Modified Melasma Area Severity Index Research Articles

Low-level laser therapy for skin rejuvenation: A safe and effective solution baked by data and visual evidence.

Skin aging and photoaging is a process that may appear at a relatively early age, causing an aesthetic problem. Common signs of skin aging include wrinkles, dyspigmentation, and decreased elasticity. Aim of this article is to study the effectiveness and safety of low-level laser therapy (LLLT) for skin rejuvenation. Thirty Syrian female patients aged 25-50 participated in this study and were diagnosed with moderate to severe melasma and wrinkles. The patients were divided into two groups and received LLLT with a wavelength of 660 nm emitting a continuous wave. The power density and dose used were 15.6 mW/cm2, and 3 J/cm2 respectively, and the laser effective area was 32 cm2. The evaluation was done before, during, and after 12 treatment sessions, based on photographs, in addition to the modified Melasma Area Severity Index (MASI), Pinch test, and Fitzpatrick's classification of facial wrinkling at baseline. Comparing before, and after treatment, and between the two groups, revealed a significant improvement in skin rejuvenation, with a statistical significance (p < 0.05). Additional outcome measures included assessments of patient satisfaction scores, and no adverse effects or re-pigmentation were reported. Our results suggest that LLLT may be a useful and safe therapeutic option in treating melasma, skin elasticity, and wrinkle improvement, which we advised to be integrated into treatment, and follow-up programs in cosmetics and dermatology.

A comparison of the effectiveness of intralesional tranexamic acid against platelet-rich plasma in the treatment of melasma

Background: Melasma, derived from the Greek word "melas" meaning "black", manifests as an acquired, more or less symmetrical hypermelanosis of sun-exposed skin. This study aimed to compare and evaluate the efficacy and safety of intradermal injection of tranexamic acid and platelet-rich plasma in treating various types of melasma. Methods: Conducted from June 2022 to December 2023 at the outpatient department of dermatology, Sri Lakshmi Narayana institute of medical sciences, Puducherry, this split-face prospective study involved 40 melasma cases. Tranexamic acid (4 mg/ml) was intradermally injected into the right side of the face, while PRP was injected into the left side. Improvement was assessed using the modified Melasma area severity index (MASI) grading system and dermoscopy, measuring disease severity and percentage of improvement before and after therapy on both sides of the face. Results: The study comprised predominantly females (80%) aged 20 to 30 years (50%), followed by those aged 30 to 40 years (35%). Most cases (93%) exhibited a gradual onset, with centrofacial (52.5%) and malar (37.5%) patterns being predominant. Mixed pattern (67.5%) was common. Pre-treatment mean MASI scores for tranexamic acid and PRP sides were 7.54 and 6.92, respectively, with post-treatment scores of 4.6 and 2.83, respectively. Conclusions: Intradermal PRP demonstrated significantly superior efficacy over intradermal tranexamic acid in managing melasma, particularly in the longer term. Thus, PRP, coupled with good compliance, may substantially reduce the disease burden compared to conventional tranexamic acid treatment.

Supramolecular salicylic acid combined with niacinamide in chloasma: A randomized controlled trial.

No trial of supramolecular salicylic acid (SSA) for chloasma is available yet. The purpose of this study was to assess the efficacy and safety of Bole DA 30% supramolecular salicylic acid (SSA) combined with 10% niacinamide in treating chloasma. This multicenter (n=15), randomized, double-blind, parallel placebo-controlled trial randomized the subjects (1:1) to Bole DA 30% SSA or placebo. The primary endpoint was the effective rate after 16 weeks using the modified melasma area severity index (mMASI) [(pretreatment-posttreatment)/pretreatment×100%]. This study randomized 300 subjects (150/group in the full analysis set, 144 and 147 in the per-protocol set). The total mMASI score, overall Griffiths 10 score, left Griffiths 10 score, and right Griffiths 10 score were significantly lower in the Bole DA 30% SSA group than in the placebo group (all P<0.001). One study drug-related AE and one study drug-unrelated adverse events (AE) were reported in the Bole DA 30% SSA group. No AE was reported in the placebo group. Bole DA 30% SSA combined with 10% niacinamide is effective and safe for treating chloasma. ChiCTR2200065346.

