Melasma Lesions Research Articles

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.

What lies behind melasma: a review of the related skin microenvironment.

Melasma is an acquired chronic pigmentary disorder affecting millions of individuals worldwide. However, the pathogenesis of melasma remains unclear. This article provides a comprehensive review of the pathophysiological changes occurring in the skin microenvironment of melasma lesions, which can be summarized as follows: (1) skin barrier dysfunction and abnormal synthesis, transport, and intracellular distribution of melanin in the epidermis; (2) basement membrane damage; (3) solar elastosis, vascular changes, senescent fibroblasts, mast cell infiltration, and sebocyte participation in the dermis; and (4) systemic factors such as sex hormones and oxidative stress. Furthermore, potential therapeutic strategies are introduced to provide novel perspectives for fundamental and clinical research related to melasma.

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.

Dermoscopic features of melasma: a descriptive study in Bali

Background: Dermoscopy or dermatoscopy is a noninvasive diagnostic tool in dermatology that identifies the pattern in pigmented lesions such as melasma. Several features commonly found in melasma include brown or gray pigmentation, pigment network, telangiectasis and sparing of follicles and sweat gland openings. This study aimed to describe the dermoscopic features of melasma in Balinese patients. Methods: A cross-sectional descriptive study conducted by Prof. dr. I G. N. G. Ngoerah General Hospital, Bali, using a secondary source in August 2023. Subjects selected with total sampling from the database in January 2021 to July 2023 at Dermatology and Venereology Outpatient Polyclinic who were diagnosed with Melasma. Characteristics obtained were Fitzpatrick skin type, occupation, contraceptive usage, lesion distributions and dermoscopic features using Dermlite DL4 polarized mode on both check and malar area. Data was analyzed descriptively using Statistical Package for the Social Sciences (SPSS) version 21. Results: A total of 23 females with melasma were included in this study. The subjects were mainly Fitzpatrick skin type IV (74%), occupation in indoor activity (87%), not using oral contraceptives (96%), and symmetrical distribution (91%). The dermoscopic features obtained mainly were light brown (100%), irregular pigment network (87%), sparing of follicles and sweat glands opening (95.7%), and irregular pattern of telangiectasis (69.6%). Conclusion: Using dermoscopy as a diagnostic tool for melasma can clarify the characteristics of melasma lesions in more detail. Further research is needed to determine the sensitivity of dermoscopic features and assess the success of treatment in melasma.

A NOVEL APPROACH TO INTRALESIONAL AUTOLOGOUS SERUM THERAPY IN MELASMA: AN OPEN-LABEL, PROSPECTIVE STUDY

Objective: The study aimed to assess the effectiveness of intralesional autologous serum therapy in Melasma. Methods: A total of 30 patients over 18 years of age were enrolled in the study with prior approval from the institute’s ethical committee. Serum was injected intradermally into the melasma lesions of the patient every 2 weeks with a 30G insulin syringe. Patients were called for follow-up every 15 days until 90 days. On each visit, clinical response to treatment was calculated using the modified Melasma Area and Severity Index (mMASI) score, and side effects were also noted, if any. Results: The reduction in mean mMASI score from baseline was not significant till the second visit (day 15) (p=0.317), while it was statistically significant from the third visit onwards (day 30) (p=0.024). The reduction in mean mMASI score from baseline 3.95±3.23 to 2.31±2.16 (41.51% improvement) is suggestive of a good response, which was also statistically significant (p≤0.001). Conclusion: Study patients perceived a significant improvement in pigmentation during the therapy period without any considerable side effects. Thus, autologous serum therapy may be a viable alternative to the existing treatment modalities for Melasma.

