Melasma Area And Severity Index Score Research Articles

Is Topical Zinc Effective in the Treatment of Melasma? A Double-Blind Randomized Comparative Study

Zinc plays a role in skin health, and preliminary data have shown its beneficial effects for melasma. We compared the effect of topical zinc with that of hydroquinone as the standard treatment on severity of melasma. Ninety-three women with melasma were randomized to receive zinc sulfate 10% or hydroquinone 4% solutions once daily for 2months. They were followed for an additional 3months while using sunscreen. The severity of melasma was assessed at baseline and at 2 and 5months using the Melasma Area and Severity Index (MASI). Eighty-two patients completed the study. The MASI score fell significantly in both groups, but a greater decrease was seen in those who received hydroquinone (43.5±15.5% vs 18.6±20.8%, p<.001). Postinflammatory pigmentation occurred in 5.2% of the zinc group and irritation in 30.9% of the hydroquinone group. Topical zinc therapy is not highly effective in reducing the severity of melasma, but further trials are needed to determine whether adding zinc to current topical treatments could improve treatment response.

Treatment of melasma in Caucasian patients using a novel 694-nm Q-switched ruby fractional laser

BackgroundMelasma is a common hypermelanosis of the face. The use of a classical Q-switched ruby laser (QSRL) to treat melasma is discussed controversially and is associated with frequent adverse effects, such as hyper- or hypopigmentation. Recently a fractional-mode (FRx) QSRL was developed to minimize the adverse effects of classical QSRL. The objective of this research was to evaluate the efficacy and safety of a novel FRx-QSRL in the treatment of melasma in Caucasian patients.MethodsWe performed a retrospective study of 25 Caucasian melasma patients (Fitzpatrick skin types I to III). Patients received one to three FRx-QSRL treatments (Tattoostar FRx, Asclepion Laser Technologies, Jena, Germany) at pulse energies of 4 to 8 J/cm2. Three blinded investigators independently evaluated the melasma area and severity index (MASI) score before treatment and at the four- to six-week follow-ups. At additional three-month follow-ups, patients evaluated subjective improvement, pain and over-all satisfaction with the treatment according to a numeric analogue score (NAS). Side effects were documented.ResultsAt four to six weeks post laser treatment for a mean of 1.4 sessions, we observed a significant (P = 0.0001) reduction of the MASI score from 6.54 to 1.98 (72.3%). Patients rated the pain of the intervention at a mean 2.46 points (0 = no pain; 10 = maximum pain), the improvement at a mean 5.55 points (0 = no improvement; 10 = maximum improvement) and the overall satisfaction at a mean 4.66 points (0 = not satisfied; 10 = maximum satisfaction). After three months, post-inflammatory hyperpigmentation (PIH) and/or recurring melasma were observed in 7 (28%) and 11 (44%) patients, respectively.ConclusionThe 694-nm FRx-QSRL is a safe and effective option for treating melasma in Caucasian patients. Over periods of >3 months, PIH and/or recurring melasma may develop at significant rates and may reduce patient satisfaction. Multiple treatment sessions with lower pulse energies and/or a post-interventional therapy with hypopigmenting ointments and UV protection may help to minimize these complications.

Salicylic acid for the treatment of melasma: new acquisitions for monitoring the clinical improvement

The Melasma Area and Severity Index (MASI) and the Melasma Severity Score (MSS) are calculated on the basis of only a subjective clinical assessment. This raises the need to have an objective score, uniform in the evaluation by different clinicians. The purpose of this study was to establish if the images by Canfield Reveal Imager can be correlated to MASI score to better evaluate the clinical efficacy of salicylic acid 33% peeling in the treatment of melasma respect to the clinical observation. The study was a voluntary observational study. Twenty female patients affected with melasma, aged between 30 and 60 years, were included in the study. Treatment with salicylic acid 33% was performed once a month, for a total of four times. The dermatologist (Doc A) examined each patient's melasma areas using MASI score, at the face-to-face observation and at Reveal images evaluation during the first (T0) and the end point time (T4). Digital photographs were also evaluated by another experienced dermatologist (Doc B), who has never seen clinically the patients before and who evaluated MASI score by Reveal images at time T0 and T4. Student's t-test and linear regression test were performed, showing statistically significant values comparing MASI score obtained by digital photo and MASI score obtained clinically. The monitoring of the improvement by Reveal images can optimize the treatment approach and the efficacy of same dermocosmetics procedures can be revised following standard criteria.

