Modified Melasma Area And Severity Index Research Articles

Melatonin: A Paradigm Shift in the Management of Melasma

Aim of the study: Comparative evaluation of the efficacy of oral melatonin in combination with oral tranexamic acid (TXA) versus the use of oral TXA alone in the management of melasma. Materials and methods: An in vivo, prospective, randomized, clinical study was conducted to compare and evaluate the efficacy of oral melatonin with oral tranexamic acid (TXA) as a combination therapy versus the use of Oral TXA alone in the management of melasma. Out of 20 patients selected, 10 patients were treated with a combination of oral melatonin and oral TXA (Group A). The remaining 10 patients were treated with oral TXA alone (Group B). Modified Melasma Area and Severity Index (MMASI) was used to assess the treatment outcomes of both the groups before starting the treatment and after every 15 days for 3 months. Result: The P value of <.05 showed that the study results were significant. It indicated a definite statistical difference between the 2 groups. Group A showed a steep unanticipated improvement in the severity score from day 15 to 2 months. Followed by sudden decrease in the severity score from 2 months to day 75 and a gradual decrease up to 3 months. On the contrary, Group B (oral TXA) showed not much improvement till day 15, followed by a slow improvement in 2 months. After 2 months, Group B showed gradual reduction in the severity score up to 3 months. Conclusion: Oral melatonin has an antioxidative property and its use along with oral TXA in the management of melasma gave better results. There was a substantial difference in the severity scores between the 2 groups, demonstrating that using oral TXA alone did not produce as good results as using it in conjunction with oral melatonin.

Combination of autologous platelet rich plasma and hydroquinone 4% is more effective than hydroquinone alone in treatment of melasma: A split-face comparative study.

Melasma is a common acquired circumscribed hyper-pigmentary disorder involving sun-exposed areas, particularly face. The high frequency of recurrence renders the management more challenging. Autologous platelet rich plasma (PRP) has promising potential in the treatment of melasma. This study evaluates the efficacy of combination of autologous PRP and Hydroquinone and compares it with the gold standard molecule 4% Hydroquinone. Thirty patients with melasma were enrolled in this split-face study conducted between 2018 and 2020. All the patients were prescribed Hydroquinone cream 4% to be applied on the affected area at night. Microneedling was performed once a month (total four sessions) on both sides of face, followed by application of autologous platelet rich plasma on right side and normal saline as control on left side of affected area. Modified Melasma Area and Severity Index (MASI) score, Patient satisfaction score and Physician's Global Assessment score were calculated at baseline and after each session and improvement was assessed. Improvement in mean modified MASI score was significant on both sides of face. Mean percentage improvement in modified MASI score on study side and control side was 82% and 69% respectively. The difference between the two sides was statistically significant in terms of modified MASI, patient satisfaction and physician global assessment scores. Adverse effects were mild and transient. Autologous platelet rich plasma is an effective and safe therapy for treatment of melasma. Combination of autologous PRP and 4% Hydroquinone showed greater improvement than hydroquinone alone.

Combined chemical peels versus trichloroacetic acid (TCA) for treating melasma: a split face study

Melasma is common skin condition presenting with hyperpigmentation. To evaluate the efficacy, tolerance, and complications of one session of combined chemical peels compared to traditional serial sessions of trichloroacetic acid (TCA) peeling in treating melasma. One session of combined chemical peels was carried out at the left side of the face, while six sessions of TCA 15% peel were carried out at the right side of the face every 10 days. The Modified Melasma Area and Severity Index (MASI) score was calculated at baseline (before starting peeling sessions), after one month (at the fourth TCA peeling session), and after three months (one month after the last TCA peeling session). Both sides of the face showed gradual reduction in modified MASI score throughout sessions. By the end of the study, the TCA-treated side showed slightly lower mean modified MASI score than the combined chemical peels-treated side of the face; however this difference was not statistically significant, (p = .405). A single session of combined chemical peels is as effective as six sessions of TCA peel in treatment of melasma. Combined chemical peels can be used as a convenient, tolerable and time saving safe procedure for treating melasma.

