Update on Melasma—Part II: Treatment

Cassiano, Daniel; Espósito, Ana Cláudia Cavalcante; Silva, Carolina N. da; Lima, Paula Basso; Dias, Joana Alexandria Ferreira; Hassun, Karime Marques; Miot, Luciane Donida Bartoli; Miot, Hélio Amante; Bagatin, Ediléia

doi:10.1007/s13555-022-00780-4

Cited by 40 publications

(29 citation statements)

References 123 publications

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“…However, the same change in the HQ group in the present study indicated that sun protection probably played a critical role in post-treatment maintenance. Direct sun exposure is one of the leading risk factors for melasma, reported by 84% of patients as a factor of clinical impairment ( 2 ). Application of broad-spectrum sunscreen throughout the pregnancy was found to be effective in the prevention of the development of melasma in pregnant women (2.7% incidence in the study vs. 53% in usual conditions) ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

“…Topical hydroquinone (HQ) remains the first-line therapy for melasma. It can reduce melanogenesis by interfering with the activity of tyrosinase and alter the formation of melanosomes by inhibiting RNA and DNA synthesis ( 2 ). As a result of these properties, melanocyte metabolism is suppressed, resulting in a gradual decrease in melanin production.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, a systematic review and network meta-analysis which selected 59 randomized controlled trials (RCTs) to compare the efficacy and side effects of 14 common therapies for melasma showed that QSNYL ranked first in efficacy and was worthy of being used as a monotherapy or in combination therapy for melasma ( 4 ). The main mechanism of QSNYL is subcellular selective photothermolysis, which means that the laser energy-induced photothermal effect targets melanosomes and shatters them into tiny particles, thus facilitating the clearance of melanin particles by phagocytes ( 2 , 3 ). However, the thermal effect could cause damage and inflammation to surrounding tissues which may result in a high incidence of side effects such as post-inflammatory hyperpigmentation (PIH) and hypopigmentation ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the efficacy and safety of picosecond Nd:YAG laser (1,064 nm), picosecond alexandrite laser (755 nm) and 2% hydroquinone cream in the treatment of melasma: A randomized, controlled, assessor-blinded trial

et al. 2023

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BackgroundIncreasing numbers of studies demonstrated that picosecond lasers (Picos) were effective and safe for melasma. However, A limited number of randomized controlled trials (RCTs) regarding Picos contribute to a modest level of evidence. Topical hydroquinone (HQ) remains to be the first-line therapy.ObjectiveTo compare the efficacy and safety of non-fractional picosecond Nd:YAG laser (PSNYL), non-fractional picosecond alexandrite laser (PSAL), and 2% HQ cream in the treatment of melasma.MethodSixty melasma patients with Fitzpatrick skin types (FST) III-IV were randomly assigned to the PSNY, PSAL, and HQ groups at a 1:1:1 ratio. Patients in PSNYL and PSAL groups received 3 laser sessions at 4-week intervals. The 2% HQ cream was applied twice daily for 12 weeks in patients of the HQ group. The primary outcome, the melasma area and severity index (MASI) score, was evaluated at weeks 0, 4, 8, 12, 16, 20, and 24. The patient assessment score by quartile rating scale was rated at weeks 12, 16, 20, and 24.ResultsFifty-nine (98.3%) subjects were included in the analysis. Each group showed significant change from baseline in MASI scores from week 4 to week 24. The MASI score in the PSNYL group showed the greatest reduction compared to the PSAL group (p = 0.016) and HQ group (p = 0.018). The PSAL group demonstrated comparable MASI improvement as the HQ group (p = 0.998). The PSNYL group had the highest patient assessment score, followed by the PSAL group and then the HQ group, although only the differences between PSNYL and HQ groups at weeks 12 and 16 were significant. Four patients (6.8%) experienced recurrence. Other unanticipated events were transient and subsided after 1 week to 6 months.ConclusionThe efficacy of non-fractional PSNYL was superior to that of non-fractional PSAL, which was not inferior to 2% HQ, thus non-fractional Picos providing an alternative for melasma patients with FSTs III-IV. The safety profiles of PSNYL, PSAL, and 2% HQ cream were similar.Clinical Trial Registrationhttps://www.chictr.org.cn/showprojen.aspx?proj=130994, ChiCTR2100050089.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of the efficacy and safety of picosecond Nd:YAG laser (1,064 nm), picosecond alexandrite laser (755 nm) and 2% hydroquinone cream in the treatment of melasma: A randomized, controlled, assessor-blinded trial

et al. 2023

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“…Because of the influence of many exogenous and endogenous factors, the pathogenesis of chloasma is complex and not completely clear so far. Although there are a variety of treatment methods for melasma, effective strategy has been unconfirmed and recurrence is widespread 3 . Therefore, a novel strategy for the cure of this refractory skin disease is still urgently needed.…”

