Treatment Of Melasma Research Articles

The Efficacy of Topical Cosmetic Containing Alpha‐Arbutin 5% and Kojic Acid 2% Compared With Triple Combination Cream for the Treatment of Melasma: A Split‐Face, Evaluator‐Blinded Randomized Pilot Study

ABSTRACTBackgroundWhile the gold standard treatment for melasma is triple combination cream (TCC), arbutin and kojic acid demonstrate their benefits and may be used as an alternative.AimsTo investigate the efficacy of cream containing alpha‐arbutin 5% and kojic acid 2% (AAK) compared with TCC for melasma treatment.Patients/MethodsA split‐faced, randomized study was conducted among 30 participants with melasma, and all were randomized to receive AAK or TCC on each side of their face for 12‐week along with 4‐week follow‐up period. The melanin index (MI), modified Melasma Area Severity Index (mMASI), and physician global assessment (PGA) scores were used to measure the effectiveness of interventions. Recurrence of melasma after treatment discontinuation was evaluated by MI and mMASI. Patient satisfactions and adverse effects were also evaluated. In the analysis, the mean difference (MD) was used for MI and mMASI, while Wilcoxon signed‐rank test was for the PGA scores, adverse effects, and patient satisfaction.ResultsThe MD of MI and mMASI scores were not different between groups (mMASI [p = 0.344] and MI [p = 0.268]). The PGA scores only showed improvement on the TCC‐treated side (p = 0.032). Compared to the AKK group, the subjects with TCC showed higher severity of recurrence (MI [p = 0.004] and mMASI [p = 0.045]). No difference in patient satisfaction score between the groups, but erythema and stinging were higher in the TCC group.ConclusionsThe AAK cream appeared to be effective for melasma treatment, highlighting a lower recurrent rate and fewer adverse events than standard therapy.Trial Registration: thaiclinicaltrials.org: TCTR20230124004

Comparative evaluation of intralesional platelet rich plasma versus tranexamic acid (50mg/ml) in the treatment of facial melasma

: Melasma is a recalcitrant hyperpigmentary condition. The pathogenesis of melasma is complex and not fully understood. Although many treatment modalities have been tried for melasma but no modality is considered as gold standard.: This study aimed to compare efficacy of intralesional platelet rich plasma with tranexamic acid (50mg/ml) in the treatment of facial melasma.: Total 64 patients were enrolled in the current study from July 2023 to March 2024. In group A, 31 patients were treated with intralesional PRP and in group B, 33 patients were treated with intralesional TXA (50mg/ml). Intralesional injections were given every 4 weekly till lesions resolve or a maximum of 6 sessions followed by monthly follow up for 3 months. Grade of clinical improvement was measured by percentage reduction in mMASI score at baseline, at every session and at follow up. Patient satisfaction score was assessed using a five-point Likert scale at the end of the study.: In the PRP group, 64.52% patients showed moderate to good response whereas in the TXA group, 72.72% patients showed good to very good response. Only 41.94% patients were satisfied in group A while 81.81% patients were satisfied with their recovery after treatment in group B.: TXA was effective in all types of melasma. PRP was significantly effective only in female patients whereas TXA was significantly effecacious in both male and female patients. We suggest monthly therapy with intralesional TXA at a higher dosage of 50 mg/ml as an efficient and time-saving treatment modality over intralesional PRP.

Combined micro-needling with topical metformin versus micro-needling with topical placebo in the treatment of melasma: a concurrent split-face study.

