Melasma Area And Severity Index Score Research Articles

Efficacy of Subdermal Poly-d,l-Lactic Acid Injections for the Treatment of Melasma.

Melasma is a chronic, recurrent skin disorder with limited long-term treatment success using conventional therapies like hydroquinone and laser treatments, which primarily target epidermal components while leaving dermal aspects untreated. To evaluate the efficacy and safety of poly-d,l lactic acid (PDLLA) subdermal injections for treating moderate melasma. Three female patients (age range: 45-59 years) with Fitzpatrick skin types III and IV received three PDLLA injection sessions at 3-week intervals. Treatment outcomes were assessed using the Melasma Area and Severity Index (MASI) and patient satisfaction scores at 12-week follow-up. All patients showed significant MASI score improvements (reduction range: 3.60-6.30 points). Patient satisfaction ratings ranged from 3 to 4 out of 4. Temporary side effects included mild edema and bruising, resolving within 72 h. PDLLA subdermal injections showed promising results in melasma treatment, potentially due to its biostimulatory effects on collagen production and dermal remodeling. Further research, including histopathological analysis, is needed to confirm long-term efficacy and safety, and understand underlying mechanisms.

Comparison of platelet-rich plasma efficacy with and without photoactivation in melasma: A randomized double-blind study.

Photoactivation has been suggested to enhance the efficacy of platelet-rich plasma (PRP) in conditions other than dermatological diseases. To evaluate the efficacy of photoactivated PRP (P-PRP) treatment for melasma by comparing it with non-photoactivated, classical PRP (C-PRP). The study consisted of 38 female patients diagnosed with melasma between April 2022 and May 2023. The patients were randomized into the P-PRP and C-PRP groups. Three sessions of P-PRP or C-PRP were applied to the patients at 2-week intervals. The Melasma Area and Severity Index (MASI) and Melasma Quality of Life Index (MELASQoL) scores were compared before and 2 weeks after treatment. The median age was 38 years, and the median disease duration was 60 months. Clinically, 94.7% of the cases were centrofacial and 5.3% were malar. According to Wood's lamp examination, 55.3% of the cases were epidermal, 13.2% were dermal, and 31.6% were mixed-type. The median pre- and post-treatment scores were 14.5 and 9, respectively, for MASI and 36.5 and 17, respectively, for MELASQoL. The post-treatment MASI and MELASQoL scores of both groups significantly decreased (p < 0.001 for both). However, the intergroup difference was not significant. When all patients were evaluated together a moderate, positive, and significant relationship was detected between PRP and the pre- and post-treatment MASI and MELASQoL scores (r = 0.494 and p = 0.002). No side effects associated with PRP were observed. PRP is an effective and safe treatment method for melasma. Further studies are needed to evaluate the contribution of photoactivation to PRP treatment in melasma.

Treatment of Melasma with Tranexamic Acid Essence Combined with Iontophoresis: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

This randomized, double-blind, placebo-controlled trial aimed to evaluate the efficacy of tranexamic acid essence combined with iontophoresis in treating melasma. Thirty participants were recruited and randomly assigned to the experimental (Group A) or control group (Group B). Group A received tranexamic acid essence iontophoresis treatment twice weekly for three months, while Group B received placebo treatment. Melasma Area and Severity Index (MASI) scores and skin luminance (L) values were assessed at baseline and weeks 4, 8, and 12. No significant differences in baseline characteristics were observed between the groups. The mean MASI score reduction rate was significantly higher in Group A (-0.10±0.12%) compared to Group B (-0.02±0.09%) (p<0.05). Skin L values significantly increased in Group A from 61.32±3.53 to 63.32±1.78, while slightly decreasing in Group B (p=0.037). Tranexamic acid essence combined with iontophoresis significantly improved MASI scores and skin luminance compared to placebo, demonstrating its effectiveness in treating melasma. Further research with larger sample sizes and longer follow-up is warranted to validate long-term effects and recurrence rates.