Section: Introductionmentioning

confidence: 99%

“…Although there are a variety of treatment methods for melasma, effective strategy has been unconfirmed and recurrence is widespread. 3 Therefore, a novel strategy for the cure of this refractory skin disease is still urgently needed.…”

mentioning

confidence: 99%

The mechanism of Croci stigma in the treatment of melasma based on network pharmacology and molecular docking

Yin

Zhao

et al. 2023

J of Cosmetic Dermatology

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Purpose To investigate the molecular mechanism of Croci stigma (CS) in the treatment of melasma by network pharmacology and molecular docking. Methods TCMSP, CTD, STITCH, SymMap, GeneCard, GenBank, OMIM and DrugBank databases were used to obtain the components and targets of CS and the targets of chloasma. STRING was used to build a protein–protein interaction (PPI) network of intersecting targets between drugs and diseases. Cytoscape was used to establish drug‐compounds‐targets‐disease network and analyze PPI network. R was used for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis and visualization. AutoDock was used for molecular docking and R was used to visualize docking results. Results Four active compounds were screened out from CS, and 31 target genes intersecting with melasma were found after further analysis. The top 10 hub genes were found after analysis of the PPI network, including TYR, TYRP1, DCT, CREB1, KITLG, MITF, ESR1, EDNRB, CD4, and PTGS2. In the enrichment analysis, melanogenesis was considered as the core pathway through which CS exerts its therapeutic effect on melasma. Molecular docking results showed that the core genes in the regulatory network had high binding activity with related active components, especially crocetin. Conclusion CS may treat melasma by regulating core targets, such as TYR, TYRP1, DCT, CREB1, KITLG, MITF, EDNRB, and PTGS2, and acting on melanogenesis. And crocetin may be the core compound worthy of further study.

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Comparison of 755‐nm picosecond alexandrite laser versus 1064‐nm Q‐switched Nd:YAG laser for melasma: A randomized, split‐face controlled, 2‐year follow‐up study

Zhou,

Li,

Hamblin

et al. 2024

Lasers Surg Med

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ObjectivesPulsed laser treatment of melasma has shown some promising results. To compare the effectiveness and safety of 755‐nm picosecond alexandrite laser (PSAL) fitted with diffractive lens array (DLA) versus 1064‐nm Q‐switched neodynimum:yttrium aluminum garnet laser (QSNYL) for the treatment of melasma.MethodsWe conducted a randomized, split face controlled, 2‐year follow‐up study. Each face was divided into two parts, each side receiving three treatments with either PSAL or QSNYL at 1 month intervals. Modified Melasma Area Severity Index scores (mMASI), pain scores, patient satisfaction and adverse events were recorded. In vivo reflectance confocal microscopy (RCM) images were acquired.ResultsTwenty subjects were enrolled and three dropped out. At 6 months, mMASI scores were significantly lower than baseline for QSNYL sides (p = 0.022), with no statistically significant difference between PSAL sides before and after treatment, PSAL sides versus QSNYL sides, or patient satisfaction scores. QSNYL treatment was associated with less pain (p = 0.014). No serious adverse events were reported. In the PSAL sides RCM showed a large number of dendritic melanocytes infiltrated in the dermis at 2 weeks and 4 weeks after treatment. Ten patients (58.82%) reported recurrence or exacerbation at 2‐year follow‐up with no statistically significant difference between the two lasers.ConclusionsQSNYL demonstrated short term clinical efficacy for melasma, but did not provide any additional benefit compared to PSAL with DLA. QSNYL was associated with less pain. There was a high recurrence rate at 2‐year follow‐up. RCM allowed the detection of cellular changes in melasma lesions.

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Update on Melasma—Part II: Treatment

Cited by 40 publications

References 123 publications

Comparison of the efficacy and safety of picosecond Nd:YAG laser (1,064 nm), picosecond alexandrite laser (755 nm) and 2% hydroquinone cream in the treatment of melasma: A randomized, controlled, assessor-blinded trial

Comparison of the efficacy and safety of picosecond Nd:YAG laser (1,064 nm), picosecond alexandrite laser (755 nm) and 2% hydroquinone cream in the treatment of melasma: A randomized, controlled, assessor-blinded trial

The mechanism of Croci stigma in the treatment of melasma based on network pharmacology and molecular docking

Comparison of 755‐nm picosecond alexandrite laser versus 1064‐nm Q‐switched Nd:YAG laser for melasma: A randomized, split‐face controlled, 2‐year follow‐up study

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