Targeting the dermis for melasma maintenance treatment

Melasma relapse is almost common after discontinuation of conventional treatment. Recent studies suggesting that photoaging dermis is the main pathomechanism of melasma, emphasize the dermal targeting therapy. We investigated maintenance effect of microneedling radiofrequency (RF) for melasma treatment. Subjects with melasma were administered oral tranexamic acid and triple combination cream for 2 months and a randomly assigned half face was treated with RF. After discontinuation of conventional therapy, the half face RF continued monthly over 6 months. Modified melasma area severity index (mMASI) score and L* value by a chromameter were collected monthly. Fifteen subjects were enrolled and eleven completed the 8-month study. At 2nd month of conventional therapy, all subjects showed improvement with a 64% reduction in mMASI score. With continuous RF treatment, the improvement was well maintained; whereas in untreated side, the Δ L* gradually decreased, returning to the baseline after the conventional therapy ended. The continuous microneedling RF therapy is beneficial in maintaining the conventional therapy of melasma suggesting the protective effect of dermal targeting therapy in melasma development.(Clinical Trial registration number: NCT05710068, date of first registration: 02/02/2023).

Efficacy and safety of a novel triple combination cream compared to Kligman's trio for melasma: A 24-week double-blind prospective randomized controlled trial.

Kligman's trio (KT), combining hydroquinone, retinoic acid and corticosteroid, is considered as the gold standard treatment of melasma. Its efficacy has never been matched before, but it is tempered by frequent adverse effects. To assess the efficacy and tolerance of a New Trio (NT) combination with isobutylamido-thiazolyl-resorcinol, retinoic acid and cortosteroid compared to KT. We conducted a 24-week monocentric trial, randomized, double-blind, controlled versus KT, with 40 melasma patients. NT and KT were applied for 12 weeks and associated with the same sunscreen applied for 24 weeks. The primary endpoint was the modified Melasma Area Severity Index (mMASI) at 12 weeks. Patient quality of life was investigated using MelasQoL. After 12 weeks, KT and NT groups both demonstrated a significant improvement in mMASI, respectively -2.84 (SE 0.69, p < 0.0002) and -4.33 (SE 0.71, p < 0.0001). The mean difference between the two groups was -1.49 (IC 95% -3.52 to 0.54, p = 0.14). MelasQoL improvement was -6.66 (SE 3.29, p = 0.0515) with KT and -12.57 (SE 3.29, p = 0.0006) with NT. The NT combination appears to be an effective treatment option for treating melasma and could be considered as a well-tolerated alternative to KT.

The Efficacy and Safety of a Low-Fluence 1064 nm Picosecond ND-YAG Laser Compared with Those of a Low-Fluence Photoacoustic Therapy Pulsed (PTP) Mode 1064 nm Q-Switched ND-YAG Laser for Treatment of Melasma: A Prospective Split-Face Study

Melasma is a challenging pigmentation disorder to treat, and although low-fluence 1064 nm picosecond ND-YAG lasers have shown potential for treating benign pigmented disorders, data on the use of this laser for melasma treatment are currently insufficient. In this prospective split-face study, twenty-four patients with melasma on the face were enrolled and randomly assigned to receive treatment on one side of the face either with a low-fluence 1064 nm picosecond ND-YAG laser or with a low-fluence PTP mode 1064 nm Q-switched ND-YAG laser. Laser treatment was performed 5 times at intervals of 2 weeks, with evaluation conducted before each treatment and 2 months after the completion of 5 treatments. Clinical pictures using a standardized, digital photographic system and dermoscopy were taken on each day of the visit. The modified melasma area severity index (mMASI), melanin index (MI), dermoscopic scores of the pigmentary and vascular elements in melasma, pain during laser treatment, and patient satisfaction score were recorded. Twenty-one participants completed the study, and from week 2 in both groups, a significant decrease in mMASI and MI were confirmed. Although no statistically significant difference was observed, the decrease in mMASI and MI were greater in the 1064 nm picosecond ND-YAG laser group than in the 1064 nm Q-switched ND-YAG laser group. The 1064 nm picosecond ND-YAG laser group showed significant improvement in the pseudoreticular network and globular pattern of dermoscopic features between week 0 and week 16, while significant improvement in the globular pattern was shown in the 1064 nm Q-switched ND-YAG laser group. No significant difference was observed between the two groups in terms of the patient satisfaction score and pain during laser treatments. Notably, no adverse events were observed in either group. In conclusion, our study demonstrated that a low-fluence 1064 nm picosecond ND-YAG laser is as effective and safe in the treatment of melasma as a low-fluence PTP mode 1064 nm Q-switched ND-YAG laser.