A study on fractional erbium glass laser therapy versus chemical peeling for the treatment of melasma in female patients

Introduction:Melasma is a commonly acquired hypermelanosis and a common dermatologic skin disease that occurs on sun-exposed areas of face.Aims:To assess the efficacy and safety of non-ablative 1,550 nm Erbium glass fractional laser therapy and compare results with those obtained with chemical peeling.Materials and Methods:We selected 30 patients of melasma aged between 20 years and 50 years for the study. The patients were divided into two groups of 15 patients each. Group I patients were subjected to four sessions of 1,550 nm Erbium glass non-ablative fractional laser at 3 weeks interval. In group II patients, four sessions of chemical peeling with 70% glycolic acid was performed.Results:After 12 weeks of treatment, percentage reduction in Melasma Area and Severity Index (MASI) score was seen in 62.9% in the laser group and 58.7% in the peels group.Conclusion:It was observed that 1,550 nm fractional laser is as effective as 70% glycolic acid peel in reducing MASI score in patients with melasma.

Efficacy and Safety of Hydroquinone, Kojic Acid and Glycolic Acid Combination in the Treatment of Melasma

Background &amp; Methodology: It was an opened clinical trial. The study was carried out from March 2009 to February 2011, in the outpatient department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh to evaluate the efficacy and side effects of the combination therapy of hydroquinone(HQ), kojic acid(KA) and glycolic acid(GA) for the treatment of melasma. Patients suffering from melasma were selected as study population. Within the period of data collection, thirty patients of melasma were assigned purposively. The efficacy was evaluated using Melasma Area and Severity Index (MASI) Score. The severity of melasma of each of the four regions (forehead, right malar region, left malar region and chin) are assessed based on three variables, percentage of the total area involved (A), darkness (D) and homogenicity (H).Results:The study showed that majority (30%) of the cases were between 20 to 25 years, majority (77%) of patients were female, (50%) patients were housewives, (50%) were in graduation level of education, (50%) of patients was found as upper class and negative family history was present in majority (80%) of cases. It was seen that highest (93%) number of patients were malar type and 7% were centro-facial type. The study showed the change in MASI Score after treatment with combination therapy (GA 2%, HQ 2% and KA 1%). After 12 weeks of treatment, the average MASI score was decreased by 24.20% indicating mild reduction of the severity of melasma and 18%, 18%, 9% and 55% patients developed side -effects like itching, burning sensation, scaling, and erythema respectively. Conclusion: Combination therapy (GA 2%, HQ 2% and KA 1%) has a few lightening effect on melasma, with no remarkable side effects. Further study should be conducted with large number of sample and longer follow up. DOI: http://dx.doi.org/10.3329/bjms.v11i3.11720 Bangladesh Journal of Medical Science Vol. 11 No. 03 July’12

Topical 5% tranexamic acid for the treatment of melasma in Asians: A double-blind randomized controlled clinical trial

Background: Topical tranexamic acid has been claimed to lighten melasma without serious adverse effects. However, controlled studies assessing the efficacy and safety of topical tranexamic acid (TA) for the treatment of melasma is limited. Objective: To assess in a double blind, randomized, prospective study, the efficacy of topical 5% tranexamic acid versus vehicle for treatment of melasma. Methods: Twenty-three women with bilateral epidermal melasma enrolled in a split-face trial lasting 12 weeks. Patients blindly applied topical 5% tranexamic acid and its vehicle, to the designated sides of the face twice daily in addition to the assigned sunscreen each morning. Pigmentation and erythema were measured objectively using a mexameter and Melasma Area and Severity Index (MASI), in addition to physician and patient global assessments. Results: Twenty-one patients completed the study. Eighteen out of twenty-three patients (78.2%) showed decrease in the melanin index on either or both sides of the face by the end of 12 weeks compared to baseline. The MASI scores were also significantly reduced on both tested sides. However, lightening of pigmentation induced by TA gel was neither superior nor different (p > 0.05) compared to its vehicle although erythema was significant on the TA-applied site (p < 0.05). Conclusions: Although lightening of pigmentation was obtained, the results were not significant between the two regimens. However, topical TA produced erythema.