Melasma is an acquired dysfunction of melanogenesis, that poses a major therapeutic challenge and tends to recur after therapy. Several combination therapies are being tested nowadays for the treatment of melasma, with promising results. Metformin, an anti-diabetic medication, seems to inhibit melanogenesis by different mechanisms. In addition, there has been a long-term improvement in melasma after microneedle therapy. To evaluate the potential therapeutic role of topical metformin combined with micro-needling for the treatment of melasma. Eighteen patients with melasma received treatment in split-face manner, right side with micro-needling and topical metformin, while the left side was treated with micro-needling and topical placebo for four sessions at 2-week intervals. Hemi-mMASI score was used for the final evaluation of results. ThevariabilitypatterninHemi-mMASI score between both sides revealed significant reduction in the right side (micro-needling + metformin), as compared to the left side (micro-needling + placebo) (2.39 ± 1.42 vs 4.72 ± 1.27, p = 0.001). The effectiveness of topical metformin in the management of melasma could be significantly improved by pretreatment with micro-needling as a combined therapy, without any apparent side effects.

Melasma Management: A Comprehensive Review of Treatment Strategies Including BTX-A.

Botulinum toxin A (BTX-A) is a widely utilized protein derived from the bacterium Clostridium botulinum, known for its effectiveness in treating various medical conditions involving muscle spasticity, involuntary muscle movements, and pain disorders. Beyond its therapeutic applications, BTX-A is also commonly used in cosmetic procedures to address dynamic wrinkles, hyperhidrosis, sebum production, pore size, and overall skin texture. While the use of neurotoxins like BTX-A for treating conditions such as UVB-induced hyperpigmentation, specifically melasma, is an emerging area of interest, it is not yet a widely recognized treatment for this dermatologic condition. This literature review serves to provide a consolidated overview of the current therapeutic implications of BTX-A treatment for melasma and explore its proposed mechanisms of action. This review aims to provide a comprehensive analysis of the current evidence base for the efficacy of BTX-A treatment on melasma. To gain a comprehensive understanding on the current theories regarding BTX-A treatment on melasma, a literature review was conducted on all the available information using PubMed. A combination of keywords was used to maximize the search results, including "botulinum toxin," "melasma," "melanogenesis," "neurotoxin," "cholinergic system," "BTX-A," and "UV-induced melasma." The search was not restricted by date, allowing for the inclusion of articles offering historical context and those providing the most recent findings. Ninety-eight articles were reviewed to provide a consolidated update on the effectiveness of botulinum toxin A in reducing the appearance of melasma and potential mechanisms of action involved in doing so. Melasma is a challenging dermatologic condition due to its chronicity and various intrinsic and extrinsic factors that influence its pathogenesis. While current treatment options for melasma include topical, oral, and light-based therapies, recent studies suggest that BTX-A may hold potential as a viable treatment modality for melasma. Despite the mechanism of action remaining unclear, it is hypothesized that BTX-A inhibition of Ach receptors on melanocytes could play a role in the reduction of melanogenesis. BTX-A treatment in melasma-affected skin demonstrates statistically significant reduction in hyperpigmented lesions associated with melasma.

Efficacy of topical Raphanus sativus seed powder mixed with honey versus hydroquinone 4% cream in the treatment of melasma - A randomized controlled trial

Efficacy of topical Raphanus sativus seed powder mixed with honey versus hydroquinone 4% cream in the treatment of melasma - A randomized controlled trial

532 nm Sub Pulsed Laser for Treating Melasma in Latin American Patients, Series of Cases

<i>Objective</i>: To analyze a series of cases treated with a 532 nm Sub Pulsed laser treatment for Melasma in Latin American Patients with Fitzpatrick type IV. <i>Background</i>: Melasma is a common, acquired, symmetrical hypermelanosis that presents as light to dark brown macules on the face usually over the forehead and malar areas that negatively impact patient’s quality of life. Many laser treatments have been described without any consensus, however, targeting the vascular component has been gaining popularity daily but the adverse reactions such as transient post inflammatory hyperpigmentation or atrophic scars have been described for treating the superficial and deep vessels. We propose a new laser range in order to treat Melasma. <i>Methods</i>: This is an observational study with 20 patients, Fitzpatrick type IV diagnosed with facial melasma that were treated with one to two sessions of a Sub Pulsed 532 nm Laser with an interval of 11 to 30 days. Dermoscopy was performed in the patients before the laser in order to show the presence of multiple vessels and pigmentation in the patients, before and after pictures were taken with Quantificare Lifeviz to show the results after the laser without any other topical or oral treatment. This Study was reviewed and approved by the Ethics and Investigation Committee of Dermalaser KPW in Lima, Peru, adhering to the highest ethical standards and following the principles Outlined in the Helsinsky Declaration. Informed Consent was obtained from all participants, who also provided written authorization for the publication of the study results and accompanying images. <i>Results</i>: In this series of cases the Modified MASI Score describes an average of 90.9% improvement in Melasma severity after the laser sessions. The pictures taken with Quantificare Lifeviz in order to asses the vascular, pigmentary and basal pictures show significant improvement. No PIH (Post inflammatory Hyperpigmentation) or major adverse reaction were described in this study.