Evaluation of glutathione peroxidase enzyme in patients with melasma: a clinical and immunohistochemical study

ObjectiveTo evaluate the role of glutathione peroxidase (GPX1) in melasma.BackgroundMelasma is a common acquired disorder of hyperpigmentation. GPX1 is an intracellular enzymatic antioxidant, and its levels are used as a major parameter representing oxidative damage that occurs in melasma. However, the clear association between GPX1 expression and melasma remains unknown.Patients and methodsThis prospective case–control study was conducted on 20 cases having melasma and 20 normal age-matched and sex-matched healthy volunteers. All sections were immunohistochemically stained for GPX1 antibody.ResultsThere was significant difference between melasma cases and normal skin as regards GPX1 epidermal distribution (P = 0.001) and intensity (P = 0.005). Also there was a statistically significant association between epidermal intensity and distribution of GPX1 and the severity of melasma assessed by the modified Melasma Area and Severity Index (MASI) score. Moreover, there was statistically significant difference between epidermal intensity and distribution of GPX1 and the degree of dermal inflammation. Also, there was a tendency of melasma cases receiving hormonal therapy to show positive dermal expression of GPX1 than cases not receiving therapy (P = 0.07).ConclusionGPX1 was expressed diffusely in the epidermis of all control cases (100%), eight of them were of mild intensity and 12 were of moderate intensity while expressed in most of melasma cases in a focal form with mild intensity expression.

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 & 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.

A Pilot Study to Compare Therapeutic Efficacy and Safety of Combined Treatment of Skin Microneedling and Depigmenting Cream versus Depigmenting Cream Alone in Facial Melasma at Tertiary Care Center.

Background:Melasma is a commonly acquired, chronic, and relapsing disorder that results in symmetrical, brownish facial pigmentation. It is more common in women than in men, which generally starts between 20 and 40 years of age, and it can lead to considerable embarrassment and distress. Managing melasma is a difficult challenge that requires long-term treatment with a number of topical agents. Microneedling has been described as a new technique to enhance the drug’s transdermal penetration, and has also been reported to result in sustained long-term improvement of recalcitrant melasma.Aim:The aim of this article was to compare the therapeutic efficacy and safety of combined treatment of skin microneedling and depigmenting cream versus depigmenting cream alone in the treatment of melasma.Materials and Methods:A prospective study was conducted with a sample size of 40 patients, with twenty in each of the treatment arms; 20 patients were treated with combined skin needling and depigmenting cream and 20 with depigmenting cream alone. The outcome was evaluated periodically for up to 2 months using the modified Melasma Area and Severity Index (MASI) score.Results:Significant reduction was observed in modified MASI score in the combined treatment, with P value <0.05.Conclusion:Combining microneedling with Kligman’s regimen gives better results in melasma treatment compared to topical treatment alone.

DEVELOPMENT AND CLINICAL EVALUATION OF TOPICAL HYDROQUINONE NIOSOMAL GEL FORMULATION FOR THE TREATMENT OF MELASMA

Objective: The goal of the present study was to develop niosomal gel as a nanocarrier for improved depigmentation effect of hydroquinone (HQ). As well as to evaluate the prepared niosomes for entrapment efficiency, transmission electron microscopy (TEM), zeta potential, and in vitro release study. As an ultimate point of the objectives was to evaluate the best-prepared niosomal gel formula clinically in well-diagnosed patients of melasma and the results were compared with a commercial product.&#x0D; Methods: The effect of incorporation of co-surfactant such as Tween 20, Tween 40, and Tween 60 with Span 80, was studied to determine the highest entrapment efficiency and the desired release rate. Niosomes showed the highest entrapment efficiency was incorporated in different gelling agents like Carbopol 934 and Carboxymethylcellulose sodium (CMC Na) with different concentrations. Accelerated stability testing of HQ from niosomal gel formulations; the expiry date t90 was estimated. The best-prepared niosomal gel formula was studied clinically in patients of melasma and the results were compared with the commercial product (Clearique 2%)®Delta Pharma Company. &#x0D; Results: There was a significant increase in the clinical efficacy of the niosomal therapy and a highly significant decrease regarding to modified melasma area and severity index (MASI), duration to achieve improvement, side effects, and the recurrence of melasma in patients treated with niosomal gel compared to the commercial product.&#x0D; Conclusion: The incorporation of hydroquinone in niosomal gel improves its therapeutic effect regarding clinical effect, duration of treatment, side effects, recurrence and patient compliance.

Melatonin and oxidative stress in melasma - an unexplored territory; a prospective study.