Korean Red Ginseng Powder in the Treatment of Melasma: An Uncontrolled Observational Study

Exposure to the sun, ultraviolet radiation, and oxidative stress are the chief etiologic factors responsible for melasma. The ingredients of Korean red ginseng powder, which include ginsenoside and phenolic compounds, have antioxidative effects and reduce ultraviolet B-induced pigmentation. This study was designed to evaluate the effectiveness and safety of Korean red ginseng powder in patients with melasma. In 25 female patients, 3 g of Korean red ginseng powder was orally administered for a 24 week period. The level of pigmentation and erythema were determined and clinical improvement was evaluated by the melasma area and severity index (MASI), melasma quality of life scale (MELASQoL), and patient- and investigator-rated global improvement scale. After 24 weeks, the MASI score decreased from 8.8 to 5.6, and MELASQoL showed improvement in 91% of patients (p<0.05). The mean level of pigmentation decreased from 184.3 to 159.7 and erythema levels decreased from 253.6 to 216.4 (p<0.05). Additionally, 74% of the patients showed some improvement in both patient- and investigator-rated global improvement scales at week 24. Korean red ginseng powder was well tolerated by most of the patients. In conclusion, Korean red ginseng powder showed good tolerability and beneficial effects in patients with melasma. The use of Korean red ginseng would be counted as a useful adjunctive therapy for patients with melasma.

Efficacy and Safety of Q-Switched 1,064-nm Neodymium-Doped Yttrium Aluminum Garnet Laser Treatment of Melasma

Melasma is a common pigmentary disorder that affects all skin types but is seen more in individuals with Fitzpatrick skin type IV to VI. Safe and effective treatment options for melasma need to be explored. Already proven effective for the treatment of pigmentary disorders, lasers have been used to treat melasma in recent years. To evaluate the efficacy and safety profile of a 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser in the treatment of melasma. Fifty patients were recruited for this study (47 female; 3 male). All were treated using the 1,064-nm QS Nd:YAG laser at low energy levels weekly for nine sessions. Follow-up was done 3 months after the final laser session, and recurrence rates were evaluated. Digital photographs were taken and the melanin index (MI) measured before each treatment visit and after the final treatment. Melasma Area and Severity Index (MASI) scores were evaluated for all of the patients. Patients were required to evaluate their satisfaction at the end of the nine treatments. We also used a confocal laser scanning microscope (CLSM) for several patients to investigate pathologic changes at baseline, after the treatments, and at the time of recurrence. Statistical analysis was performed to evaluate clinical response and factors related to the therapeutic outcome. Mean MI decreased 35.8%, from 70.0 at baseline to 44.9 after the treatment (p<.001). Mean MASI scores decreased 61.3% after therapy (from 10.6-4.1, p<.001); 70% of patients had more than a 50% decrease in their MASI values, and 10% had 100% clearance. Recurrence rate at the 3-month follow-up was 64%. CLSM findings indicated less melanin in the treated regions, although it increased at recurrence. Multiple linear regression indicated that the therapeutic outcome depended on disease severity at baseline (p=.001, R=0.494). Minimal adverse events were observed during the study. The 1,064-nm QS Nd:YAG laser is an effective and safe treatment for melasma, although recurrence rates remain high, and further adjunctive therapy needs to be explored to prevent this recurrence.

Efficacy of 694-nm Q-Switched Ruby Fractional Laser Treatment of Melasma in Female Korean Patients

Melasma is a common acquired symmetrical hypermelanosis of sun-exposed areas of the skin. Although the classical Q-switched ruby laser (QSRL) has been used successfully for the removal of tattoos and for the treatment of cutaneous pigmented lesions, its efficacy for melasma remains controversial. We used repeat low-dose fractional QSRL treatment for melasma and analyzed the clinical results. Fifteen Korean women with melasma were enrolled. Each patient received six low-dose fractional QSRL treatments to the face at 2-week intervals. Two investigators independently evaluated Melasma Area and Severity Index (MASI) scores before each session and 4 and 16 weeks after the final session. The intensities of pigmentation and erythema were assessed by measuring skin reflectance using a tristimulus color analyzer. Mean MASI score decreased from 15.1 ± 3.3 before treatment to 10.6 ± 3.9 16 weeks after the final treatment. The lightness of pigmentation (L-value) increased from 56.6 ± 3.5 before treatment to 59.9 ± 2.8 16 weeks after the final treatment. Multiple treatment sessions of low-dose fractional QSRL may be an effective strategy for the treatment of dermal or mixed-type melasma.

