Improvement Of Melasma Research Articles

Split-Face Study Using a 1,927-nm Thulium Fiber Fractional Laser to Treat Photoaging and Melasma in Asian Skin

Although the 1,927-nm thulium fiber fractional laser is effective and safe for treating photoaging, clinical data regarding this modality remain limited. To investigate the efficacy and safety of the 1,927-nm thulium fiber fractional laser for treating photoaging and melasma in Asians. Twenty-five participants received three laser treatments (at 3-week intervals) on the half of the face with more-severe photoaging and melasma. Independent investigators evaluated clinical improvement 2 and 6months after the final treatment. Improvement in melasma was evaluated using the Melasma Area and Severity Index. Subjective satisfaction rates were also evaluated. Adverse events were assessed, and pain was scored using a visual analog scale (VAS). Histologic changes were observed using immunohistochemical staining. Clinical improvement of photodamaged facial skin was remarkable on the treatment side. Most participants reported that their subjective satisfaction rate was greater than slight satisfaction. Downtime for healing required approximately 1week. No severe adverse events occurred. Mean VAS score during treatment was 4.8. Collagen regeneration and melanin decrease were observed histologically. The 1,927-nm thulium fiber fractional laser is a safe, effective treatment for photoaging and melasma in Asians.

The efficacy in melasma treatment using a 1410 nm fractional photothermolysis laser

Melasma treatment modalities including topical and procedural therapy have been employed with variable results and high recurrence rate. To quantitatively assess improvement in melasma and side effects after 1410nm fractional photothermolysis laser treatments and to determine efficacy at 1-, 2- and 3-month follow-up after treatment. Thirty volunteers with melasma were treated with 1410nm fractional photothermolysis for four passes on full face and additional four passes on melasma area. They were randomly treated on one side of their face with 20mJ at 5% coverage and the other side of their face with 20mJ at 20% coverage. All subjects were treated monthly for five times. Melanin index, Visual analogue scale and Melasma Area and Severity Index score were measured at baseline and 1-, 2- and 3-month follow-up after complete treatment protocol. There was statistically significant improvement of Melanin index at 2- and 3-month follow-up visits, but not at 1-month follow-up visit. Visual analogue scale and Melasma Area and Severity Index score improved significantly on both sides at 1-, 2- and 3-month follow-ups. The overall patients' satisfaction was significantly higher on the side treated with 20mJ, 5% coverage. Adverse reactions included erythema, dryness and post-inflammatory hyperpigmentation on melasma area. Those side effects were significantly more intense on the side treated with 20mJ, 20% coverage. 1410nm fractional photothermolysis laser treatment is a safe and temporary effective procedure for melasma; however, long-term follow-up is still needed. Only 5% coverage should be used to minimize risks of adverse effects.

Successful treatment of hydroquinone-resistant melasma using topical methimazole

Melasma is an acquired hyperpigmentation skin disorder in sun-exposed areas. It occurs almost exclusively over the face, and is most commonly seen in women. Several depigmenting agents have been used for the treatment of melasma among which hydroquinone has been the most widely used due to its efficacy and safety in short-term use. However, hydroquinone is recently reported to be a cytotoxic and mutagenic compound in mammalian cells and is thus banned in several countries. Hydroquinone ban has caused investigators to search for alternative depigmenting agents for the treatment of melasma in recent years. Methimazole is an antithyroid agent orally used in humans since several decades and has been shown that when applied topically, it inhibits melanin synthesis and causes skin depigmentation in lab animals as well as human subjects. Herein, we report two hydroquinone-resistant melasma patients who were successfully treated with methimazole cream. Application of 5% methimazole cream once daily resulted in significant improvement of melasma in both patients after 8 weeks. The efficacy of methimazole for melasma treatment as well as its advantages over other known depigmenting compounds (non-mutagenicity, non-cytotoxicity and high tolerability profile) suggests that topical methimazole should be added to the armamentarium of anti-melasma treatment.