Melasma, an acquired disorder of hyperpigmentation, is the most common pigmentary disorder in India. Many factors are implicated in the pathogenesis, and recently the role of oxidative damage including melatonin has been postulated. This study was undertaken to evaluate the role of oxidative stress and serum melatonin in pathogenesis of melasma. Seventy-five patients with melasma and an equal number of age and sex-matched controls were included in the study. Clinical characteristics were noted, and baseline severity assessment using modified Melasma Area and Severity Index (MASI) was done in all patients. Serum melatonin, catalase, protein carbonyl, and nitric oxide levels were measured and compared between cases and controls. The serum levels of melatonin and catalase were significantly lower among the cases as compared to controls, while the serum levels of protein carbonyl and nitric oxide were significantly higher in cases compared to controls. There was no statistically significant correlation between these markers of oxidative stress and severity of the disease. Oxidative stress is increased in patients with melasma compared to the control group in this study. A state of melatonin deficit also exists in patients with melasma. No correlation between the oxidative stress and severity of the disease was found. Further and larger studies including therapeutic trials with powerful antioxidants are warranted.

Clinical and epidemiologic features of melasma: a multicentric cross-sectional study from India.

Though melasma is a common skin condition in India, epidemiological studies are few and geographically confined. The present study was designed to gain insights into factors involved in causation and aggravation of melasma, demographic distribution, clinical presentations, and treatment patterns. A cross-sectional multicentric study was conducted in 10 centers distributed across the four regions of India. Data including demographics, personal and family medical history, triggering and aggravating factors, clinical patterns, and details of past treatment regimens were recorded, and severity was estimated using the modified Melasma Area and Severity Index (MASI) score. Data collected by site dermatologists were collated and analyzed. The study evaluated 1,001 patients with melasma from 10 centers. Mean age was 38.02years. Females dominated (85%). Proportion of males was highest in theeast (22.2%) and lowest in thesouth (10.8%). Majority of patients belonged to intermediate skin phototypes. There was a significant difference (P = 0.000) between duration of sun exposure and duration of cooking fire/occupational heat exposure across the four regions. There was a significant association (P=0.003, Mann-Whitney U test) and a positive correlation between duration of cooking heat/occupational heat exposure and severity of melasma. Sunscreens were used by only one-fifth of the study population (19.6%) whereas use of steroids and triple combinations was more common (28%). One of the largest studies on melasma from the subcontinent, this study describes the epidemiological determinants of melasma. Data suggests that the duration of cooking fire/occupational heat exposure may be linked to severity of melasma. Sunscreenuse seems inadequate in Indian patients; use of steroid-containing medications is more common.

Evaluation of the Efficacy and Safety of Topical and Oral Glutathione in Treatment of Melasma

AbstractBackground: Melasma is an acquired symmetrical hyper-pigmentation that typically presents on the face. Its etiology is multifactorial; its treatment remains a challenge and unsat-isfactory. Glutathione is a major antioxidant which plays critical roles in protecting cells from oxidative damage and the toxicity of xenobiotic electrophiles, and maintaining redox homeostasis.Aim of the Work: To assess the efficacy and safety of topical and oral glutathione in the treatment of melasma.Patients and Methods: This study included 30 female patients with melasma were selected among those attending the Outpatient Clinic of Dermatology and Venereology De-partment, Tanta University Hospitals during the period between December, 2015 and February, 2017. The studied patients were divided into 3 groups. Group I (10 patients) applied glutathione (2%) cream to right side of the face while placebo cream to left side (as a control) twice daily for 10 weeks. Group II (10 patients) received oral glutathione capsules (500mg/day) for 4 weeks. Group III (10 patients) received oral placebo capsules (as a control) once daily for 4 weeks. Modified melasma area and severity index (MASI) score was calculated before and after therapy. The patients were followed up for a period of 3 months.Results: Significant reduction in modified MASI was observed in patients treated with topical and oral glutathione (p=0.011) and (p=0.007) respectively, while patients treated with topical or oral placebo had no response. Topical and oral forms of glutathione were safe and well tolerated.Conclusion: Glutathione is safe, tolerable and effective whitening agent when used in topical cream (2%) and also in oral form in treatment of melasma.

RESPONSE TO INTRADERMAL AUTOLOGOUS PLATELET RICH PLASMA INJECTION IN REFRACTORY DERMAL MELASMA: REPORT OF TWO CASES

Refractory dermal melasma is resistant to conventional treatment. Platelet rich plasma (PRP) may help to reduce the pigmentation of melasma. We present a case report on the clinical outcome of 2 patients with melasma, given PRP, as an adjunct therapy. PRP was administered at a monthly interval for 2 sessions in combination with a monthly Q-switched Nd Yag laser treatment and topical alpha arbutin application. A modified melasma area and severity index (MASI) was evaluated by two dermatologists who were blinded. At the follow up on the 3rd months, the MASI score was reduced by mean 33.5% for case 1 and 20% for case 2. There were no clinical complications for case 1. However recurrence of melasma was noted in case 2 by a worsening of the MASI score mean to 53% at the sixth months follow up. In conclusion, intradermal PRP injection as an adjunct to the conventional treatment of melasma presented with differing results in two cases.