Is non‐ablative 1550‐nm fractional photothermolysis an effective modality to treat melasma? Results from a prospective controlled single‐blinded trial in 51 patients

Melasma is a common benign pigmentary disease and can pose a substantial therapeutic challenge. Although the use of non-ablative fractional photothermolysis (NFP) has gained much popularity, there are still very few evidence-based data supporting NFP in the treatment of melasma. To assess the efficacy and safety of NFP for the treatment of melasma in a controlled observer-blinded parallel-group study. Fifty-one patients [90.2% women, 9.8% men; mean age 40.3±6.1 (control group) and 41.7±11.4 (treatment group)] received a broad-spectrum sunscreen either alone (n=25; 49.0%) or in combination with a 1550-nm NFP treatment (n=26; 51.0%) [energy: 15 mJ/microthermal zone (MTZ); total density: 1048 MTZs/cm(2); density per pass: 131 MTZs/cm(2); number of passes: 8; total coverage: 20%]. Four sessions of NFP treatment were performed at 3-week intervals on each subject in the treatment group. Patients were evaluated at baseline and 12 weeks after final treatment. The primary efficacy variables were the Melasma Area and Severity Index (MASI) and the physician's global assessment (PGA); secondary efficacy variables were the patients' subjective assessment of improvement and patient satisfaction. Safety was evaluated through the reporting of adverse events. The percentage of subjective improvement was virtually identical in both groups: one-third of the patients reported a 'marked improvement' and another half reported 'some improvement'. Twenty-three patients in each group declared that they were 'satisfied' with the treatment result. The MASI corroborated the patients' subjective estimate, both in terms of the degree of improvement and the lack of a group difference. In both groups, the MASI score and the PGA were reduced significantly after therapy, and the reduction was also clinically relevant. No serious side-effects were reported in either group. Our findings do not support the hypothesis of NFP providing a substantial benefit in treating melasma when compared with the lone application of a broad-spectrum sunscreen.

Effects of trans-4-(aminomethyl) cyclohexanecarboxylic acid/potassium azeloyl diglycinate/niacinamide topical emulsion in Thai adults with melasma: a single-center, randomized, double-blind, controlled study

Background: Melasma is an acquired hyperpigmentary disorder characterized by dark patches or macules located on the cheeks, forehead, upper lip, chin, and neck. Treatment of melasma involves the use of topical hypopigmenting agents such as hydroquinone, tretinoin, and azelaic acid and its derivatives. Objective: The purpose of this study was to assess the efficacy of a formulation containing a combination of trans-4-(aminomethyl) cyclohexanecarboxylic acid/potassium azeloyl diglycinate/niacinamide compared with an emulsion-based control in the treatment of melasma in Thai adults. Methods: In this single-center, randomized, double-blind, controlled study, Thai patients with mild to moderate facial melasma (relative melanin value [RMV] in range of 20–120) were randomized for the application of either the test or the emulsion-based (control) product in the morning and before bedtime for 8 weeks. The supplemental sunscreen product with sun protection factor 30 was distributed to all patients. Subjects were assessed for the intensity of their hyperpigmented skin area by measuring the difference in the absolute melanin value between hyperpigmented skin and normal skin (RMV). This parameter was used as a primary outcome of this study. Additionally, the severity of melasma was determined visually using the Melasma Area and Severity Index (MASI) scored independently by 3 investigators. The assessments of melasma intensity and other skin properties were performed before administration (week 0) and every 2 weeks thereafter for up to 8 weeks. Other skin properties, including moisture content, pH, and redness (erythema value), were measured. Adverse events (AEs), including erythema, scaling, and edema, were also assessed by a dermatologist using the visual grading scale of Frosch and Kligman and COLIPA. Results: The resulting primary intent-to-treat (ITT) population included 33 patients in the test group and 34 patients in the control group. Sixty patients completed all 8 weeks of the study (on-treatment [OT] population): 91% (30) of the 33 patients in the test group, and 88% (30) of the 34 patients in the control group. Between-group differences in mean RMV were statistically significant at week 6 in both the primary ITT ( P = 0.005) and OT ( P = 0.006) populations. The significant differences in mean MASI scores between the test and the control groups were initially observed at weeks 4 ( P = 0.005) and 8 ( P = 0.027) in the OT and primary ITT populations, respectively. Other parameters, including skin pH, erythema, and moisture content did not significantly change from baseline at any time point of study. The incidence of AEs was not different between the test (4/33 [12%]) and control (5/34 [15%]) groups. Conclusions: The significant differences in RMVs between the test and control groups were observed after 6 weeks of treatment, both in the primary ITT and OT populations. The incidence of patients with AEs was not significantly different between the test and control groups.