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

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

Glutathione as a skin-lightening agent and in melasma: asystematic review.

Hyperpigmentary disorders, including melasma, are challenging to treat. Glutathione has anti-melanogenic and antioxidant properties, which led to its use as a skin-lightening agent. Our objective was to review the published evidence and literature on the efficacy and safety of glutathione as a skin-lightening agent and in the treatment of melasma. A literature search was done in the PubMed, Embase, and Cochrane library databases using the search terms "glutathione as a skin-lightening agent" and "glutathione in melasma" for the past 10 years. The level of evidence, strength of recommendation, and risk of bias assessment were evaluated. Among various forms of topical glutathione, glutathione 0.5% was significantly more effective compared to glutathione 0.1% and placebo. For glutathione alone versus glutathione plus microneedling, more improvement was seen. Five randomized controlled trials and a single open-arm clinical study on oral glutathione at doses of 250 mg once a day, 250 mg twice a day, and 500 mg once a day showed a significant reduction in the melanin index compared to placebo. The combination of topical 2% glutathione plus oral glutathione was superior to monotherapy alone. There was only one placebo-controlled study on intravenous (IV) glutathione [6/16 (37.5%) vs. 3 (18.7%), (p0.054)]. The risk of bias assessment showed that almost an equal number of studies have low and high risk of bias. Topical versus oral glutathione both provide moderately efficacious skin-lightening outcomes that are localized versus generalized and have minimal versus substantial adverse effects, but they are unsustainable, with variable costs. IV glutathione is contraindicated due to lack of efficacy and side effects. It may work more as an antioxidant in melasma.

Latin American consensus on the treatment of melasma.

Melasma is a chronic, relapsing hyperpigmentation disorder that primarily affects photoexposed areas, occurring most frequently in adult women with darker skin phototypes. The primary factors contributing to its development include sun exposure, sex hormones (e.g., pregnancy), and genetic predisposition. Melasma is highly prevalent in Latin America, where many countries lie in intertropical zones and exhibit significant ethnic diversity because of centuries of intermixing among Native Americans, Europeans, and Sub-Saharan Africans. Nine Latin American experts formulated a DELPHI-based consensus to develop a valuable approach for treating melasma in this diverse population. After establishing an accurate diagnosis, assessing the impact on quality of life, and determining disease severity, the consensus recommends mitigating known triggers and promoting rigorous photoprotection. Active therapy should be tailored based on individual characteristics (e.g., pregnancy status, previous treatments, skin sensitivity). Treatment options include topical depigmenting agents, systemic therapies, and procedural interventions such as laser therapy, microneedling, and chemical peels. Periodic reassessment of the treatment is essential, with strategies adjusted if targeted outcomes are not achieved. Once clinical remission is attained, patients should continue using topical depigmenting agents and maintain strict photoprotection measures to prevent recurrence.

Efficacy of Microneedle as an Assisted Therapy for Melasma: A Meta-analysis and Systematic Review of Randomized Controlled Trials.

