A pilot study of oral tranexamic acid and Glycyrrhizin compound in the treatment of recalcitrant Riehl’s melanosis

Abstract

Summary Background Up till now, there is no standardized and satisfactory treatment strategy for Riehl’s melanosis. Objective In this pilot study, we evaluated the efficacy and safety of a novel combination therapy with oral administration of tranexamic acid (TA) and Glycyrrhizin compound for recalcitrant Riehl’s melanosis. Methods Ten patients with Riehl’s melanosis were recruited in this study. After elimination of potential contraindication, all patients were treated with 500 mg TA together with 150 mg Glycyrrhizin compound per day orally for 3 months, followed by 500 mg TA per day orally alone for another 3 months. Lesions were imaged by reflectance confocal microscopy (RCM), dermatoscopy, and VISIA® Complexion Analysis System monthly. Mexameter was adopted to evaluate Melanin Index (MI) and Erythema Index (EI). Clinical outcome scores were given by both physicians and patients. Results Seven out of ten patients received “marked improvement”, while two received “moderate improvement” and one “minimal improvement” at the final visit. Both mean MI and EI were significantly decreased compared with baselines. Furthermore, RCM and dermatoscopy analyses confirmed the improvement of pigmentation and erythema with decreased pigment granules and telangiectatic vessels. Conclusion Oral administration of TA in combination with Glycyrrhizin compound may be an effective therapy for Asian patients with recalcitrant Riehl’s melanosis.

Dynamic evaluation of an in vivo postinflammatory hyperpigmentation model using reflectance confocal microscopy and spectrophotometry

“…Instead, notable inflammatory infiltration and angiogenesis were identified. These results indicated vascular structures and inflammatory infiltrations could largely affect skin tones, coherent with recent clinical evidence that anti‐inflammatory and anti‐angiogenesis therapies could improve skin tones in patients with melasma 15 and melanosis 16 . It was worth noting that new microvessels were more evident on live images rather than captured ones, as the erythrocyte showing apparent movement could only be reflected by video.…”

Acquired Dermal Macular Hyperpigmentation

“…Recent studies have demonstrated good efficacy on treatment of Riehl's melanosis with low-pulse energy 1064-nm Q-switched Nd-YAG laser; combination of low-fluence Q-switched 1064 nm Nd-YAG laser, hydroquinone cream and oral tranexamic acid; and Q-switched 1064 nm Nd-YAG laser-operated as a dualpulse at half-fluence and 140-μs intervals in Asian skin [ Table 3 ]. [ 41 42 43 44 45 46 ] However, in our experience, the improvement offered by Q-switched ND-YAG laser is modest and short lasting.…”

Clinical Evaluation of Sequential Transdermal Delivery of Vitamin B6, Compound Glycyrrhizin, Metronidazole, and Hyaluronic Acid Using Needle-Free Liquid Jet in Facial Seborrheic Dermatitis

“…Both the glycyrrhizin compound and metronidazole have an anti-inflammatory effect. Due to the similar pharmacological efficacy to corticosteroids but with milder adverse effects (24), compound glycyrrhizin has been widely utilized in several dermatologic disorders for many years (6,8). Metronidazole is an antiprotozoal and imidazole-derived antibacterial agent; it also has immunomodulatory effects on leukocyte chemotaxis and suppresses cell-mediated immunity (25), which makes metronidazole an effective therapy option for FSD.…”