed the instructions of the dermatologist and the pharmacist had more efficiency, while the others had less efficiency. From this we can conclude that any change in the skin for better efficiency should be managed by a dermatologist.

Refractory solar lentigines successfully treated with 532-nm nanosecond Nd:YAG Vasculature Salvage Laser Surgery (VSLS) system: Case series.

Solar lentigo, a common epidermal hyperpigmented lesion found in sun-exposed areas, results from the proliferation of melanocytes and the accumulation of melanin. Although various treatments for solar lentigo have been explored, they often lead to complications, including prolonged erythema and post-inflammatory hyperpigmentation (PIH), posing significant concerns. This study evaluated the safety and efficacy of the Vasculature Salvage Laser Surgery (VSLS) system. We treated six Korean patients, each with solar lentigo, in a single session using the 532-nm nanosecond neodymium-doped yttrium aluminum garnet (Nd:YAG) VSLS system, with follow-up periods ranging from 3 to 10weeks. The treatment led to the complete removal of pigmented lesions in all patients without resulting in PIH, even in cases where previous laser treatments had failed. The only side effect observed was mild erythema, which resolved over the long term in most instances. The VSLS system emerges as a safe and effective treatment for pigmented lesions, including refractory solar lentigines. Nonetheless, additional studies are required to verify its long-term efficacy.

Sunscreens prescribed to patients with skin of color and/or with melasma: A survey of 221 dermatologists and dermatology residents in Spain.

Dark-skinned individuals (DSI) present high rates of melasma and post-inflammatory hyperpigmentation. The use of sunscreens with mineral filters is essential for prevention and treatment. Our objective was to determine the preferences of dermatologists and dermatology residents in the prescription of sunscreens for DSI. An anonymous survey of attendees at an online photoprotection event held on March 31, 2022, in Spain. The survey was answered by 66.6% (221/332) of the attendees: 159 dermatologists (71.9%) and 62 dermatology residents (28.1%). Respondents reported recommending the use of sunscreen to a median of 80% of DSI [interquartile range (IQR), 50-90]. Physicians reported prescribing tinted sunscreens to a median percentage of 60% (IQR, 25-90) of DSI with acne; and to a median percentage of 90% (IQR, 58-99) of DSI with melasma. The most prescribed photoprotectors to DSI with melasma were organic broad-spectrum sunscreens with antioxidants: 102/220 (46.4%) and mineral broad-spectrum sunscreens (with iron oxides): 45/220 (20.4%). In DSI with melasma or other pigmentary disorders, the most preferred features of sunscreens were as follows: sun protection factor ≥ 30: 217/221 (98.2%), UVA protection: 214/221 (96.8%), color for camouflage: 150/220 (68.2%) and mineral filters such as titanium dioxide and zinc oxide: 151/220 (68.6%) or iron oxides: 131/220 (59.5%). Online survey, potential inclusion bias. Respondents reported to prescribe sunscreens to the majority of DSI, and tinted sunscreens for the majority of DSI with pigmentary disorders. However, the most frequently recommended sunscreens for DSI were organic broad-spectrum sunscreens with antioxidants.

53156 Prevention of post-inflammatory hyperpigmentation in dark skin types after a non-ablative laser

53156 Prevention of post-inflammatory hyperpigmentation in dark skin types after a non-ablative laser

53373 BAK to the Future: Systematic Review of Bakuchiol as a Treatment of Post-Inflammatory Hyperpigmentation

53373 BAK to the Future: Systematic Review of Bakuchiol as a Treatment of Post-Inflammatory Hyperpigmentation