The Profile and Triggering Factors of Melasma Patients: A Retrospective Study

Background: Melasma is a skin pigmentation disorder characterized by brownish hyperpigmented lesions with symmetrical distribution and irregular borders. It becomes a cosmetic problem that causes a negative impact on quality of life and a lack of confidence in patients. The etiology of melasma is not completely understood, but several factors that trigger melasma can be explained. Yet, the profile and triggering factors associated with the prevalence of melasma patients in Surabaya are still unexplored. Purpose: To determine the profile and triggering factors of melasma patients in the Dermatology and Venereology Outpatient Unit of Dr. Soetomo General Academic Hospital Surabaya from January to December 2019. Methods: A retrospective descriptive study using data from medical records with a total sampling technique. Result: In this study, most of the melasma patients were female (97.5%), dominated by the age group 46-55 years (49.4%), and worked as housewives (40.74%). The triggering factors found in patients were sun exposure (96.3%), cosmetics (67.9%), hormonal (49.4%), and family history (22.2%). The physical examinations of melasma lesions showed that they were mostly located in the malar area (72.8%), light brown colored (74.7%), and 2.0 – 4.0 cm in size (54.3%). Wood’s lamp examination showed that most of the lesions had firm and indistinct borders (55.6%). Conclusion: The triggering factors of melasma are multifactorial, but we suspect that sun exposure plays an important role in affecting melasma.

Adaptability of melanocytes post ultraviolet stimulation in patients with melasma.

Dynamic in vivo changes in melanin in melasma lesions after exposure to ultraviolet (UV) irradiation have not been described. To determine whether melasma lesions and nearby perilesions demonstrated different adaptive responses to UV irradiation and whether the tanning responses were different among different locations on face. We collected sequential images from real-time cellular resolution full-field optical coherence tomography (CRFF-OCT) at melasma lesions and perilesions among 20 Asian patients. Quantitative and layer distribution analyses for melanin were performed using a computer-aided detection (CADe) system that utilizes spatial compounding-based denoising convolutional neural networks. The detected melanin (D) is melanin with a diameter >0.5 µm, among which confetti melanin (C) has a diameter of >3.3 µm and corresponds to a melanosome-rich package. The calculated C/D ratio is proportional to active melanin transportation. Before UV exposure, melasma lesions had more detected melanin (p = 0.0271), confetti melanin (p = 0.0163), and increased C/D ratio (p = 0.0152) in the basal layer compared to those of perilesions. After exposure to UV irradiation, perilesions have both increased confetti melanin (p = 0.0452) and the C/D ratio (p = 0.0369) in basal layer, and this effect was most prominent in right cheek (p = 0.030). There were however no significant differences in the detected, confetti, or granular melanin areas before and after exposure to UV irradiation in melasma lesions in all the skin layers. Hyperactive melanocytes with a higher baseline C/D ratio were noted in the melasma lesions. They were "fixed" on the plateau and were not responsive to UV irradiation regardless of the location on face. Perilesions retained adaptability with a dynamic response to UV irradiation, in which more confetti melanin was shed, mainly in the basal layer. Therefore, aggravating effect of UV on melasma was mainly due to UV-responsive perilesions rather than lesions.

Efficacy and tolerability of neoretin discrom control serum in the treatment of melasma

Objectives: To evaluate the efficacy and safety of Neoretin Discrom Control Serum for the treatment of melasma.Methods: A clinical trial in 36 melasma patients treated with Neoretin Discrom Control Serum for 4 months. Patients were re-examined at weeks 4, 8, 12, 16; Facial pictures by digital camera were taken and were evaluated the improvement of melasma on the MASI scale, on dermoscopy, the change in Melanin index through the Mexameter, clinical side effects and patient satisfaction during and after treatment was noted.Results: Melasma treatment with Neoretin Discrom Control Serum resulted in a 64% reduction in MASI (from 15.23 to 5.52) after 4 months of treatment. Melanin index measured by Mexameter also decreased after 4 months with a reduction rate of 30.4%. The most common undesirable effect is a stinging sensation (52.8%). Other side effects include itching, burning, redness, dry skin, scaling, acne, and hyperpigmentation. Side effects were encountered mainly in the first month and were mild-moderate. No serious side effects and no systemic side effects were detected. After 4 months of treatment, the patient’s self-rated melasma lesions improved by 46%, with an average satisfaction score of 7.8/10.Conclusion: Neoretin Discrom Control Serum proved to be an effective and safe product for the treatment of melasma. It should be combined with moisturizers and skin-soothing creams to minimize unwanted effects.

Targeting senescent dermal fibroblasts responsible for hyperactive melanocytes in melasma

Targeting senescent dermal fibroblasts responsible for hyperactive melanocytes in melasma

The dermoscopic characteristics of melasma in relation to different skin phototypes, distribution patterns and wood lamp findings: a cross-sectional study of 236 melasma lesions.