Melasma is a common hyperpigmentary disorder, it has variety of treatment options, but it usually has a poor curative effect and high recurrence rate. Microneedles have shown certain prospects in the treatment of melasma as an assisted therapy, but there is no consensus on its efficacy and safety. To evaluate the efficacy and safety of microneedles as an adjuvant treatment for melasma. Statistical tools were used to adjust the improvement of MASI scores in all studies to obtain standardized mean differences (SMD), and then, meta-analysis were performed. Risk ratio (RR) was utilized to assess adverse reactions, clinical effectiveness, and patient satisfaction. The effects of microneedle-assisted treatment for melasma begin to manifest at the 4th week, with optimal results observed at the 24th week, and with a high patient satisfaction. Compared with oral medication alone, microneedle-assisted therapy began to be more effective at week 12 and continued by 24weeks. Compared with laser therapy alone, microneedle-assisted therapy also showed stronger efficacy, at the 8th week, microneedle-assisted treatment was significantly more effective, reaching its peak at the 12th week. Finally, in the comparison of microneedle and microinjection therapy, microneedle has always been more significant than micro-injection. Microneedle is a valuable adjunctive therapy for melasma treatment. It enhances long-term clinical outcomes compared to monotherapy and is associated with high patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Melasma Revisited: National Survey Reveals How Dermatologists Diagnose and Treat This Complex Skin Condition.

Melasma is a chronic condition characterized by dark patches on the facial skin. It has a known female gender dominancy, and women usually think of melasma as being a serious cosmetic problem. Treatment of melasma can be seriously challenging, thus, dermatologists may employ different approaches for melasma. This study aimed to investigate how dermatologists diagnose and treat patients with melasma and to present the general characteristics of patients with melasma. A survey was conducted using Google Forms targeting dermatologists in Turkiye. A total of 199 dermatologists (142 females/57 males) participated in the study. Most of the participants (52.3%) were residents. Majority gender of the patients was female and most common age range of patients with melasma was 30-40 years. Mixed melasma was the most common type (57.4%). Malar region was the most frequent location (58.6%). Wood's lamp examination was used by 25.6% of the participants. Topical treatment was the first-line choice for melasma therapy (95%), with Kligman's formula being the most used topical agent (69.8%). Oral therapy was not used by 70.8% of the participants. Tranexamic acid was the first choice for oral treatment (23.4%). Only 24.9% of the dermatologists used laser/light therapy, and Q-switched Nd-YAG laser was the most preferred device (58%). The most common recurrence rate was 41%-60% (45.9%). The findings of the current study investigating the melasma management in Turkiye revealed a female predominance and peak prevalence in the 30-40 years age group. Kligman's formula is the preferred topical treatment, whereas oral tranexamic acid remains underutilized. Recurrence rates are high, highlighting the need for preventative strategies. This study emphasizes the importance of personalized approaches and ongoing research for effective melasma management.

Combined Efficacy of Q-Switched 785 nm Laser and Tranexamic Acid Cream in the Treatment of Melasma: A Prospective Clinical Study

Background and Objectives: Melasma, a hypermelanotic dermatologic condition that mainly affects women, poses challenges due to its complex etiology involving environmental and genetic factors. Its pathophysiology, marked by intricate histological changes, is not fully understood. This study explored the efficacy and safety of a new 785 nm picosecond laser in treating facial melasma. Materials and Methods: An 11-participant cohort, comprising women with Fitzpatrick phototypes II-III, underwent a treatment protocol with a new 785 nm picosecond laser. The clinical evaluation used the Global Aesthetic International Score (GAIS) and the Five-Point Likert Scale Questionnaire. The aim of the study was to understand the capacity of the 785 nm wavelength laser to interact with both the pigmentary and vascular components of melasma. Results: The GAIS outcomes revealed excellent (18.2%), good (54.5%), poor (18.2%), and no results (9.1%). The Likert Scale responses varied from very satisfied (18.2%) to slightly satisfied (9.1%). Clinical images at three months demonstrated resolution of melasma with no adverse events. Conclusions: This non-invasive procedure showed positive outcomes and high patient tolerance, emphasizing its potential in melasma management. However, in order to fully understand the interactions of pigmentary and vascular components with the 785 nm wavelength laser, further research is required. The small cohort represents a limitation for this study, therefore studies that include a larger number of patients are needed to assess the effectiveness of this laser treatment for facial melasma.