Comparison between the efficacy of cysteamine cream and combined hydroquinone cream in the treatment of melasma using skin analytical systems: An open-label quasi-randomized controlled trial in Asia patients

Abstract Background: The mainstay of treatment for melasma is topical hydroquinone or preparations containing hydroquinone. In recent years, cysteamine cream has gained popularity in the treatment of hyperpigmentation disorders. Objectives: This study aimed to compare the efficacy of combined hydroquinone/betamethasone to cysteamine in the treatment of melasma. Methods: Eighteen patients had completed this open-label controlled trial. Subjects received either 5% cysteamine cream or a combination of 4% hydroquinone cream and 0.06% betamethasone valerate for 12 weeks according to standardized protocols. Patients were assessed at recruitment, 4 weeks, and 12 weeks after treatment for Melasma Area and Severity Index (MASI) scores. Other parameters relating to skin complexions and patient satisfaction were also assessed. Results: Patients treated with hydroquinone (n = 7) and cysteamine (n = 11) both showed significant decreases in MASI score at week 12: 33.1% (P = 0.009) and 37.9% (P = 0.009), respectively. There was no statistically significant difference between the two treatment groups (P = 0.236). Melanin content at week 12 decreased by 8.8% (P = 0.016) in the hydroquinone group and 11.5% (P = 0.046) in the cysteamine group, with no significant difference between the groups (P = 0.253). No significant differences were observed between the groups for other parameters or patient satisfaction. Conclusion: Cysteamine cream may provide an alternative treatment option for individuals with melasma, offering fewer side effects while delivering comparable results.

Assessing the efficacy of oral tranexamic acid as an adjuvant to triple combination topical treatment in melasma: a meta-analysis of randomized controlled trials

Abstract Melasma is a skin pigmentation disorder that lacks consistent treatment success, despite various methods used. Tranexamic acid (TXA) has shown hypopigmentation properties, but whether its administration should be combined with standard treatment has yet to be clarified. We aimed to perform an investigation of the effectiveness and safety of oral TXA as an adjuvant to triple combination cream (TCC) treatment in melasma. We searched PubMed, Embase and Cochrane (CENTRAL) for studies that compared TCC + adjuvant TXA to TCC treatment alone in patients with melasma. Outcomes of interest included change from the baseline Melasma Area and Severity Index (MASI) score, recurrence of melasma and adverse events. Statistical analysis was performed using R Studio 4.3.2. Four trials involving 490 patients were included. In the pooled analysis, the decrease from baseline in MASI score [mean difference –3.10, 95% confidence interval (CI) –5.85 to –0.35] was significantly higher in patients treated with oral TXA as an adjuvant to TCC compared with TCC alone. Melasma recurrence [risk ratio (RR) 0.28; 95% CI 0.16–0.49] was significantly lower in the group treated with TCC and TXA. Regarding erythema (RR 0.63, 95% CI 0.34–1.17) and burning (RR 0.59, 95% CI 0.30–1.17), no statistically significant difference was found. This meta-analysis demonstrated statistically significant benefits of TCC + TXA combination treatment compared with TCC alone. Furthermore, the results suggest that the addition of TXA to TCC treatment may reduce melasma recurrence.

Comparative study of melasma in patients before and after treatment based on lipomics

BackgroundSkin barrier alterations play a crucial function in melasma development. Past researches have demonstrated variations in lipid content between the epidermis of melasma lesions and normal tissues, along with the varied expression of lipid-related genes in melasma. This study aimed to analyze the lipidome profiles of skin surface lipids (SSL) in patients with melasma before and after treatment to understand associated abnormalities.MethodsMelasma was treated with tranexamic acid orally and hydroquinone cream topically. Disease was assessed using the Melasma Area and Severity Index (MASI), and the impact to life was evaluated with Melasma Quality of Life (MELASQoL) score. Epidermal melanin particles were observed using reflection confocal microscopy (RCM), whereas epidermal pigment and blood vessel morphology were observed using dermoscopy, and SSL samples were collected. Specific information regarding alterations in lipid composition was obtained through multivariate analysis of the liquid chromatography-mass spectrometry data.ResultsAfter treatment, patients with melasma exhibited decreased MASI and MELASQoL scores (P < 0.001); RCM revealed reduced melanin content in the lesions, and dermoscopy revealed fewer blood vessels. Fifteen lipid subclasses and 382 lipid molecules were identified using lipidomic assays. The expression levels of total lipids, phosphatidylcholine, and phosphatidylethanolamine in the melasma lesions decreased after treatment (P < 0.05).ConclusionThis study revealed alterations in the SSL composition after effective melasma treatment, suggesting a compensatory role for lipids in melasma barrier function. The mechanism involving SSL and the lipid barrier, which influences melasma’s occurrence, needs further elucidation.