Pulse in Pulse Intense Pulsed Light for Melasma Treatment: A Pilot Study

A new type of intense pulsed light IPL with pulse-in-pulse (PIP) mode (multiple fractionated subpulses in one pulse width) has recently been developed. To evaluate the clinical efficacy and safety of PIP IPL in patients with melasma. Half of each patient's face was treated with IPL and six treatment sessions with a low-fluence quality-switched neodymium-doped yttrium aluminum garnet laser (IPL/T) every 2weeks. The other half was treated with PIP IPL. Outcome assessments included photography, modified Melasma Area and Severity Index (MASI) score, and patient satisfaction. The melanin and erythema indices were used for objective evaluation. Patients were followed up for 6months after the last treatment. All patients completed the study successfully. On both treated sides, the melanin index decreased significantly after treatment. The modified MASI score also fell 54.4% on the PIP IPL side and 50.0% on the IPL/T side. No patients reported serious aggravation of melasma for 6months after the last treatment. Patients favored PIP IPL due to less discomfort during and after treatments. PIP IPL may be a safe and promising treatment for melasma.

Intense Pulsed Light and Low-Fluence Q-Switched Nd:YAG Laser Treatment in Melasma Patients

BackgroundRecently, low fluence collimated Q-switched (QS) Nd:YAG laser has drawn attention for the treatment of melasma. However, it needs a lot of treatment sessions for the substantial results and repetitive laser exposures may end up with unwanted depigmentation.ObjectiveWe evaluated the clinical effects and safety of the combinational treatment, using intense pulsed light (IPL) and low fluence QS Nd:YAG laser.MethodsRetrospective case series of 20 female patients, with mixed type melasma, were analyzed using medical records. They were treated with IPL one time, and 4 times of weekly successive low fluence Nd:YAG laser treatments. At each visit, digital photographs were taken under the same condition. Melanin index (MI) and erythema index (EI) were measured on the highest point on the cheekbones. Modified melasma area and severity index (MASI) scores were calculated by two investigators using digital photographs.ResultsThe mean values of MI and EI decreased significantly after treatments. The modified MASI score has decreased by 59.35%, on average. Sixty percents of the participants did not require any more treatments, and no clinical aggravations were observed during the follow-up period (mean 5.9 months).ConclusionIPL and low fluence laser may elicit a clinical resolution in the mixed type melasma with long term benefits.

Better clinical results with long term benefits in melasma patients

Background: Low fluence Q-switched Nd:YAG laser has become popular in the treatment of melasma in Asian patients. However, it needs a lot of treatment sessions for substantial results and repetitive laser exposures may end up with unwanted depigmentation. Objective: We evaluated clinical effects and safety of combinational treatment using intense pulsed light and low fluence Q-switched Nd:YAG laser over laser treatment alone. Methods: Retrospective case series of 35 female patients with mixed type melasma were analyzed. Group A were treated with combination methods and group B with laser alone. At each visit, digital photographs were taken. Erythema index (EI) and melanin index (MI) were measured on the highest point on cheekbones. Modified melasma area and severity index (MASI) scores were marked using photographs by two blinded investigators. Results: The mean values of MI and EI decreased significantly in both groups. Modified MASI score reduction were 59.35% and 45.66% in groups A and B, respectively. In group A, 12 out of 20 patients were followed up (mean 5.9 months) without any further treatments and no clinical aggravations were observed. All patients in group B required at least five more treatment sessions for satisfactory results. Conclusion: Combination treatment may provide more rapid clinical resolution in mixed type melasma with possible long term clinical benefits.

Glycolic Acid Peels Versus Amino Fruit Acid Peels in the Treatment of Melasma

Chemical peels are becoming more popular as a treatment modality for melasma. To compare the therapeutic effects of glycolic acid (GA) peels and amino fruit acid (AFA) peels in patients with melasma. In this single-blind, randomized right-left comparison study, patients received 12 serial peels on the two halves of the face at 2-week intervals for 6 months. Clinical evaluation based on the modified Melasma Area and Severity Index (MASI) scores was performed at baseline and at 3 and 6 months. The modified MASI scores at 3 and 6 months in both application areas decreased significantly from baseline (p<.05). When the two applications were compared with each other, there was no statistically significant difference between GA and AFA in terms of regression of melasma (p>.05). During the application, it was observed that AFA peels caused fewer problems than GA peels did. Based on the results of this study, GA and AFA peels for melasma therapy were efficacious, but the AFA peel was found to be less irritating and was better tolerated.