Efficacy of the 1064-nm Q-switched Nd:YAG laser in melasma

Background: Melasma is difficult to treat and often recalcitrant to various treatments such as topical preparations and lasers. Objectives: To evaluate the efficacy and safety of the 1064-nm Q-switched Nd:YAG laser in Asian patients with melasma. Methods: Twenty-three Korean patients (skin types III–V) with melasma were treated with the 1064-nm Q-switched Nd:YAG laser at 1-week intervals for 10 weeks. The melasma area and severity index (MASI) score, lightness of melasma, patient satisfaction score and side effects were assessed at baseline, 4, 7, and 10 weeks and 1, 2, and 3 months after the last treatment. Results: A decreased MASI score and increased lightness of melasma were statistically significant at 7 and 10 weeks. Follow-up data was statistically significant at 1, 2, and 3 months after the last treatment (p-value < 0.05). The patient satisfaction score was statistically significant at 4, 7, and 10 weeks. Follow-up data were statistically significant at 1, 2, and 3 months after the last treatment (p-value < 0.05). No significant side effects were noted. Conclusion: The 1064-nm Q-switched Nd:YAG laser is a safe and effective modality for treating melasma in Asian patients.

Reliability assessment and validation of the Melasma Area and Severity Index (MASI) and a new modified MASI scoring method

The Melasma Area and Severity Index (MASI), the most commonly used outcome measure for melasma, has not been validated. We sought to determine the reliability and validity of the MASI. After standardized training, 6 raters independently rated 21 patients with mild to severe melasma once daily over a period of 2 days to determine intrarater and interrater reliability. Validation was performed by comparing the MASI with the melasma severity scale. The darkness component of the MASI was validated by comparing it with the difference between mexameter scores for affected versus adjacent normal-appearing skin. The area component of the MASI was validated by comparing it with the area of each section of the face determined by computer-based measurement software. The MASI score showed good reliability within and between raters and was found to be valid when compared with the melasma severity scale, mexameter scores, and area measurements. Homogeneity assessment by raters showed the least agreement and can be removed from the MASI score without any loss of reliability. Patients were limited to Hispanic, African, and Asian backgrounds. The MASI is a reliable measure of melasma severity. Area of involvement and darkness are sufficient for accurate measurement of the severity of melasma and homogeneity can be eliminated.

Different therapeutic modalities for treatment of melasma

Chemical peels and topical depigmenting agents have become a popular modality in the treatment of melasma. To compare the clinical efficacy of trichloroacetic acid peel 20%vs. Jessner's solution peel vs. the topical mixture of hydroquinone 2% and kojic acid. Forty five patients with melasma were randomly assigned into three groups of fifteen patients each. Group A received Jessner's solution peel, group B received trichloroacetic acid peel 20%, and group C received topical hydroquinone 2% and kojic acid. All patients were seen in follow-up period after 16 weeks; clinical evaluation using Melasma Area and Severity Index (MASI) score and photography were recorded before and after treatment and after 16 weeks. There was a decrease in MASI score in all three groups after treatment and after follow-up period but after treatment MASI score was statistically significantly lower in group A than group C (P = 0.01), and it was also statistically significantly lower in group B than group C (P < 0.001) but there was no statistically significant difference between groups A and B. After the follow-up period, MASI score was statistically significantly lower in group A than group C (P < 0.001), statistically significantly lower in group B than group C (P < 0.001), and statistically significantly lower in group B than group A (P = 0.035). The statistical analysis was done through one-way anova followed by least significant difference (LSD). Trichloroacetic acid 20% showed better results than Jessner's solution as peeling agent and hydroquinone 2% with kojic acid as a topical agent in the treatment of melasma.