Intradermal injection of tranexamic acid versus platelet-rich plasma in the treatment of melasma: a split-face comparative study

Millions of people throughout the world suffer from the acquired condition of hyperpigmentation known as melasma. Melasma is characterized by symmetrically oriented hyperpigmented macules and patches. Many treatment options are available with variable degrees of efficacy and tolerability. The aim of the work was to evaluate and compare the effectiveness and safety of intradermal tranexamic acid (TXA) versus intradermal platelet-rich plasma (PRP) in the treatment of various types of melasma. The current split-face prospective study included 40 cases with melasma. Tranexamic acid (TXA) was injected intradermally into the right side of the face by using a concentration of 4 mg/ml, while platelet-rich plasma (PRP) was injected intradermally into the left side. In both sides, a total of three sessions of treatment were provided, once every 4 weeks. Digital photographs were taken before each treatment session and 3 months after the last session. The modified melasma area severity index (mMASI) grading system and dermoscopy were used to assess the improvement in the condition. The disease severity and percentage of improvement were assessed by mMASI score before and after therapy across both sides of the face. along with determining the degree of satisfaction and side effects among the included cases. The mean mMASI score before therapy in the TXA side was 4.59 ± 2.87, while in the PRP side, the mean mMASI score before therapy was 4.72 ± 2.72 with no statistically significant difference between the two sides (p = 0.841). After 3 months of treatment, the mean mMASI score in the TXA-treated side was 2.49 ± 1.58 with a mean percentage of decrease of 45.67 ± 8.10%, while in the PRP side, the mean mMASI score after treatment was 2.17 ± 1.41 with a mean percentage of decrease of 53.66 ± 11.27%. There was a high statistically significant decrease in the mMASI score after treatment on both sides (p < 0.001); however, the percentage of score reduction in the PRP side compared to the TXA side was statistically higher. Intradermal injection with PRP revealed higher efficacy in the treatment of melasma as compared to TXA injection with no significant difference regarding the associated side effects.

Efficacy and safety of topical agents in the treatment of melasma: What's evidence? A systematic review and meta-analysis.

Various topical agents have been used to treat melasma; however, a large-scale evaluation among the currently available treatment is lacking. The aim of this study was to evaluate the efficacy and safety of topical agents for melasma. The MEDLINE, Embase, Web of Science, Cochrane, and Alt-Healthwatch databases were searched in November 2021. Original studies that reported pre- and post-treatment Melasma Area Severity Index (MASI)/modified Melasma Area Severity Index (mMASI) scores and/or adverse effects (AEs) were eligible for inclusion. The main outcome was the efficacy analyzed by the changes in the pre- and post-treatment with standardized mean difference (SMD) of MASI/mMASI scores; the AEs were calculated with incidence proportion by the reported percentage of skin irritations. A total of 45 studies (2359 patients) and 55 studies (4539 patients) met the inclusion criteria for efficacy and AEs, respectively. Hydroquinone (HQ) monotherapy (SMD -1.3, 95% CI [-1.6 to -1.0]), HQ-containing combination therapy (-1.4, [-1.7 to -1.1]), cysteamine (-1.6, [-2.0 to -1.2]), tranexamic acid (-1.5, [-2.0 to -1.1]), azelaic acid (-1.3, [-1.7 to -1.0]), and kojic acid (-0.9, [-1.3 to -0.5]) demonstrated comparable efficacy, while zinc sulfate did not exhibit statistically significant improvement (-1.2, [-2.7 to 0.4]). HQ-containing combination therapy (50.9%) and cysteamine (42.2%) demonstrated the highest incidence of irritation, while azelaic acid (18.7%), kojic acid (5.3%), and tranexamic acid (0.8%) revealed a lower risk. In this meta-analysis, non-HQ agents except zinc sulfate may be considered as an alternative to HQ-containing agents. However, treatment should be guided by patient's tolerance, availability, and physicians' experience.