Evaluation the efficacy of microneedling with topical metformin solution compared with microneedling with topical vitamin C solution in treatment of melasma.

Several treatment modalities have been used for the treatment of melasma. Topical metformin is an anti-diabetic drug, which has melanopenic action. Vitamin C acts on melanin by inhibiting the tyrosinase enzyme, thus inhibiting melanogenesis. To compare the efficacy and safety of microneedling combined with topical metformin solution versus microneedling combined with topical vitamin C in the treatment of melasma. A spitted-face interventional comparative on 30 female patients suffering from melasma. The right side of the face was treated with microneedling and topical metformin, while the left side was treated with microneedling and topical vitamin C solution. Hemi-MASI score decreased significantly after treatment from before treatment in both groups P-value < 0.001. The percentage of improvement of Hemi-MASI score metformin group was 48.29%, While with vitamin C group was 37.19%. There was a significant improvement in dermoscopic findings in microneedling with topical metformin than with topical vitamin C group. Microneedling with topical metformin or topical vitamin C solution can be an effective and safe therapeutic option for treating melasma with no significant side effects.

Potential molecular mechanisms of Danggui-Shaoyao-San in the treatment of melasma based on network pharmacology with molecular docking

Although Danggui-Shaoyao-San (DSS) is frequently used in China to treat melasma, its underlying mechanism still needs to be better understood. Our aim is to determine the mechanism behind DSS in treating melasma through network pharmacology (NP). The DSS active compounds alongside corresponding target genes are identified by accessing the TCMSP database and SwissTargetPrediction. Melasma-associated targets are retrieved from the GeneCards, DisGeNet, Durgbanks, OMIM, and TTD databases. Next, we build a component-target association network via Cytoscape software while generating a protein-protein interaction network utilizing the STRING database. Subsequently, both core target genes and active compounds are determined. Through the DAVID database and Bioinformatics tools, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses are conducted. Lastly, the CB-Dock2 server is deployed to conduct molecular docking (MOD). The results manifest that alisol B, cerevisterol, and Wallichilide, among others, are active compounds in DSS, while PTGS2, ESR1, and ESR2 are core target genes. Both GO and KEGG analyses showcase that the potential core drug components modulate pathways in cancer, chemical carcinogenesis-receptor activation, calcium, relaxin, and estrogen signaling by exerting their effects on biological processes. These processes include negative gene expression regulation as well as positive regulation of both cytosolic calcium ion concentration and transcription from the RNA polymerase II promoter, thereby playing an anti-melasma pharmacological role. The MOD displays that core target genes have good binding activity with the active compounds. To conclude, NP demonstrates that DSS can serve as an innovative medication for treating melasma.

Melasma removal using Q-Switched Neodymium-doped Yttrium Aluminium Garnet laser toning and high-intensity focussed ultrasound.

To evaluate the effectiveness of combining high-intensity focussed ultrasound and a Q-switched neodymium-doped yttrium aluminium garnet 1064nm low-fluence toning laser in the treatment of melasma. The experimental study was conducted from November 2020 to August 2021 at the medical physics laboratory, College of Medicine, Mustansiriyah University, Baghdad, Iraq, and comprised individuals of either gender aged >25 years having mixed form melasma in malar and forehead areas. Each participant received high-intensity focussed ultrasound treatment on the right side. After 2 weeks, Q-switched neodymium-doped yttrium aluminium garnet 1064nm low-fluence toning laser was applied to the melasma patches 4 times at one-week intervals. Melasma area and severity index scores were noted at baseline and at each visit for each patient. Visual analogue scale was used for objective evaluation. After the 4 laser sessions, all the patients completed a 3-month follow-up. Data was analysed using SPSS 24. Of the 25 subjects, 15(60%) were females and 10(40%) were males. The overall mean age was 41.6±8.46 years (range: 22-60 years). There was a significant improvement with high-intensity focussed ultrasound (p<0.05). In the 3rd laser session, there was a significant difference in melasma area and severity index score of 2.48 for the right side and 3.12 for the left side (p<0.05). In the 4th session, there was a significant difference in melasma area and severity index score of 1.68 for the right side and 2 for the left side (p<0.05). No post-inflammatory hyperpigmentation or rebound was noted. High-intensity focussed ultrasound combined with toning laser was more effective than Q-switched neodymium-doped yttrium aluminium garnet 1064nm low-fluence laser alone in removing difficult melasma from the malar area in the 2nd, 3rd and 4th sessions, and from the forehead in the 3d and 4th sessions.