Efficacy and safety of mesotherapy with tranexamic acid versus vitamin C in the treatment of melasma: A meta-analysis and systemic review.

The exact pathogenesis of melasma is not yet known, and its treatment remains challenging. Mesotherapy with tranexamic acid (TXA) and vitamin C was both reported to have certain effects on melasma. In spite of that several articles have compared the efficacy and safety of the two drugs on melasma, most of them were clinical study with small sample size. To evaluate the efficacy and safety of mesotherapy with TXA versus vitamin C in treating melasma through meta-analysis and systemic review. The authors searched PubMed, Web of Science, Springer, and ScienceDirect for studies that compared mesotherapy with TXA versus vitamin C as a treatment for melasma. Primary outcomes were change in melasma area and severity index (MASI) before and after the treatment. Finally, five studies with a total of 127 patients were included in the systematic review. There was no statistic difference in the change in MASI score between the TXA and vitamin C groups (mean difference, 0.16; 95% CI, -0.79 to 1.11). Mesotherapy with both TXA and vitamin C is safe and effective in the treatment of melasma.

Novel 532-nm Q-switched Nd: YAG laser for the treatment of melasma and rejuvenation: a prospective, randomized controlled comparison with 1,064-nm Q-switched Nd: YAG laser.

Melasma is a common pigmentary and photoaging disorder. Although various treatments, including 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS-Nd: YAG) laser toning, are available for melasma, results are often unsatisfactory. We aimed to determine the efficacy and safety of 532-nm QS-Nd: YAG laser (shortwave toning) in patients with melasma and facial rejuvenation. Fifty-two patients were recruited to receive either 1,064-nm QS-Nd: YAG laser or 532-nm QS-Nd: YAG laser every 2 weeks for 8 sessions and a 2-month follow-up visit in a randomized controlled double-blinded study. The primary outcome measure was the Melasma Area and Severity Index (MASI) score. Dermoscope and high-frequency ultrasound (HFUS) were used to assess the improvement of melasma and photoaging. 532-nm QS-Nd: YAG laser achieved significantly higher improvement in the MASI score (P = 0.000). The Dermoscopic melasma score (DMS) displayed significant change and confirmed the improvement. HFUS showed a significant decrease in the thickness of the subepidermal low-echogenic band (SLEB) and increases in dermal thickness and dermal density in both groups (P = 0.000 for all). The rate of very satisfied responses was significantly higher in the 532-nm laser group (P = 0.001). There was no significant difference in the visual analog scale pain assessment score (P = 0.248) and recurrence rate (P = 0.734) between the two groups. 532-nm QS-Nd: YAG laser (shortwave toning) proved to be an effective and safe treatment for melasma and rejuvenation. Shortwave toning was significantly better for pigmentation clearance, while 1,064-nm laser showed better improvement in skin rejuvenation.

Comparison of Efficacy of 5% Tranexamic Acid vs 20% Azelaic Acid in Patients of Melasma