Melasma is an acquired, pigmentary disorder characterized by the appearance of brown to bluish-gray patches with well-demarcated or ill-defined borders, most commonly on the face. This challenging hyperpigmentation disorder is generally observed in women; sun exposure, pregnancy, oral contraceptive use, genetic influences and chemical agents are some etiopathogenetic factors. Even though readily diagnosed by clinical examination; dermoscopy, Wood lamp findings and histopathology may also help the clinicians to confirm the diagnosis and to disclose the features of the melasma such as melanin depth and melasma type. In our study, we aimed to investigate the dermoscopic properties of facial melasma in accordance with different skin phototypes, age, distribution patterns, presence of other facial dermatoses, etiological factors and wood lamb findings. In the present cross-sectional study, patients clinically diagnosed with facial melasma in a secondary care hospital were included. Demographical data, personal history, distribution patterns of the melasma, dermoscopic features, Wood lamp examination findings, the presence of any other facial dermatosis, possible underlying risk factors and skin phototypes were determined. One hundred fifty nine patients with a total number of 236 melasmas with variable distribution patterns were included. The mean age was 37.91years, whereas the mean age at the onset of the melasma was 32.43years. One hundred thirty three participants were females, whereas 26 were males. The most prevalent risk factors of melasma were exposure to UV light (62.2%), pregnancy (50.6%) and genetic predisposition (43.6%). The most common melasma localization was cheek (43.6%) followed by T zone (33.1%). The most common dermoscopic findings were brown reticular pseudonetwork (73.3%), increased vascularity and telangiectasia (51.7%) and brown clods (33.1%). Brown reticular pseudonetwork was present at a higher rate in patients with skin phototype V compared to the ones with skin phototype II (p = 0.033). Our study shows that dermoscopic findings of melasma may differ across different skin phototypes, melasma localizations, possible associated risk factors and age.

Pathogenesis of melasma

AbstractTo adequately guide future therapies, it is important to elucidate the pathogenesis of melasma. Chronic ultraviolet (UV) radiation exposure, hormonal stimulation, and genetic predisposition play a role in melasma. A widely accepted theory for the pathogenesis of melasma is the increase of melanin through UV, which leads to the upregulation of melanin stimulating receptors (MSR) such as melanocortin‐1 receptors (MC1R), resulting in increased hormone binding and melanin production. Furthermore, there are similarities between the histopathologic presentation of melasma and solar elastosis, a hallmark of photo‐aged skin. These overlaps include altered basement membrane, increased vascularization, and increased mast cell count. There is significant data showing greater degree of solar elastosis in the melasma skin compared to the perilesional skin. Additionally, an etiologic factor in the pathogenesis of melasma is hormonal exposure to estrogen. Melasma has increased prevalence among menstruating women, women on oral contraceptives, and pregnant women. In melasma lesions, studies have shown an increased number of estrogen receptors and progesterone receptors in the dermis and epidermis, respectively. Previously, increased melanogenesis was thought to be the sole contributing factor to the pathogenesis of melasma but more recently, aberrant vasodilation and angiogenesis have been found to play a role. Nitric oxide, a potent vasodilator, was found to be overexpressed at the dermal‐epidermal junction and was hypothesized to contribute to melasma through stimulation of tyrosinase and increasing vascularity. In conclusion, the various mechanisms implicated in melasma include melanocyte dysfunction, solar elastosis, mast cell dysfunction, hormonal influence, vascular transformation, and basement membrane damage.

Efficacy of cysteamine and methimazole in treating melasma: A comparative narrative review.

Melasma is a chronic and acquired pigmentary condition that primarily affects women and undermines patient satisfaction and confidence. Melasma mostly affects females, accounting for 90% of all cases. It affects people of all races, particularly those with skin types IV and V who live in areas with lots of UV radiation. According to the studies, Melasma lesions are seen throughout the face in centrofacial, malar, and mandibular patterns. Melasma lesions on the forehead, cheeks, nose, upper lip, and/or chin are the most prevalent centrofacial pattern. Melasma lesions can also be detected along the periorbital area, especially in Asian people. Melasma is notably resistant to treatment, with many patients experiencing only temporary relief and relapses. Combining therapies that target numerous pathologic components, including photodamage, inflammation, aberrant vascularity, and abnormal pigmentation, generally results in the most dramatic therapeutic improvements. Treatments for dark circles include topical depigmenting medicines like hydroquinone, kojic acid, azelaic acid, and topical retinoic acid, and physical treatments such as chemical peels, surgical adjustments, and laser therapy. The objective of therapy should be to figure out what is causing the hyperpigmentation and what is contributing to it. This article provides an overview of melasma therapies and the efficacy of methimazole and cysteamine for melasma therapy.