The treatment of melasma by silymarin cream

BackgroundMelasma is an acquired increased pigmentation of the skin characterized by symmetrical and confluent grey-brown patches usually on the areas of the face exposed to the sun. Silymarin strongly prevents photocarcinogenesis, and significantly prevented melanin production. The objectives of this study were the assessment of safety and efficacy of topical Silymain (SM) cream in a double-blind placebo controlled study for treatment of melasma patients.MethodsExperimentally on 24 Albino rabbits were randomly divided into 4 equal groups. [A] No treatment, [B] received placebo, [C] treated with SM cream (0.1), & [D] treated by SM (0.2), were applied topically before UV sun light exposure for 30 days, assessed clinically & tissue pathology. Clinically on 96 adults diagnosed with melasma randomized to three equal groups to receive one of the tested drugs applied twice daily for 4 weeks, evaluated by the response; lesion size, melasma area and severity index score, Physician global assessment, and subjective assessment.ResultsThe Clinical and histopathology observations were reduced significantly in SM groups. Clinically; all patients showed significant excellent pigment improvement & lesion size reduction with SM treatments from the 1st week. All patients were fully satisfied 100%. No side effects were observed.ConclusionsSilymarin showed tremendous improvement of melasma in a dose-dependent manner, and was effective in prevention of skin damage caused by U.V. sunlight. It is a safe new candidate effective treatment for melasma.Trial registrationAustralian New Zealand Clinical Trials Registry - ACTRN12612000602820

Comparison between the efficacy of 10% zinc sulfate solution with 4% hydroquinone cream on improvement of melasma

Background:Melasma, a common disorder of hyperpigmentation, is often difficult to treat. Although 10% zinc sulfate solution has been reported to be useful for patients with melasma, controlled trials are lacking.Materials and Methods:72 women with moderate to severe melasma were divided randomly into 2 groups. Group A were treated with 10% zinc sulfate solution and group B with 4% hydroquinone cream twice-daily. The results were evaluated by photoevaluation by patients based on subjective satisfaction and a blinded dermatologist using MASI score. Assessments were obtained at baseline and at 2 and 6 months after starting treatment.Results:According to MASI score changes during treatment, there was a reduction in both groups at 2 months, however, the reduction in group B was more significant (the reduction in mean ± SD MASI was 0.7 ± 0.7 in group A vs. 2.7 ± 1.6 in group B). In addition, the patients in group B continued to decrease MASI score for the remainder of the study period at 6 months follow-up (0.3 ± 0.5) in comparison with patients in group A who did not show more reduction in MASI score.Conclusions:The study indicates that topical zinc sulfate is not as effective in treating disease as was observed in the previous open study. A comparative study with sunscreen and placebo is necessary to determine if topical zinc sulfate is truly superior to sunscreen and placebo in this respect.

Sequential Treatment with Triple Combination Cream and Intense Pulsed Light is More Efficacious than Sequential Treatment with an Inactive (Control) Cream and Intense Pulsed Light in Patients with Moderate to Severe Melasma

Triple combination (TC) cream is a stable combination of fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05% and is currently the only hydroquinone-containing drug approved by the Food and Drug Administration for the treatment of melasma. To evaluate the safety and efficacy of TC cream when used sequentially with intense pulsed light (IPL) treatments in patients with moderate to severe melasma. This was a 10-week, split-face study in which 56 patients with symmetrical melasma lesions were treated with TC cream on one side of the face and an inactive control cream on the other side of the face. Patients also had two IPL treatments at weeks 2 and 6. (Topical treatment was suspended during IPL treatments ± 1 day.) Melasma severity was significantly less with TC cream and IPL than with inactive cream and IPL at weeks 6 (p=.007) and 10 (p=.002). Improvement in melasma was greater with TC cream and IPL than with inactive cream and IPL according to investigator and patient evaluations at weeks 6 and 10 (p<.001 for both time points). Treatment with TC cream and IPL was well tolerated. The results of this study suggest that TC cream and IPL treatment is an effective and safe treatment option for patients with melasma.