Treatment of melasma by a combination of intense pulsed light with advanced optimal pulse technology and human-like collagen repair dressing: A case series study.

To observe the efficacy and safety of a combination of intense pulsed light (IPL) with advanced optimal pulse technology (AOPT) and human-like collagen repair dressing in the treatment of melasma.Ten patients with melasma were treated using IPL with AOPT once a month for a total of 8 times, and received the treatment of external human-like collagen repair dressing after each operation. The efficacy was evaluated with the modified Melasma Area Severity Index (mMASI) score and satisfaction score, respectively, before treatment, after each treatment and at 4 months after the end of the whole treatment course.The melasma was significantly lightened in all 10 patients after 8 times of treatments. The mMASI score before treatment was (8.6 ± 3.8) points, which decreased significantly to (5.1 ± 2.7) points after 8 times of treatments, and there was a significant difference in mMASI score between before and after 8 times of treatments (P = .001). The mMASI score was (3.3 ± 2.2) points at 4 months after the end of whole treatment course, and there was no significant difference in mMASI score between after 8 times of treatments and 4 months after the end of whole treatment course (P > .05). The satisfaction score was (7.2 ± 1.4) points after 8 times of treatments and (7.1 ± 1.4) points at 4 months after the end of whole treatment course, there was no significant difference in satisfaction score between after 8 times of treatments and 4 months after the end of whole treatment course (P > .05).A combination of IPL with AOPT and human-like collagen repair dressing can effectively decrease the severity of melasma, and is associated with a higher patient satisfaction score and a lower risk of relapse after discontinuation of treatment.

Evaluation of therapeutic efficacy of tranexemic acid compared to kligman formula in the management of melasma

Facial melanoses (FM) are a common presentation in Indian patients, causing cosmetic disfigurement with considerable psychological impact. Melasma is an acquired non-inflammatory hypermelanosis of multifactorial etiology with significant cosmetic deformity. Different treatment modalities have been utilized in different studies with varying outcomes. Recent clinical trials with Tranexamic acid are promising. : To compare the therapeutic efficacy of Tranexamic acid (TXA) in 2 different modalities with Modified Kligman formula in the management of melasma. : This is a prospective, randomised, open‑label study with a sample size of 45 patients of melasma fulfilling inclusion and exclusion criteria were randomly divided into 3 groups, 15 in each group. Group A: At home, daily applicatioin of modified kligman formula at night for 3 months. Group B: 12 sittings of microneedling followed by Tranexamic acid application was done weekly. Group C: 12 sittings of intralesional tranexamic acid (4mg/ml) was done weekly. Clinical images and dermoscopic images were taken at each visit including modified Melasma Area Severity Index (MASI) scoring, patient global assessment and physician global assessment to assess the clinical response. : Modified kligman formula group showed 42% improvement in MASI score by the end of 12 weeks, where as intralesional Tranexamic acid group showed 36% improvement followed by 30% improvement in microneedling with Tranexamic acid group. When statistically compared with Analysis of variance (ANNOVA) test, there was no significant difference (p=0.62) between three groups. But in individual groups there was significant difference (p&amp;#60;0.05) in MASI at 0 weeks and 12 weeks. Dermoscopic images showed perilesional hypopigmentation and telangiectasias with modified kligman formula, which was not seen with Tranexamic acid. Patient assessment score revelaed satisfaction with modified kligman formula in view of home application and pain during microneedling and microinjections which was not there in this group. : Modified kligman formula is found to be superior in the treatment of melasma, because of the synergistic activity of its components. But it has its own demerits of long term usage. Hence, Tranexamic acid which showed comparable results with kligman formula can be used either as a primary modality or as an adjuvant supportive therapy for maintanence.

Efficacy and Safety of Using Noninsulated Microneedle Radiofrequency Alone Versus in Combination with Polynucleotides for the Treatment of Melasma: A Pilot Study.