Treatment of Melasma in Asian Skin Using a Fractional 1,550-nm Laser

Melasma is a common hyperpigmentation disorder that can cause refractory cosmetic disfigurement, especially in Asians. Fractional photothermolysis (FP) has been reported to be effective for the treatment of melasma, despite small study populations and short follow-up periods. To evaluate the efficacy and safety of FP for the treatment of melasma in Asians. Twenty-five patients with melasma received four monthly FP sessions and were followed up to 24 weeks after treatment completion. Efficacy was evaluated using objective and subjective ratings, Melasma Area and Severity Index (MASI), melanin index tracking, and skin elasticity measurements. Investigators observed clinical improvements in 60% and patients in 44% at 4 weeks after treatment, but the figures decreased to 52% and 35%, respectively, at 24 weeks after treatment. Mean MASI scores decreased significantly from 7.6 to 6.2. Mean melanin index decreased significantly after the first two sessions, but it relapsed slightly in subsequent follow-ups. The treatment did not alter skin elasticity. Hyperpigmentation was observed in three of 23 subjects (13%). Treatment of melasma with FP led to some clinical improvements, but it was not as efficacious as previously reported at 6-month follow-up. We recommend judicious use of FP for the treatment of melasma in Asian skin because of its limited efficacy.

A randomized, double‐blind, placebo‐controlled trial of oral procyanidin with vitamins A, C, E for melasma among Filipino women

Melasma is a common, acquired, symmetric hypermelanosis characterized by irregular brown to gray-brown macules on the cheeks, forehead, nasal bridge, cutaneous part of the upper lip, mandible, and the upper arms. Few trials have been conducted regarding the potential benefits of oral procyanidin in melasma. To assess the safety and efficacy of oral procyanidin + vitamins A, C, E among Filipino patients with epidermal melasma. A randomized, double-blind, placebo-controlled trial lasting 8 weeks, involving 60 adult female volunteers with bilateral epidermal melasma, Fitzpatrick skin types III-V, was conducted at the Section of Dermatology, Research Institute for Tropical Medicine, Department of Health, Manila, Philippines. Patients received either the test drug or placebo, twice daily with meals. Changes in pigmentation were measured using a mexameter, the melasma area and severity index (MASI), and a global evaluation by the patient and investigator. Safety evaluations were performed at each follow-up visit. Fifty-six patients completed the trial. Mexameter results demonstrated a significant decrease in the degree of pigmentation in the left malar (165.85 +/- 70.909) and right malar (161.33 +/- 61.824) regions (P < 0.0001). MASI scores showed a significant improvement in the left malar (2.4862 +/- 1.67816) and right malar (1.8889 +/- 1.67110) regions (P = 0.001). Procyanidin + vitamins A, C, E proved to be safe and well tolerated, with minimal adverse events. In this 8-week trial period, oral procyanidin + vitamins A, C, E proved to be safe and effective among Filipino women with epidermal melasma.

Clinical Efficacy of 25% l-Ascorbic Acid (C'ensil) in the Treatment of Melasma

L-Ascorbic acid is used to treat melasma; however, it is quickly oxidized in aqueous solutions. Thus, C'ensil, a formulation containing 25% l-ascorbic acid and a chemical penetration enhancer, was created to promote the penetration of l-ascorbic acid into the skin. To evaluate the efficacy of C'ensil in patients with melasma. Forty subjects with melasma were treated with C'ensil during an open-label trial over a period of 16 weeks. Each subject's skin pigmentation was assessed every 4 weeks using the Melasma Area and Severity Index (MASI) and mexameter score. In addition, transepidermal water loss, skin dryness and irritation, and quality of life (Melasma Quality of Life Scale [MelasQoL]) were evaluated. After 16 weeks, a significant decrease was noted in the degree of pigmentation based on the patients' MASI and mexameter scores. MelasQoL scores also decreased, indicating an increase in the subjects' quality of life. Our data indicate that C'ensil is an effective treatment modality for melasma.