Background: Melasma is a significant cosmetic concern globally, affecting individuals across various ethnic backgrounds, particularly in South Asian populations. The condition's etiology is complex, involving genetic, hormonal, and environmental factors such as sun exposure. Despite numerous treatment options, melasma remains challenging to manage effectively. Recent studies have explored the efficacy of tranexamic acid and azelaic acid, both of which target the melanin synthesis pathway but through different mechanisms. Objective: The aim of this study was to compare the effectiveness of topical 5% tranexamic acid versus 20% azelaic acid in the treatment of melasma, with a focus on changes in the Melasma Area and Severity Index (MASI) scores. Methods: This prospective comparative study was conducted at the Dermatology department of PIMS Hospital, Pakistan, over six months from August 2023 to January 2024. A total of 200 patients with melasma were enrolled and randomly assigned to two groups: Group A received 5% tranexamic acid cream, and Group B received 20% azelaic acid cream, both applied twice daily. Inclusion criteria included men and women aged 18 to 50 years with a diagnosis of melasma for at least six months. Pregnant women, patients with a history of Systemic Lupus Erythematosus (SLE) or Discoid Lupus Erythematosus (DLE), and those on hormonal therapy were excluded. The primary outcome measure was the change in MASI scores from baseline to the end of the study period. Data were analyzed using SPSS Version 25. Results: The study found significant differences in treatment efficacy between the two groups. Group A (tranexamic acid) showed a reduction in MASI scores from 7.94 ± 1.88 at baseline to 5.50 ± 1.61 post-treatment. Group B (azelaic acid) demonstrated a decrease from 8.21 ± 1.96 to 5.89 ± 1.49. The proportion of patients experiencing excellent response was higher in Group A (36.0%) compared to Group B (19.0%), with a statistically significant difference in overall treatment efficacy (P&lt;0.0001). Conclusion: Topical 5% tranexamic acid was more effective than 20% azelaic acid in improving MASI scores in patients with melasma. This study supports the inclusion of tranexamic acid as a preferable treatment option for melasma, offering a promising alternative for those not responding to conventional therapies.

Efficacy and safety of novel topical pigment-correcting regimen with biweekly diamond tip microdermabrasion procedures on facial hyperpigmentation.

Facial hyperpigmentation can negatively affect an individual's emotional and psychosocial well-being. Assess safety and tolerability of a combination of microdermabrasion (DG) procedures using a novel brightening pro-infusion serum (EC-DG) with a targeted at-home treatment regimen in subjects with mild to severe facial hyperpigmentation, including melasma, post-inflammatory hyperpigmentation, and dark spots. This 12-week, open-label study enrolled 18 subjects (Fitzpatrick skin types I-IV) who underwent 6 in-office DG procedures with EC-DG (one procedure administered biweekly), along with daily topical application of a brightening treatment serum and dark spot cream. End points included change from baseline across multiple skin quality attributes and the Melasma Area and Severity Index (MASI), self-assessment questionnaires, and tolerability assessments. The combination treatment was well tolerated and resulted in significant (p ≤ 0.05) improvements from baseline in radiance, tactile roughness, and moisturization/hydration immediately after the first treatment, in MASI score at day 3, and in overall hyperpigmentation at week 4. Most (94.1%) subjects were satisfied with treatment. DG procedures using EC-DG combined with a targeted at-home skincare regimen are effective and tolerable for treating facial hyperpigmentation across a broad range of skin types.

Efficacy of Oral, Topical, and Intradermal Tranexamic Acid in Patients with Melasma - A Meta-Analysis.

Tranexamic acid (TXA) has recently shown promising results in the treatment of melasma. The objective of this study was to generate statistical evidence on the efficacy of TXA with different routes. We searched studies in PubMed, Cochrane, ClinicalTrials.gov, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A change in melasma area and severity index (MASI)/modified MASI score from the baseline at the end of 8 and 12 weeks was seen. Inverse variance method was used for continuous data to measure standard mean difference (SMD) at a 95% confidence interval (CI). RevMan version 5.4 was used for analysis, and statistical heterogeneity across studies was reported using I2 statistics. P < 0.05 was considered significant. Totally, 28 randomized control trials were included. At 8 weeks, oral TXA showed a significant change in SMD of 1.61, 95% CI 0.44-2.79, P = 0.007; at 12 weeks, oral TXA showed SMD of 2.39, 95% CI 1.42-3.35, P < 0.00001 compared to adjuvant treatment. At 8 weeks, topical TXA did not show a significant change with SMD of -0.05, 95% CI -1.08-0.97, P = 0.92; at 12 weeks, topical TXA did not show a significant change with SMD of 0.66, 95% CI -0.10-1.42, P = 0.09 compared to adjuvant treatment. Similarly, for intradermal TXA at 8 weeks, results were not significant with SMD of 1.21, 95% CI -0.41-2.83, P = 0.14, and at 12 weeks, SMD was -0.55, 95% CI -2.27-1.18, P = 0.54 compared to adjuvant treatment. Tranexamic acid in an oral formulation can be used along with adjuvant treatment for the management of melasma. Data are still required for topical and intradermal routes. Owing to the fact that our included studies had a lot of heterogeneity, more research is needed along with addressing the adverse effects of tranexamic acid as well as its variation in different skin colors.