IntroductionThis split-face, double-blind, randomized controlled study investigated the efficacy and safety of using a microneedling radiofrequency (RF) device with polynucleotides (PN) versus RF alone for the treatment of melasma.MethodsThirty adult participants with melasma (Fitzpatrick skin types III–V) received three treatments with an invasive, bipolar, pulsed-type microneedling RF device on both sides of the face. The treatment sessions occurred once every 2 weeks. The hemifaces of each participant were designated for treatment and control with PN and normal saline solution (NSS), applied after treatment with RF. Measurements were made of melanin index (MI), erythema index (EI), skin roughness (by the Antera 3D system), modified melasma area severity index (mMASI) for each hemiface, and patients’ self-assessed improvement. These occurred at baseline and again following the final treatment (2 weeks and 1, 2, 3, and 6 months after). Mean values were obtained for MI, EI, skin roughness, and mMASI. A generalized estimating equation (GEE) was used to compare the obtained values for the outcome measures across all assessment points.ResultsAll patients were women (mean age, 43.2 ± 7.0 years). Mixed melasma predominated (61.5%; n = 16), and the mean duration of melasma was 8.9 ± 6.5 years. Twenty-six participants were followed up to the 6-month assessment point. Significant improvements were observed from baseline in MI, skin roughness, and mMASI scores for both the PN and control sides at 6 months, with no statistically significant differences between sides. Patients’ self-assessed improvement scores also showed a positive trend. Melasma recurrence was observed in three patients at 2, 3, and 4 months after the last treatment session (10% recurrence rate).ConclusionsThe combination of an invasive, bipolar, pulsed-type microneedling RF with PN is not superior compared with microneedling RF alone in the treatment of melasma. Microneedling RF may be considered as safe and efficacious for the improvement of skin roughness, and as an adjunctive treatment option for melasma.Clinical Trial RegistrationThis study was registered on ClinicalTrials.gov and assigned NCT number TCTR20210804002.

A comparative evaluation of the efficacy of intralesional tranexamic acid versus platelet rich plasma in the treatment of melasma.

Melasma is a benign, acquired disorder of hyperpigmentation commonly affecting the face. Though easily diagnosable, a tangible treatment for melasma still remains elusive.Our aim was to compare the therapeutic efficacy and safety of tranexamic acid (TXA) and platelet rich plasma (PRP) microinjections in treating patients with melasma. In total, 40 patients with melasma (10 males, 30 females; age range: 21-54 years) were enrolled, and randomly assigned to one of the two groups consisting of 20 patients each. Group A (3 males, 17 females) received intradermal microinjections of TXA (4mg/ml) and group B (5 males, 15 females) received intradermal microinjections of PRP, once every 4 weeks for a total of five treatment sessions. Clinical images were taken at each visit and improvement in melasma was evaluated using both melasma area severity index (MASI) and modified melasma area severity index (mMASI) scoring systems. Percentage reduction of both MASI and mMASI scores were also assessed at each visit, and the grade of melasma improvement was accordingly outlined for each patient. The study was completed by 18 patients in group A (TXA) and 15 patients in group B (PRP). In group A, both MASI and mMASI scores reduced significantly from 16.6 ± 9.227 at baseline to 10.028 ± 8.07 at end point; and 8.885 ± 5.418 at baseline to 4.639 ± 3.863 at end point, respectively (p value <0.01). Similarly in group B significant reduction in both scores were observed at the end of treatment. MASI declined from 20.42 ± 7.979 to 12.253 ± 7.37; and mMASI plummeted to 5.613 ± 3.98 from 10.673 ± 4.642 (p value <0.01). In group A, the difference in mean reduction of MASI and mMASI from baseline to end point was 6.572 ± 4.528 and 4.211 ± 2.647, respectively. In group B, the difference in mean reduction of both scores at the end of treatment reflected values of 8.167 ± 4.975(MASI) and 5.06 ± 2.977 (mMASI). No significant adverse effects were encountered in both treatment arms during the entire duration of study. Both TXA and PRP microinjections were found to be effective and safe therapeutic options for melasma, providing rapid and substantial improvement even when used as standalone therapies. Although PRP mesotherapy was found to be slightly better than intradermal TXA in our study, the results were not significant statistically.