Tyrosinase Inhibition: A Potent Mechanism of Action of Plants used in Treatment of Melasma

Melasma is a common skin problem causes brown to grey-brown patches on the several parts of face such as cheeks, chin, Nose Bridge, forehead, and above the upper lip. It is characterized as increased production and accumulation of melanin, which could be unfavourable and develops serious skin diseases. Finding natural depigmenting agents is necessary because many synthetic agents now on the market have a number of unfavourable side effects. In traditional Ayurvedic medicinal plants have been used for the treatment of skin diseases such as hyperpigmentation, melasma, age spot etc. In this study herbal medicines, for the treatment of melasma were searched in references, with their scientific names and chemical constituents showing depigmentation effect of these plants or their isolated compounds, with different melanogenesis and tyrosinase inhibition mechanism. This activity reviews the herbal plant used in melasma and highlights the role of plants constitutes responsible for treatment of melasma.

Optical Coherence Tomography as a Diagnosis-Assisted Tool for Guiding the Treatment of Melasma: A Case Series Study.

Background/Objectives: Multiple underlying pathomechanisms may lead to melasma, but there has been no report on the use of optical coherence tomography (OCT) to reveal specific pathomechanisms in individual patients and provide individualized treatments accordingly. Using real-time OCT images, we studied the pathomechanisms of melasma in 12 female patients and the effects of individualized treatments. Methods: Patients were divided into good and bad improved groups according to the improvement in hyperpigmentation at month 4. Results: In the bad improved group, all melanin or confetti melanin had significantly decreased at month 2 or month 4 while granular melanin ratio at month or month 4 significantly increased, the most parameters of dendritic-sharped cells (DCs) before and after treatment were not significantly different, the collagen area or collagen density at month 4 significantly decreased. In the good improved group, there was slightly low all melanin/confetti melanin at month 4 and high granular melanin at month 4 in comparison to the bad improved group. Moreover, most of the parameters in the DCs at month 4 significantly increased while most parameters in collagen at month 4 significantly decreased. Conclusions: OCT is useful in revealing the involved pathomechanisms of melasma in individualized patients. Positive treatment results can be achieved through individualized therapy regimen targeting the pathomechanisms.

Nano-vesicular systems for melanocytes targeting and melasma treatment: In-vitro characterization, ex-vivo skin retention, and preliminary clinical appraisal

Melasma represents an acquired melanogenesis disorder resulting in skin’s hyperpigmentation effect. Although several approaches are adopted for melasma treatment, nanotechnology presents the most convenient one. Therefore, the present work aimed to formulate and characterize three nano-vesicular systems namely, liposomes, penetration enhancer containing vesicles (PEVs) and invasomes to enhance the topical delivery of the skin whitening agent; alpha arbutin (α-arbutin) for the treatment of melasma. Liposomes were prepared according to a 23 full factorial design and the selected formula was further employed for the preparation of PEVs and invasomes. Results showed that the three vesicular systems exhibited nano-sizes ranging from 151.95 to 672.5 nm, negative charges ranging from −12.50 to −28.20 mV, high entrapment efficiencies ranging from 80.59 to 99.53 %, good stability and prolonged-release of α-arbutin for 24 h after dispersion in hydrogel form. The deposition study from the vesicular hydrogel confirmed their effectiveness for the drug’s accumulation in the skin reaching an average of 1.6-fold higher in the stratum corneum, 1.6–1.8-fold higher in the epidermis, and 1.6–1.8-fold higher in the dermis compared to the free drug dispersion in hydrogel. A preliminary clinical split-face study on patients suffering from melasma revealed that α-arbutin-loaded liposomes and PEVs in hydrogel forms showed better clinical outcomes compared to the free α-arbutin hydrogel as well as to the previously published α-arbutin encapsulated in chitosan nanoparticles and dispersed in hydrogel form. This delineates the aforementioned nano-vesicular systems as effective and clinically superior delivery means for melasma management.