فعالية الحقن الدقيق الموضعي داخل الأدمة لحمض الترانكساميك بتركيز 4 ملغ/ مل في علاج الكلف

Background: Melasma is a common acquired hyperpigmented dermatosis due to a disorder in the function of the melanogenesis process. Nowadays, there are many used treatments for melasma but it is still a big cosmetic problem. The Aim of our study is to evaluate the efficacy and safety of intradermal microinjection of tranexamic acid TXA in the treatment of melasma in Syrian women. Methods: A total of 34 women with melasma, attending Tishreen University Hospital in Lattakia-Syria from January 2020 to January 2021 were included in this prospective (before and after) study. We applied topical anesthesia then we injected 0.05 ml TXA (4 mg/ml) intradermally into the melasma lesions at 1 cm intervals by using a 30-gauge insulin syringe. We repeated this procedure every 2 weeks for 12 weeks. A clinical investigator evaluated the results by using the modified Melasma Area and Severity Index (mMASI) at baseline and at 4, 8, and 12 weeks. Patients were followed up after 3 months from completing the treatment. Results: The mean mMASI scores decreased from 6.99±3.4 at baseline to 5.98±3.2, 4.59±2.5 and 3.49±2.3 at weeks 4, 8, 12 respectively. This decrease was clinically and statistically significant with a p-value = 0.0001. Our patients did not show serious side effects. Conclusion: According to that, we suggest that localized intradermal microinjection of tranexamic acid at a concentration of 4 mg/ml is an effective and safe therapeutic method for melasma.

Efficacy of intradermal injection of tranexamic acid and ascorbic acid versus tranexamic acid and placebo in the treatment of melasma: A split-face comparative trial.

Background and AimsMelasma is a common dermatologic disorder characterized by symmetrical hyperpigmented lesions on the face. Although various therapeutic options are available for melasma, its treatment remains challenging. The present study evaluated the safety and efficacy of intradermal microinjection of tranexamic acid (TA) plus ascorbic acid in treating melasma lesions compared with TA and placebo.MethodsFrom September 2019 to May 2020, 24 patients with symmetrical melasma were enrolled in a prospective, double‐blind, split‐face, randomized controlled clinical trial. Each patient received 50 mg/ml TA and 50 mg/ml ascorbic acid for one side of the face (A) and 50 mg/ml TA and placebo for the other side (B) every 2 weeks for 12 weeks. The Melasma Area and Severity Index (MASI) score, Physician Global Assessment, and pain were measured at baseline and at 4, 8, 12, and 24 weeks. Statistical analysis was done using SPSS software version 16, and data were reported as mean ± standard deviation or median and interquartile range. χ 2 and Fisher's exact tests were used to test differences between the groups.ResultsBoth groups experienced a significant decrease in MASI scores compared with the baseline. The MASI score was significantly less in the intervention group than the placebo group at the 8th and 12th weeks. However, burning pain was significantly more prominent in the intervention group.ConclusionIntradermal injection of ascorbic acid combined with TA can be beneficial in treating melasma. Currently, there are numerous treatment modalities for melasma. However, the results still vary, and satisfactory outcomes are yet to be reached.

Tranexamic Acid in Melasma: Comparative Evaluation of Therapeutic Efficacy of Oral Tranexamic Acid versus Its Transepidermal Administration.