A prospective, split-face study comparing 1,064-nm picosecond Nd:YAG laser toning with 1,064-nm Q-switched Nd:YAG laser toning in the treatment of melasma

Background Recently, a low-fluence picosecond (ps) laser is an emerging option for removing pigmented lesions. Objectives We aimed to evaluate the efficacy and safety of a 1,064-nm ps Nd:YAG laser as compared to a 1,064-nm Qs Nd:YAG laser for melasma treatment in an Asian. Methods Twenty Korean patients with facial melasma were enrolled and randomly treated with a 1,064-nm ps Nd:YAG laser on one side of the face and 1,064-nm Qs Nd:YAG on the other side at 2-week intervals for five sessions. At each visit, the modified Melasma Area Severity Index (mMASI), patient satisfaction scores, visual analogue scale (VAS) scores, and adverse events were assessed. Results Both groups showed significant clinical improvement and decreased mMASI scores compared to the baseline. No statistically significant difference was observed in the mMASI score between the two treatment techniques at any time point. The melanin index showed no statistically significant improvement in both groups, and no significant differences were observed in patient satisfaction scores and VAS scores between both modalities. Conclusions A 1,064 nm ps Nd:YAG laser is as effective and safe as a conventional 1,064 nm Qs Nd:YAG laser in the treatment of melasma in Asian skin, but no superior outcome was observed.

A Randomized Comparative Study of Intralesional Tranexemic Acid and Kligman's Regimen in Indian Patients with Melasma.

Context:Melasma is an acquired chronic disorder of hyperpigmentation. Tranexamic acid (TXA) has been shown to be effective in reducing the severity of melasma.Aims:The aim of this study is to compare the efficacy of intralesional TXA with topical Kligman’s regimen in the treatment of facial melasma and to assess their safety profile.Settings and Design:A double arm open-labeled randomized controlled trial was conducted at a tertiary care center in western India.Materials and Methods:Sixty-eight cases of facial melasma of either sex and age ≥ 18 years were randomized into two groups. Group A received intradermal injections of TXA 4 mg/mL, whereas group B received topical Kligman’s therapy. Patients were evaluated at baseline, 4th, 8th, and 12th week semi-objectively using modified melasma area severity index (mMASI) score, physician’s global assessment scale, and patient’s global assessment scale.Statistical Analysis:Data were analyzed using SPSS v16 software. Mann–Whitney U-test, Friedman’s analysis of variance test, and Pearson’s χ2 test were used. P-value less than 0.05 was considered as statistically significant.Results:Fifty-nine patients completed the study. The decrease in mean mMASI score was statistically significant at 4th, 8th, and 12th week for both groups. On intergroup comparison, a statistically significant difference was observed between both the groups at 12th week (P < 0.01), with group B showing better response to therapy but no difference at baseline and at 4th and 8th week. Group A showed no significant side effects, whereas group B showed erythema, burning, and hypopigmentation in nine, six, and three patients, respectively.Conclusion:Kligman’s regimen remains the gold standard for melasma but with multiple serious adverse effects. Intralesional TXA is a safe and promising modality in the treatment of melasma. It can be used in non-responding cases and in those who develop side effects of Kligman’s regimen.

A Prospective, Interventional Study of Oral Tranexamic Acid With Antioxidants and Local Glycolic Acid for The Treatment of Resistant Melasma

Background: Melasma is a common acquired hyperpigmentation of sun-exposed areas. It is highly treatment resistant and with high chances of recurrence. Treatment of melasma using oral tranexamic acid (TA) with antioxidants and glycolic acid is a novel concept. Objective: Aim of the study was to assess efficacy and safety of novel combination therapy for the treatment of resistant melasma. Method: It was a prospective interventional trial conducted on a total of 10 patients with melasma, who did not respond to topical skin lightening therapy. The severity and extent of pigmentation was assessed by modified melasma area severity index (mMASI). Patients were then prescribed oral TA with high dose of vitamin C, Iron &amp; folic acid along with local glycolic acid. The response to treatment was assessed by mMASI and clinical photographs at 8th week and after 3 months on completion. Result: Significant difference between mMASI was observed among the study population. 60% patients showed 100% improvement and 40% showed 75% improvement from the baseline mMASI at 8 weeks after commencing treatment and 100% patients showed 100% improvement on 3 months completion. Conclusion: Based on the study results, oral TA in combination with antioxidants and glycolic acid can be used as a potential new, effective, and safe treatment for resistant melasma

Efficacy and safety of 0.15% isobutylamido thiazolyl resorcinol combined with hyaluronic acid vs 0.15% isobutylamido thiazolyl resorcinol or hyaluronic acid alone in melasma treatment: A randomized evaluator-blind trial.