The Effect of Melasma on the Quality of Life in People with Darker Skin Types Living in Durban, South Africa.

Melasma is a common skin disorder of acquired hyperpigmentation that appears commonly on the face. Although asymptomatic, melasma causes psychosocial and emotional distress. This study aimed to assess melasma's severity on people with darker skin types, evaluate the effects of melasma on the quality of life (QoL), and establish QoL predictors in affected individuals. This was a cross-sectional analytic study that enrolled 150 patients from three private dermatology clinics in Durban, South Africa who were diagnosed with melasma. The severity of melasma alongside QoL were measured using a melasma area and severity index (MASI) score and melasma quality of life scale (MELASQoL), respectively. The associations among factors and QoL were explored using multivariable methods and stepwise regression analysis. p-values less than 0.05 were considered significant. Enrolled patients were predominantly females (95%), of which 76% were of black African ethnicity, 9% were of Indian ethnicity, and 15% had mixed ancestry, with an average age of 47.30 years. Family history revealed that 61% had no prior melasma cases, while 39% had affected relatives, most commonly mothers (41%). The cheeks were the most common site for melasma. MASI score of Masi (β = 0.209, t = 2.628, p < 0.001), the involvement of cheeks (β = -0.268, t = -3.405, p < 0.001), level of education (β = -0.159, t = -2.029, p = 0.044), and being menopausal (β = -0.161, t = -2.027, p = 0.045) were found to be predictors of QoL. A regression model was created to forecast MELASQoL using these four predictors. This equation's significance lies in its ability to enable the remote assessment of MELASQoL based on these four variables. It offers a valuable tool for researchers and medical professionals to quantitatively and objectively evaluate the impact of melasma on an individual's quality of life.

Comparative Efficacy of Chemical Peeling Agents in the Treatment of Melasma.

Melasma is a complex skin disorder characterized by brown or dark patches, primarily affecting facial areas. Despite numerous treatment options, the effective management of melasma remains challenging. This study aims to fill a gap in the literature by rigorously comparing the effectiveness of three prevalent chemical peeling agents, 15% trichloroacetic acid (TCA), 15% phenol, and 2% glycolic acid, in treating melasma. A randomized controlled trial was conducted involving patients who were clinically diagnosed with melasma. Participants were divided into three groups, each receiving one of the chemical peeling treatments. The primary measure of efficacy was the Melasma Area and Severity Index (MASI) score, recorded before and after the treatment series. Side effects were also documented and analyzed. Preliminary findings suggest a significant reduction in MASI scores in the group treated with 15% TCA peel. The average MASI score reduction was 8.5 points for the TCA group, 6.0 points for the phenol group, and 5.2 points for the glycolic acid group. Side effects such as redness and mild irritation were noted but were least prevalent in the TCA group. Our study indicates that 15% TCA peel is not only effective but also comparatively safer in treating melasma. It shows a more rapid and significant improvement in reducing melasma symptoms than 15% phenol and 2% glycolic acid peels. However, further research is warranted to validate these findings over a larger population.

Evaluation of the effectiveness of microneedling with tranexamic acid in comparison with microneedling with vitamin C in the treatment of melasma: A prospective and single-blind clinical trial.