Associação de emblica, licorice e belides como alternativa à hidroquinona no tratamento clínico do melasma

Melasma is a common skin pigment disorder with a difficult clinical response to treatment. To evaluate the clinical efficacy and safety of the association of Belides, Emblica and Licorice 7%, compared to Hydroquinone 2%, in the treatment of melasma. After 60 days of exclusive use of an SPF35 sunscreen, 56 women, 18 to 60 years of age, phototypes I to IV, with epidermal or mixed melasma, were divided into two different groups in a mono-blind clinical study: A) cream with Belides, Emblica and Licorice, applied twice a day; B) cream with Hydroquinone 2%, used at night. They were observed in a 60-day study; every 15 days, they were submitted to medical evaluation, self-evaluation, and photographic registration (Visia(®)). 50 volunteers (89%), 23 in Group A and 27 in Group B, concluded the study. Two volunteers in Group A and 7 in Group B had mild skin adverse events. Depigmentation was observed through medical evaluation (Group A: 78.3%; Group B: 88.9%) and volunteers' self-evaluation (Group A: 91.3%; Group B: 92.6%); these results were statistically significant (p<0.001), with no differences between groups (p>0.05). This pattern of results was observed by Visia® in the number (p = 0.001) and size and tone (p<0.001) of the uv stains, for both groups, with no differences between them (p>0.05). There were no statistic differences between groups in the improvement of melasma. Group A showed less skin adverse events. Therefore, the association of Emblica, Licorice and Belides is a safe and efficient alternative for the treatment of melasma.

Non‐ablative 1,550 nm fractional laser therapy versus triple topical therapy for the treatment of melasma: A randomized controlled split‐face study

Melasma is a uichronic, often relapsing skin disorder, with poor long-term results from all current therapies. To assess efficacy and safety of non-ablative 1,550 nm fractional laser therapy (FLT) as compared to the gold standard, triple topical therapy (TTT). Twenty-nine patients with melasma were included in a randomized controlled observer-blinded study with split-face design. Each side of the face was randomly allocated to either 4-5 non-ablative FLT sessions (15 mJ/microbeam, 14-20% coverage) or TTT (hydroquinone 5%, tretinoin 0.05%, triamcinolone acetonide 0.1% cream). TTT was applied once daily for 15 weeks until the last FLT session. After this last treatment, patients were asked to apply TTT twice weekly on both sides of the face during follow-up. Improvement of melasma was assessed by patient's global assessment (PGA), patient's satisfaction, physician's global assessment (PhGA), melanin index, and lightness (L-value) at 3 weeks, and at 3 and 6 months after the last treatment. Mean PGA and satisfaction were significantly lower at the FLT side (P<0.001). PhGA, melanin index, and L-value showed a significant worsening of hyperpigmentation at the FLT side. At the TTT side, no significant change was observed. At 6 months follow-up, most patients preferred TTT. Side effects of FLT were erythema, burning sensation, edema, and pain. Nine patients (31%) developed PIH after two or more laser sessions. Side effects of TTT were erythema, burning sensation, and scaling. Given the high rate of postinflammatory hyperpigmentation, non-ablative 1,550 nm fractional laser at 15 mJ/microbeam is not recommendable in the treatment of melasma. TTT remains the gold standard treatment.

Treatment of Melasma Using Fractional Photothermolysis: A Report of Eight Cases with Long-Term Follow-Up

Melasma on the face is difficult to treat and is often refractory to multiple treatment modalities. To investigate the safety and efficacy of fractional photothermolysis (FP) for the treatment of melasma and to determine recurrence rates with this treatment method. Eight female patients (Fitzpatrick skin type II-IV) with clinically diagnosed melasma on the face were treated using FP (1,550 nm Fraxel SR laser). Two to seven treatments were performed at 3- to 8-week intervals. Treatment levels ranged from 3 to 10, corresponding to 9% to 29% surface area coverage (8-10 passes per treatment). Energies used ranged from 6 to 40 mJ. Physician and patient assessments were recorded at each visit and at a follow-up visit 7 to 36 months (mean 13.5 months) after the last treatment session. At the last treatment, assessments revealed greater than 50% clinical improvement in melasma in five of eight patients. Follow-up assessments by the evaluating physician revealed sustained efficacy in five patients. Recurrence was reported in three patients. No significant adverse effects were noted. FP is a safe and effective treatment for refractory melasma, with long-term remission.

Melasma: Treatment with 10% tretinoin peeling mask

Melasma is one of the most frequently acquired hyperpigmentation disorders clinically characterized by symmetrical brown patches on sun exposed areas. The first approach is an avoidance of sun exposure and inflammation combined with a use of photoprotection. Patient treatment is particularly difficult and challenging, and necessitates consideration of many therapies, including tretinoin to obtain an amelioration of this important skin condition. To evaluate the efficacy of a 10% tretinoin peeling mask before and after treatment using standardized digital photos, mexameter measures, and melasma area and severity index (MASI) evaluation. The present study was carried out on 20 female patients. Physician global evaluation showed moderate or marked improvement of melasma in all patients using three parameters of assessment: digital photography, mexameter measurement, and the MASI. Tretinoin peeling mask can be considered an alternative treatment modality in treating melasma. We noted a particular high tolerability and efficacy without adverse events.