Melasma is a common disorder of hyperpigmentation mainly affecting the face. It is difficult to treat and is a cause for great cosmetic concern for the patient. So, we did this research to compare the therapeutic efficacy of tranexamic acid (TXA) through oral route versus its transepidermal administration with a dermaroller in melasma. This was a hospital-based, interventional study carried over a span of 1 year on 40 patients with facial melasma. The enrolled patients were randomly divided into 2 groups of 20 patients each. Group A patients received oral tablet TXA in a dose of 250 mg twice daily for 12 weeks and Group B patients were given TXA solution transepidermally into the melasma lesions using a dermaroller at 2 weekly interval for 12 weeks. Thereafter, all patients were followed up for improvement in Melasma Area and Severity Index (MASI) score, adverse effects and relapse at 4 weekly intervals till 24 weeks. All the patients were evaluated for therapeutic outcome both objectively (by MASI) and photographically at 4, 8, 12, 18, and 24 weeks. Grading of improvement was done by assessing percentage reduction in MASI score. Majority of the patients, 24 (60%) in our study had centrofacial pattern of melasma followed by malar pattern seen in 16 (40%) patients. The baseline MASI score was 11.98 (± 5.47) in Group A and 12.13 (± 3.16) in Group B. The mean MASI score in Group A at the end of 4, 8, 12, 18, and 24 weeks was 9.75 (±4.83), 6.09 (±3.64), 4.21 (±2.48), 2.56 (±1.95), and 3.10 (±3.38) while these values were 9.73 (±3.32), 6.06 (±2.75), 4.55 (±1.89), 2.94 (±1.36), and 3.09 (±1.32) for Group B. At the end of 24 weeks follow-up period, good (51%-75% improvement) and very good (>75% improvement) response occurred in 5 (25%) and 14 (70%) patients in Group A and 11 (55%) and 9 (45%) patients in Group B, respectively. However, the final reduction in MASI score was similar in both the groups. Relapse was uncommon and occurred at 24 weeks in 1 patient from Group A. The major limitation was small sample size due to time limitation and long follow-up period. Oral and transepidermal TXA appear equally effective suggesting that the efficacy of TXA is perhaps independent of its route of administration. Oral therapy is convenient for the patient. Transepidermal therapy of TXA has the advantage of local action, hence systemic side effects are avoided, but it is slightly painful and the time period between consecutive microneedling sessions is left to the prerogative of the treating doctor, hence a proper quantification is lacking. Moreover, scheduling of maintenance sessions is necessary as melasma is prone for recurrence.

Dermal Pathology in Melasma: An Update Review.

BackgroundMelasma is a complex and multipathophysiological condition that is challenging to treat. The roles of each element in the dermis were highlighted in this recent year due to targeting it with emerging therapies. Although some studies have demonstrated abnormal findings in the dermis of melasma lesions, there are no integrated data regarding these findings.PurposeThis article aims to discuss each finding in the dermis of melasma lesions and to provide some ideas about treatment options.MethodsAn Internet search was completed using the MEDLINE, Embase, Scopus, and Google Scholar databases for relevant literature through June 2021 and reference lists of respective articles. Only the articles published in English language were included.ResultsSeveral studies have focused on the dermal changes in melasma. Common findings included basement membrane disruption, pendulous melanocytes, marked solar elastosis, increased melanophages, increased mast cells, and neovascularization. In addition, each of them had the specified mechanism that may relate with the others.ConclusionSeveral changes in the dermis of melasma lesion may be connected with pathological changes in the epidermis. This may serve as a potential target treatment for melasma, which requires a multimodal approach.

Study of the therapeutic efficacy and safety of intralesional tranexamic acid (25 mg/ml) for the treatment of melasma in male patients: A single centered “before-after” observational study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Melasma is a common and difficult to treat hypermelanosis of poorly understood etiopathogenesis with great tendency to relapse. Tranexamic acid (TA) has been used in various formulations for its treatment, but there is paucity of studies/data and no consensus on the optimum dosage of intradermal TA, especially among the male patients. To study the efficacy and safety of intralesional TA 25 mg/ml for the treatment of melasma in male patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Total 58 males were enrolled for study from July 2019 to June 2020. TA in 25 mg/ml strength injection and about 0.05 ml was injected intradermally at 1 cm apart on the entire melasma lesion, not exceeding 50 mg per visit and repeated every 4 weekly for 12 weeks. The percentage reduction in MASI was the primary outcome measure. It was determined every 4th week till 12 weeks and finally at 24 weeks for recurrence.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean MASI decreased from baseline score of 8.42±5.63 to 6.71±4.65, 5.09±3.59 and 3.41±3.06 at the follow up week 4, 8 and 12 respectively with a significant decrease from 8th week onwards. Majority of the patients were satisfied with their improvement after treatment (67.2%) without any significant adverse effects.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; However, the TA was found to effective in all the three histopathological types of melasma but the dermal melasma was least responsive as well as earliest to relapse. We recommend monthly therapy at 25 mg/ml as more efficacious, time saving and cost effective to all the three types of melasma.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Computer-Aided Detection (CADe) System with Optical Coherent Tomography for Melanin Morphology Quantification in Melasma Patients.