Treatment of Melasma Using Variable Square Pulse Er: YAG Laser Resurfacing

Treatment of melasma remains a challenge. Laser treatments show limited efficacy, with a high rate of recurrence and side effects. Recently, variable-pulsed erbium:yttrium aluminum garnet (Er:YAG) lasers have shown favorable results in skin resurfacing, with minimal downtime and adverse effects. To determine the efficacy and side effects of variable square pulsed (VSP) Er:YAG laser resurfacing for treatment of epidermal type melasma. Twenty Thai women with epidermal-type melasma were treated with two passes of VSP Er:YAG laser resurfacing using a 7-mm spot size, pulse duration of 300 micros, and a fluence of 0.4 J/cm(2). Two treatments were given 1 month apart. Visual analog scale (VAS), Melasma Area and Severity Index (MASI) score and melanin index (MI) were measured at baseline and 1, 2, and 4 months after treatment. There was a significant improvement in VAS from baseline at 1-, 2-, and 4-month follow-up visits (p<.001). Significant improvement in MASI score at the 2-month visit from baseline (p=.004) was also observed. The average MI measured using melanin reflectance spectrometry measurements corresponded to MASI score rating. VSP Er:YAG laser resurfacing effectively but temporarily improved epidermal-type melasma. Recurrence was observed after the treatment was discontinued.

Topical 10% Zinc Sulfate Solution for Treatment of Melasma

Multiple modalities have been used in the treatment of melasma, such as bleaching agents, chemical peels, and antioxidants. Topical zinc sulfate has peeling and antioxidant effects. The objective was to evaluate the efficacy and safety of topical 10% zinc sulfate solution in the treatment of melasma. This study was conducted at the Department of Dermatology & Venereology, Baghdad Teaching Hospital. Twenty-eight patients with melasma were treated with 10% zinc sulfate solution. Every patient was instructed to apply the formula twice daily and to be seen every 2 weeks for 2 months. The severity of melasma was assessed before, during, and after treatment with the melasma area and severity index (MASI). All patients were instructed to apply a broad-spectrum sunscreen with SPF>30 before sun exposure during treatment and for the 3-month follow-up period. Fourteen patients were treated with 10% zinc sulfate solution. The mean MASI score before treatment was 9.45, which changed to 4.70 after therapy. This corresponds to a percentage improvement of 49.78% and was statistically significant (p<.0005). No side effects were reported apart from a mild stinging sensation reported in a few patients. Most patients maintained improvement 3 months after cessation of therapy. Topical 10% zinc sulfate solution is a new effective, safe, and noncostly formulation in the treatment of melasma.

Efficacy and Safety of Intense Pulsed Light in Treatment of Melasma in Chinese Patients

BACKGROUND Melasma is commonly seen in the Asian population. Traditional therapies are less effective and may cause adverse effects. OBJECTIVE The objective was to study the efficacy and safety of a new intense pulsed light (IPL) device in the treatment of melasma in Chinese patients. METHODS Eighty-nine women with melasma were enrolled in this open-labeled study. Subjects received a total of four IPL treatments at 3-week intervals. Changes in facial hyperpigmentation and telangiectasis were evaluated using an objective, skin colorimeter (Mexameter, Courage & Khazaka), the melasma area and severity index (MASI), and a global evaluation by the patients and blind investigators. RESULTS Sixty-nine of 89 patients (77.5%) obtained 51% to 100% improvement, according to the overall evaluation by dermatologists. Self-assessment by the patients indicated that 63 of 89 patients (70.8) considered more than 50% or more improvement. Mean MASI scores decreased substantially from 15.2 to 4.5. Mexameter results demonstrated a significant decrease in the degree of pigmentation and erythema beneath the melasma lesions. Patients with the epidermal-type melasma responded better to treatment than the mixed type. Adverse actions were minimal. CONCLUSION IPL treatment is a good option for patients with melasma. Adverse actions of IPL were minimal and acceptable.