Energy-based methods and nanocarrier-based approaches for melasma treatment

Melasma is a chronic disease caused by excessive melanin production in the skin, affecting the quality of life, especially in women. As a kind of skin hyperpigmentation, it can be caused by sun exposure, genetics, hormones, drugs, or inflammation. Melasma treatment can be effective when the product penetrates well into the skin. As an essential skin barrier, the stratum corneum displays a significant role in topical and transdermal drug delivery. In this regard, numerous strategies have been developed to increase the skin permeability and efficiency of drugs. This review explores energy-based methods and nanocarrier-based approaches for melasma treatment, focusing on enhancing drug delivery to the viable epidermis and overcoming SC. Physical methods have some advantages like increasing the skin penetration and also some drawbacks, including frequent visits, high costs, and the need for advanced equipment and trained operators. Further, these methods are often combined with high energy and special technics. As an emerging physical-based method that could be used to treat patients with multiple medications, microneedle patch is drawing interest due to its ease of use, ability to pinpoint drug delivery, and fewer side effects. In addition, they can penetrate drug molecules into deeper layers of skin and provide more sustainable results compared to conventional methods. Nanocarrier-based systems like transferosome and ethosome (deformable liposomes) are also effective options for skin penetration and treating melasma and skin hyperpigmentation. Despite several benefits, such as high entrapment efficiency, good permeation, and increased bioavailability of drugs through the skin, their stability problems and limitations toward nanoparticle production on an industrial scale are the most significant drawbacks of this method. In the current review, we looked at the articles published between 2010 and August 2023 on energy-based methods and nanocarriers-based approaches have been used to treat melasma.

Topical Ascorbic Acid Mesotherapy with Microneedling versus Topical Tranexamic Acid Mesotherapy with Microneedling for Melasma: A Therapeutic Comparative Study

Background &amp; objectives: Melasma is a common skin hyperpigmentation syndrome that frequently includes reproductive-aged females, and numerous therapies with various consequences have been suggested. Thus, the objective was to compare the microneedling and mesotherapeutic effects of ascorbic acid versus tranexamic acid for melasma treatments. Methods: This interventional therapeutic prospective study was conducted on 40 patients with melasma at Khabat Consultation Center for Skin Diseases, Sulaimaniyah, Iraq, from March 2022 to August 2022. Sociodemographic data of patients were collected together with a family history of melasma using a well-designed questionnaire. Half of the patients were treated with ascorbic acid, while the rest were treated with tranexamic acid using a derma pen. Results: Highly significant reduction of MASI score were seen before and after treatment (p&lt;0.001) were seen in mean scores before and after treatments for both types of treatments (ascorbic acid and tranexamic acid). Moreover, ascorbic acid results in the highest mean score reduction in skin type III (p=0.746), while tranexamic acid results in the highest mean score in skin type IV (p&lt;0.05). Furthermore, the dermal melasma recorded the highest mean score, and the lowest level was observed in the epidermal melasma for both ascorbic acid and tranexamic acid groups. No significant difference was found between both studied groups in sociodemographic data and other studied variables (family history, skin type, previous treatment, and duration of melasma). Conclusions: Both types of therapy mesotherapy was effective in treating melasma; however, their potencies varied on different skin types and according to melasma types.