Melasma is a common skin condition. Microneedling acts as a dermal delivery system that facilitates the penetration of lightening agents such as vitamin C and tranexamic acid (TXA) into the deeper layers of the skin. Therefore, this study aimed to compare the effectiveness of microneedling with TXA with microneedling and vitamin C in treating melasma. In patients with melasma, microneedling was performed at 2-3 mm depth. During that, TXA and vitamin C were poured on the skin of each side of the face, and then each ampoule was soaked for 15 min. This method was performed three times in 2-week intervals, and the results were compared by measuring the Melasma Area and Severity Index (MASI) score before, during, and 2 months after the completion of the treatment. The average MASI score in the baseline in the TXA group was 4.61, and in the vitamin C group was 4.58. The average MASI score in the patients treated with TXA in the last treatment session was 2.40, and the group treated with vitamin C was 2.44. The study results showed that the treatment was effective in both groups based on MASI score. Although there was a difference between the responses of the two groups, it was not significant. Microneedling with vitamin C and TXA is a safe and effective treatment option without side effects for treating melasma.

Comparative Study of Combination of Oral Tranexamic Acid With Modified Kligman's Formula Versus Oral Tranexamic Acid With Azelaic Acid 15% in the Treatment of Melasma.

Background Melasma is a persistent skin condition affecting individuals of Asian, African, and Hispanic backgrounds. It causes dark patches on sun-exposed areas of the face. The exact causes are unclear, but UV light and hormonal factors play a role. Melasma significantly impacts physical appearance and quality of life, causing emotional and social distress. Objective The objective was to compare the efficacy of a combination of oral tranexamic acid and modified Kligman's formula vs. oral tranexamic acid and 15% azelaic acid. Material and methods This two-year interventional study occurred at the Outpatient Department of Dermatology, Venereology, and Leprosy in Sawangi, Maharashtra. It included male and female patients aged 18-50 with melasma seeking treatment. Ethical approval was obtained, and data collection involved medical histories, skin examinations, and calculating the Melasma Area and Severity Index (MASI). Results The study found no significant association between age groups and subject distribution in Groups A and B. Significant differences were observed in MASI scores within each group over time. There was a significant difference in mean MASI scores between Group A and Group B at the eight-week mark. A burning sensation was significantly associated with the groups, while no significant association was found for erythema. Conclusion This study concludes that combining oral tranexamic acid with a modified Kligman's formula is more effective in treating melasma than combining oral tranexamic acid with azelaic acid 15%.

A comparative study between the use of the combination of trichloroacetic acid peeling with hydroquinone and hydroquinone alone in patients with melasma

Background: Melasma is a common acquired pigmentary disorder that is aesthetically displeasing. Kligman’s and Modified Kligman’s formula using topical steroids, hydroquinone and retinoids, and various other depigmenting agents is being widely used all over for melasma with varying results. Chemical peeling is newly added to the therapeutic armamentarium and is showing encouraging results worldwide in patients with melasma. However, comparative studies are lacking in abundance in our part of the world. Aims and Objectives: To determine if serial trichloroacetic acid peels provide additional benefits when combined with time-tested topical therapy with hydroquinone 4% in patients with melasma. Materials and Methods: Fifty melasma patients were divided into two groups of 25 each. One group received serial trichloroacetic acid peel combined with topical hydroquinone 4%. The other group only received topical hydroquinone 4% cream. The results were evaluated by a clinical investigator both subjectively and with photographs taken at baseline, 12 weeks, and 21 weeks. For clinical evaluation, the melasma area and severity index (MASI) was used. Results: A significant decrease in MASI score from baseline to 21 weeks was observed in both groups (P&lt;0.001). The group receiving the trichloroacetic acid peel 20% showed a trend toward more rapid and greater improvement, with statistically significant results (P&lt;0.001). Only a few side effects were observed in the peel group. Conclusion: This study demonstrates that serial trichloroacetic acid peels provide an additional effect to a topical regimen of 4% hydroquinone cream for treating melasma in Fitzpatrick skin types III and above if used judiciously and under supervision. It demonstrates that superficial chemical peels can be used as an adjunct with better efficacy to treat patients with melasma.