Low-Fluence Q-Switched Neodymium-Doped Yttrium Aluminum Garnet (1,064 nm) Laser for the Treatment of Facial Melasma in Asians

Pigment lasers have been used in melasma with unsatisfactory results. To determine the effectiveness and safety of 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS-Nd:YAG) laser treatment of melasma in Asians. Split-face randomized study comparing combination QS-Nd:YAG laser and 2% hydroquinone with topical treatment in dermal or mixed-type melasma. Twenty-two patients were treated with 1,064-nm QS-Nd:YAG laser, 6-mm spot size, 3.0- to 3.8-J/cm(2) fluence for five sessions at 1-week intervals. Pigmentation was objectively recorded using a colorimeter (lightness index score), and subjective assessments were evaluated using the modified Melasma Area and Severity Index (mMASI) score. After five laser treatments, statistically significant improvement of melasma from baseline was observed in colorimeter (p<.001) and mMASI score (p<.001) on the laser side. The laser side achieved an average 92.5% improvement in relative lightness index and 75.9% improvement in mMASI, compared with 19.7% and 24%, respectively, on the control side (p<.001). Mottled hypopigmentation developed in three patients. During follow-up, four of 22 patients developed rebound hyperpigmentation, and all patients had recurrence of melasma. QS-Nd:YAG laser treatment for melasma in Asians produced only temporary improvement and had side effects. Common complications were hypopigmentation, melasma recurrence, and rebound hyperpigmentation.

Histologic and ultrastructural analysis of melasma after fractional resurfacing

Fractional photothermolysis is a popular treatment option for photodamaged skin and other cutaneous conditions. Recently, successful improvement in melasma has been achieved with this laser system. We undertook this study to evaluate the ultrastructural changes associated with fractional laser treatment of melasma. Ten subjects with skin types III and IV and a clinical diagnosis of epidermal melasma were treated with a 1,550-nm erbium:glass laser delivering light in a fractional manner (Fraxel SR 750, Reliant Technologies, Inc., Mountain View, CA) every 2 weeks for a total of four sessions. Biopsies were obtained from all subjects both before treatment and at 3 months following the final treatment. All biopsies were analyzed by light and electron microscopy for treatment-induced changes. In addition, a secondary endpoint of the study was to assess for clinical improvement in melasma following fractional resurfacing. This assessment was performed by the investigator using pre- and post-treatment photographs. Light microscopy on post-treatment specimens showed a relative decrease in melanocytes compared to the pre-treatment ones. Post-treatment electron microscopy revealed fewer melanocytes and a relative absence of melanin in the surrounding keratinocytes compared to pre-treatment specimens. In addition, six subjects with skin type III were determined to have good improvement, whereas four subjects with skin type IV had fair improvement, as assessed by the investigator. Post-treatment ultrastructural changes are consistent with an elimination process and may help to explain clinical improvement following laser treatment.

A comparison of triple combination cream and hydroquinone 4% cream for the treatment of moderate to severe facial melasma

The aim of this study was to compare the efficacy and safety of a triple combination (TC) cream and monotherapy with hydroquinone (HQ) cream in the treatment of moderate to severe facial melasma. A total of 120 patients applied TC cream once daily or HQ cream twice daily for 8 weeks. Evaluations included static global severity assessment of melasma, improvement of melasma over time, local tolerability, and adverse events. TC cream was significantly more effective than HQ cream from week 4 onwards: lesions were approximately equivalent to the surrounding skin in 35% of all TC-treated patients, compared to 5% of those who used HQ cream (P = 0.0001). Improvement of more than 75% was achieved by 73% of TC cream patients and 49% of HQ cream patients (P = 0.007). The incidence of adverse events (erythema, burning sensation, and desquamation) was similar in both groups. No patient dropped out of the study because of drug-related adverse events. TC cream was more effective than the HQ cream for the treatment of moderate to severe facial melasma. Both products had similar safety profiles.