Melasma has a complex pathogenesis, and various aggravating factors contribute to its recalcitrance to treatments. A combination of isobutylamido thiazolyl resorcinol (ITR) and hyaluronic acid (HA) could increase melasma treatment efficacy. To compare the efficacy and safety of 0.15% ITR plus HA vs 0.15% ITR or HA alone in melasma treatment. Ninety-two patients received ITR 0.15% plus HA (n=30), 0.15% ITR (n=31), or HA (n=31) along with broad-spectrum sunscreen application for 12weeks. Treatment efficacy was determined using modified Melasma Area Severity Index (mMASI), average melanin and melanin variation with Antera3D® , and safety based on transepidermal water loss. Compared with the HA group, the ITR+HA group showed significantly reduced mMASI at weeks 4, 8, and 12 (p=0.026, 0.015, and 0.001, respectively), whereas the ITR group showed a significant reduction at week 12 (p=0.027). There was no significant difference in the mMASI or average melanin level between the ITR+HA and ITR groups. Melanin variation was significantly lower in the ITR+HA group than in the ITR group at weeks 4, 8, and 12 (p=0.027, 0.019, and 0.023, respectively). The combination of 0.15% ITR and 0.15% ITR+HA effectively reduced melasma severity. HA could synergistically improve melasma homogeneity.

Fractional 1064 nm Picosecond Laser in Treatment of Melasma and Skin Rejuvenation in Asians, A Prospective Study.

Facial melasma is a disfiguring pigmentation and occurs frequently with aging skin. Topical treatment alone was often suboptimal. A recent study showed that fractional picosecond laser has promising result in benign pigmentary lesions. This study aims to investigate the efficacy and safety of 1064 nm picosecond laser in treatment of facial melasma and skin rejuvenation in Asian skin. Patients of Asian descent seeking treatment for facial melasma and skin rejuvenation were screened and recruited. Each patient received up to nine laser treatments at 4-6 weeks intervals with a fractionated nonablative 1064 nm picosecond laser. Baseline and posttreatment modified Melasma Area Severity Index (mMASI) and Global Aesthetic Improvement Scale (IGAS) were assessed by blinded investigators based on the clinical photographs. Subject overall satisfaction was assessed by the questionnaires after treatment. All adverse events were documented. Twenty patients were recruited with a median age of 52.7 ± 8.2 years. Three subjects had Fitzpatrick skin type III and 17 had skin type IV. All subjects received nine laser sessions. Over 70% of patients were satisfied with the treatment outcomes. There was a statistically significant improvement in mMASI which reduced from 10.8 at baseline to 2.7 and 3.6 at 6 and 12 weeks post-treatment, respectively (both P < 0.01). For skin rejuvenation, 70% reported at least a moderate improvement at 6 weeks of post-treatment. No major side-effect was reported. Erythema was the most frequent transient response, while some reported edema (1.1%). Both resolved spontaneously. None reported hypo- or hyperpigmentation after treatment. The overall mean pain scare (VAS) was 1.92. Fractionated non-ablative 1064 nm picosecond laser was effective in treatment of melasma and skin rejuvenation. It was also safe and well tolerated. Importantly, there was no hypo or hyperpigmentation reported. Lasers Surg. Med. 00:00-00, 2021. © 2021 Wiley Periodicals LLC.

Comparison of the Effectiveness 3% Tranexamic Acid Cream Versus 4% Hydroquinone Cream for Treatment of Epidermal Type Melasma