Comparative Study of 35% Glycolic Acid (GA) Peel versus 15% Trichloroacetic Acid (TCA) in Patients Primed with 4% Hydroquinone and Sun Block for the Treatment of Melasma

Objective: To compare the effects of 35% Glycolic acid (GA) peel versus 15% Trichloroacetic Acid (TCA) in patients primed with 4% Hydroquinone and sunblock for Melasma treatment.&#x0D; Study Design: Quasi-experimental stud.&#x0D; Place and Duration of Study: Department of Dermatology, Combined Military Hospital, Jhelum Pakistan, from Jul to Nov 2020.&#x0D; Methodology: Forty-eight melasma patients were included and divided randomly into two groups; Group-A patients were treated with 15%Trichloroacetic Acid (TCA), while Group-B patients were treated with 35% Glycolic Acid (GA). Peeling was performed fortnightly in 4 sessions. Melasma area and severity index (MASI) scoring was calculated before and after peeling.&#x0D; Results: In our study, we found that pre-treatment MASI score in Group-A Trichloroacetic Acid (TCA) was 9.25±3.11 and in Group-B Glycolic Acid(GA), the pre-treatment MASI was 18.42±7.24, (p&lt;0.001). The post-treatment MASI score in Group- A (TCA) was found to be 4.52±2.77and in Group-B (GA), it was 8.67±4.30, (p&lt;0.001). TCA was associated with more burning, frosting, and skin cracking, while Glycolic Acid (GA) was associated with a scale of no to mild pain and mild burning.&#x0D; Conclusion: Both the peeling agents, 35% Glycolic Acid (GA) peel and 15%Trichloroacetic Acid (TCA), in patients primed with 4% Hydroquinone and sunblock, are effective in reducing MASI scores. However, TCA showed better results.

Comparison of the efficacy and safety of picosecond Nd:YAG laser (1,064 nm), picosecond alexandrite laser (755 nm) and 2% hydroquinone cream in the treatment of melasma: A randomized, controlled, assessor-blinded trial.

Increasing numbers of studies demonstrated that picosecond lasers (Picos) were effective and safe for melasma. However, A limited number of randomized controlled trials (RCTs) regarding Picos contribute to a modest level of evidence. Topical hydroquinone (HQ) remains to be the first-line therapy. To compare the efficacy and safety of non-fractional picosecond Nd:YAG laser (PSNYL), non-fractional picosecond alexandrite laser (PSAL), and 2% HQ cream in the treatment of melasma. Sixty melasma patients with Fitzpatrick skin types (FST) III-IV were randomly assigned to the PSNY, PSAL, and HQ groups at a 1:1:1 ratio. Patients in PSNYL and PSAL groups received 3 laser sessions at 4-week intervals. The 2% HQ cream was applied twice daily for 12 weeks in patients of the HQ group. The primary outcome, the melasma area and severity index (MASI) score, was evaluated at weeks 0, 4, 8, 12, 16, 20, and 24. The patient assessment score by quartile rating scale was rated at weeks 12, 16, 20, and 24. Fifty-nine (98.3%) subjects were included in the analysis. Each group showed significant change from baseline in MASI scores from week 4 to week 24. The MASI score in the PSNYL group showed the greatest reduction compared to the PSAL group (p = 0.016) and HQ group (p = 0.018). The PSAL group demonstrated comparable MASI improvement as the HQ group (p = 0.998). The PSNYL group had the highest patient assessment score, followed by the PSAL group and then the HQ group, although only the differences between PSNYL and HQ groups at weeks 12 and 16 were significant. Four patients (6.8%) experienced recurrence. Other unanticipated events were transient and subsided after 1 week to 6 months. The efficacy of non-fractional PSNYL was superior to that of non-fractional PSAL, which was not inferior to 2% HQ, thus non-fractional Picos providing an alternative for melasma patients with FSTs III-IV. The safety profiles of PSNYL, PSAL, and 2% HQ cream were similar. https://www.chictr.org.cn/showprojen.aspx?proj=130994, ChiCTR2100050089.