Dark skin-type individuals have a greater tendency to have pigmentary disorders, among which melasma is especially refractory to treat and often recurs. Objective measurement of melanin amount helps evaluate the treatment response of pigmentary disorders. However, naked-eye evaluation is subjective to weariness and bias. We used a cellular resolution full-field optical coherence tomography (FF-OCT) to assess melanin features of melasma lesions and perilesional skin on the cheeks of eight Asian patients. A computer-aided detection (CADe) system is proposed to mark and quantify melanin. This system combines spatial compounding-based denoising convolutional neural networks (SC-DnCNN), and through image processing techniques, various types of melanin features, including area, distribution, intensity, and shape, can be extracted. Through evaluations of the image differences between the lesion and perilesional skin, a distribution-based feature of confetti melanin without layering, two distribution-based features of confetti melanin in stratum spinosum, and a distribution-based feature of grain melanin at the dermal–epidermal junction, statistically significant findings were achieved (p-values = 0.0402, 0.0032, 0.0312, and 0.0426, respectively). FF-OCT enables the real-time observation of melanin features, and the CADe system with SC-DnCNN was a precise and objective tool with which to interpret the area, distribution, intensity, and shape of melanin on FF-OCT images.

A Study on Applying Slide-Free Label-Free Harmonic Generation Microscopy For Noninvasive Assessment of Melasma Treatments With Histopathological Parameters

Melasma, which is thought to be associated with hyperactivation of melanocytes, is a common hyperpigmentary skin disorder. To treat this skin disorder, dermatologists can benefit from in vivo information of cellular morphometrics to evaluate pathologies of melasma and effectiveness of treatments. To acquire this useful information, we applied the in vivo slide-free label-free harmonic generation microscopy (HGM) to retrieve real-time HGM images and subsequent critical histopathological parameters. These in vivo quantitative parameters included melanin mass density (MMD), melanocyte dendricity score (MDS), melanophage density (MPD), and thickness of dermal papilla zone (DPZ). The statistical results from 33 recruited Asian female melasma patients showed that MMD, MDS, and MPD in melasma lesions were significantly higher than those in the surrounding normal skin; by contrast, the DPZ was lower. After treatment, the MMD, MPD, and DPZ restored toward the normal level; however, we observed no significant change of MDS. Our study indicates that these parameters are able to serve as clinical indices to evaluate the histopathological characteristics of melasma patients and the effectiveness of treatments.

Evaluate the efficacy of intradermal tranexamic acid in melisma.

Objective: To evaluate the efficacy of intradermal tranexamic acid in melasma. Stduy Design: Cross-Sectional study. Setting: Out-patient Department of Dermatology at Dow University of Health Sciences. Period: January 2018 to June 2018. Material &amp; Methods: Enrolling 73 patients the research was done on patients with resistant melasma. For this 0.2 ml tranexamic acid diluted in 0.8 ml normal saline was injected intradermally into the melasma lesion at 1 cm distance at every 2 weeks for 4 months and results were analysed by using the modified Melasma Area and Severity Index (MASI) at their first visit and then monthly with strict sun protection. A total of 73 patients were included in this study with age ranging from 22 years to 47 years. All of them had resistant melasma and had not taken any treatment for the last six months. Results: Out of 73 patient 10 (13.7%) patients had poor response, 48 (65.8%) patients had fair response, 14 (19.1%) patients had good responses and only 1 (1.4%) had excellent response. No significant side effects were observed. Out of 73 patients, 63 patients were satisfied with the treatment. Only 2 patients complained of redness over the affected area which subsided within a week without any intervention, no other side effects were noted. Conclusion: Intralesonal tranexamic acid is safe, effective and an affordable option in resistant melasma.