Background: Melasma is an acquired hypermelanosis in areas that are exposed to sun. especially in face. Severity of melasma is measured using modified Melasma Area Severity Index (mMASI) and Melanin Index (MI). Hydroquinone (HQ) is an effective drug and also a gold standard in terms of melasma treatment. However. thedrawback of hydroquinone is the treatment duration which is quite long. the occurence of side effects. and also recurrence potential. Several recent studies shows that one of the anti-pigmentation agent options. the tranexamic acid (TA). is able to prevent melanocyte activation. The results of various studies found that the use of TA showed a significant improvement in MASI scores.&#x0D; Objective: To compare the effectivity of 3% TA cream with 4% HQ cream as an alternative therapy in epidermal type melasma treatment.&#x0D; Methods: A double-blind. matched. randomized clinical trial was conducted during July 2019 until August 2019 at Dr. Mohammad Hoesin General Hospital Palembang. Subjects were divided into two groups. The first group. consists of 30 participants. get 3% TA cream; and the second group. consists of 30 participants. get 4% HQ cream. Subjects who fulfilled the inclusion criteria was included through a simple randomization. Study subjects wer given random cream pot (with label A or B on it) according to the result of simple randomization. Finally. every subjects’ melasma severity was measured using mMASI and mexameter ® .&#x0D; Results: There were differences in terms of baseline. 4 th weeks and 8 th weeks after treatment mMASI scores in 3% TA and 4% HQ group. At 8 th week. the mMASI score the 3% TA group was lower than 4% HQ group. There was no differences in baseline. 4 th weeks and 8 th after treatment MI between the two groups. Melanin index for 3% TA group was lower than 4% HQ group.&#x0D; Conclusion: Three-percent TA cream and 4% HQ cream is effective in decreasing mMASI score and MI in epidermal type melasma. There were differences in terms of the mMASI score during the 8th week after treatment between 3% TA and 4% HQ group.

Comparison of the Effectiveness 3% Tranexamic Acid Cream Versus 4% Hydroquinone Cream for Treatment of Epidermal Type Melasma

A B S T R A C TBackground: Melasma is an acquired hypermelanosis in areas that are exposed tosun. especially in face. Severity of melasma is measured using modified MelasmaArea Severity Index (mMASI) and Melanin Index (MI). Hydroquinone (HQ) is aneffective drug and also a gold standard in terms of melasma treatment. However. thedrawback of hydroquinone is the treatment duration which is quite long. theoccurence of side effects. and also recurrence potential. Several recent studies showsthat one of the anti-pigmentation agent options. the tranexamic acid (TA). is able toprevent melanocyte activation. The results of various studies found that the use ofTA showed a significant improvement in MASI scores. Objective: To compare theeffectivity of 3% TA cream with 4% HQ cream as an alternative therapy in epidermaltype melasma treatment. Methods: A double-blind. matched. randomized clinicaltrial was conducted during July 2019 until August 2019 at Dr. Mohammad HoesinGeneral Hospital Palembang. Subjects were divided into two groups. The first group.consists of 30 participants. get 3% TA cream; and the second group. consists of 30participants. get 4% HQ cream. Subjects who fulfilled the inclusion criteria wasincluded through a simple randomization. Study subjects wer given random creampot (with label A or B on it) according to the result of simple randomization. Finally.every subjects’ melasma severity was measured using mMASI and mexameter ® .Results: There were differences in terms of baseline. 4 th weeks and 8 th weeks aftertreatment mMASI scores in 3% TA and 4% HQ group. At 8 th week. the mMASI scorethe 3% TA group was lower than 4% HQ group. There was no differences in baseline.4 th weeks and 8 th after treatment MI between the two groups. Melanin index for 3%TA group was lower than 4% HQ group. Conclusion: Three-percent TA cream and4% HQ cream is effective in decreasing mMASI score and MI in epidermal typemelasma. There were differences in terms of the mMASI score during the 8th weekafter treatment between 3% TA and 4% HQ group.

A split face randomized controlled trial comparing 1,064nm Q-switched Nd-YAG laser and modified Kligman's formulation in patients with melasma in darker skin.

No randomized studies compared the efficacy and safety of modified Kligman's triple combination (TC) with 1,064nm Q-switched Nd-YAG laser (QSNYL) in melasma in darker skin. To compare the efficacy and safety of QSNYL and TC in the treatment of melasma in Fitzpatrick skin types IV and V. In this split face randomized controlled trial, participants' cheeks were randomized to receive either weekly QSNYL (group A) or daily TC (group B) for 12weeks, followed by 12weeks of follow-up. Twenty-eight patients completed the intervention, and 21 of them completed follow-up. We found a significant but modest reduction in mean melanin index, modified Melasma Area Severity Index (MASI), and photographic and patient's assessment in both modalities (P<0.01). No significant differences were detected between the groups. All patients had reappearance of pigmentation by the end of follow-up. Adverse reactions were significantly more in group B (P<0.001). The desired sample size could not be achieved. No statistically significant differences were observed between QSNYL and TC as monotherapy in melasma. Reappearance of melasma is inevitable after stopping treatment.