Evaluation of the Efficacy and Safety of A New Pigment Correction Cosmetic Protocol in Caucasian Women with Melasma

Melasma is one of the most prevalent acquired pigmentation disorders, especially among women due to its hormonal background. There is a wide variety of therapeutic alternatives available for its treatment given its multifactorial origin and complexity. Cosmetic protocols based on depigmenting agents remain one of the cornerstones of melasma treatment. Aim: To evaluate the efficacy and safety of a new cosmetic pigment correction protocol in the treatment of melasma in Caucasian women. Methods: A single-blind, prospective, single-center study was conducted in 20 women between 25 and 65 years of age, phototypes II-IV with mildmoderate facial melasma. For 90 days patients applied a sunscreen and moisturizing cream in the morning and a pigment correction protocol at night consisting of a skin retinization regime combining two formulations with Retinsphere® technology. (Neoretin DC Ultra emulsion and Neoretin DC transition cream). Treatment results were evaluated by clinical assessment, Observ® photography and non-invasive instrumental measurements such as the erythema and melanin index by Mexameter. The Melasma Area and Severity Index (MASI) were recorded, and patients completed both a quality of life questionnaire (MELASQoL) and a subjective evaluation. Results: MASI score was significantly reduced at all study visits, with a significant reduction in the area and severity of melasma already observed at 30 days and a 48% reduction at the end of treatment. In the opinion of the investigator and patients, some degree of improvement was reported in 95% of patients at the end of treatment and neither patients nor the investigator reported worsening of melasma at the end of treatment as compared to baseline. The degree of melasma improvement observed by patients increased progressively and significantly from day 45 onwards, reaching an improvement of almost 70% at the end of the treatment. The adverse effects evaluated, (peeling, erythema, burning, tightness, irritation, and itching) increased gradually, being higher at T45 and T60, coinciding with the greater frequency of application of the formulations. Effects were however transient and in no case reached statistical significance or required treatment discontinuation. Conclusion: The cosmetic pigment correction protocol under study appears to be an effective therapeutic option for the treatment of melasma. The retinization regime, which consisted in the gradual application of the more powerful formulation alternated with a transition formulation, made it possible to achieve both efficacy and good tolerability to the therapeutic regimen.

Clinical Evaluation of Efficacy and Tolerability of Oral Tranexamic Acid in Comparison with Hydroquinone plus Sunscreen in Subjects with Melasma: A Single Blind, Randomized Clinical Trial Study

Background: Melasma is a common chronic acquired hyper pigmentary disorder of skin, particularly among Asian and Hispanics. Females are more affected than men. It has a significant impact on appearance, causing psychosocial and emotional distress and reducing the quality of life of the affected individual. Tranexamic acid (TA) can be used to treat melasma. Objectives: To compare the efficacy of oral Tranexamic acid and Hydroquinone (HQ) plus sunscreen in the treatment of melasma. Methods: It was prospective, interventional clinical trial conducted among 150 Bangladeshi melasma patients visiting the Dermatology and Venereology OPD of DMCH between January 2016 and June 2017. Patients were divided randomly into two groups, 75 in each, by lottery method. First group (Group A) was treated with 4% Hydroquinone plus sunscreen (regular) daily for 12 weeks and second group (Group B) was treated with Tranexamic acid 250mg twice a day for 12 weeks. Response was evaluated on the basis of Melasma Area and Severity Index (MASI) and Melasma Quality of Life (MELASQoL) Questionnaire. The mean scores of both variables were compared between both groups. Results: Epidermal melasma was comparatively quicker and better responded to the treatment than dermal or mixed variants. The mean MASI and mean MELASQoL scores between both groups were not significantly different at 4 weeks (p&gt;0.05) but was significantly effective in Group B at 8 and 12 weeks (p&lt;0.05). The mean MASI scores of Group A (HQ &amp; sunscreen) were 11.43±1.82, 9.98±1.99 and 8.94±2.16 at 4, 8 and 12 weeks respectively. The mean MASI scores of Group B (TA) were 11.34±1.92, 9.30+2.07 and 7.19±2.16 at 4, 8 and 12 weeks respectively. Similarly, the mean MELASQoL scores of Group A (HQ &amp; sunscreen) were 34.95±6.61, 29.40±6.60 and 25.87±7.19 at 4, 8 and 12 weeks respectively. The mean MELASQoL scores of Group B (TA) were 33.12±6.40, 26.19±6.43 and 20.63±6.70 at 4, 8 and 12 weeks respectively. Conclusion: Oral Tranexamic acid is more ..