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OBJECTIVES Melasma is a chronic acquired condition characterized by grayish-brown macules and patches with a distinct border on the face. Although various treatments methods have been suggested for treating melasma, none has been completely successful. The aim of the study was to compare the efficiency of erbium: yttrium-aluminum-garnet (Er:YAG) laser and 4% hydroquinone (HQ) with the effects of intradermal tranexamic acid (TA) and 4% HQ for the treatment of refractory melasma. METHODS The study included 31 female patients with refractory melasma. The left or right side of the patient's face was chosen randomly to receive laser therapy with topical HQ on the one side (i.e., the laser side) and intradermal injection of TA plus topical HQ on the other side (i.e., the mesotherapy side). Digital photography was performed at baseline, at the end of the treatment, and three months after the treatment as follow-up. Two independent dermatologists evaluated the modified Melasma Area and Severity Index (mMASI) score according to the pictures. Overall, 27 patients completed the study and went through the clinical evaluation. RESULTS Treatment using HQ in combination with either Er:YAG laser therapy or intradermal injection of TA significantly improved the hemi-mMASI and resulted in higher patient satisfaction. While the improvement was not significantly different between the two regiments after the treatment and upon follow up and both were equally efficient in the treatment of refractory melasma (p = 1.308), recurrence rate was higher after treatment with Er:YAG laser than TA (12% vs 34%). CONCLUSION This study confirmed the comparable efficacy of TA plus topical HQ versus Er:YAG laser plus topical HQ for the treatment of refractory melasma. Both groups improved significantly and no subject left the treatment because of adverse effects.

Alopecia as a disease condition can be a symptom of other ailments, the body’s reaction to medications, hormonal changes, nutritional deficiencies, hygiene negligence, too intense or frequent cosmetic procedures, or it can constitute an independent disease syndrome. Depending on the individual genetic traits, alopecia may also be inherited. Usually, there is no one universal cause for this disease to occur. Properly conducted diagnosis of the problem and individually selected therapeutic substances can help to deal with this problem or at least delay hair loss associated with the physiological aging process. One of the treatments that are used to support the treatment or prevention of alopecia is needle mesotherapy. It is a local treatment that delivers healing substances having stimulating, regenerating, and nourishing effects directly to the skin or hair follicles. The medicinal substances administered during the needle mesotherapy treatment include peptides, biotin, minoxidil, d-panthenol, vitamins, and minerals, alone or in the form of mixtures, as well as platelet-rich plasma and stem cells. The effects of needle mesotherapy in alopecia are visible after a single treatment when hair loss stops. On the other hand, the thickening and regrowth of new hair are visible after a series of treatments. The full course of therapy depends on the type of alopecia, a patient’s condition, and its comorbidities. It usually consists of four to eight treatments performed at two-week intervals. In the case of alopecia, they are visible after two months, and to maintain the effect, a reminder treatment is recommended after six months. Not all people can undergo such a procedure. The main contraindications include: (1) pregnant and lactating women; (2) children and persons under the age of 18; (3) people who are allergic to any of the ingredients of the administered preparation; (4) people with skin lesions, skin diseases, active infections (bacterial, viral, fungal) or susceptibility to streptococcal infections (recurrent strep throat); (5) people taking drugs: immunosuppressants, anticoagulants, non-steroidal anti-inflammatory drugs, high doses of glucocorticosteroids; (6) patients with decompensated diabetes, neoplastic, mental, rheumatic diseases, or other autoimmune disorders. Needle mesotherapy is very popular in cosmetology and aesthetic medicine clinics. This innovative method is a proven and relatively safe procedure in the fight against various skin conditions, including alopecia. Keywords: excessive hair loss, alopecia, needle mesotherapy, platelet-rich plasma, biomimetic peptides, stem cells.

Mesotherapy (local intradermal therapy, LIT) is a technique used to slowly spread drugs in tissues underlying the site of injection to prolong the pharmacological effect with respect to intramuscular injection. Recommendations for proper medical use of this technique have been made for pain medicine and rehabilitation, chronic venous disease, sport medicine, musculoskeletal disorders, several dermatological conditions, skin ageing, and immune-prophylaxis. Although mesotherapy is considered a valid technique, unresolved questions remain, which should be answered to standardize methodology and dosing regimen as well as to define the right indications in clinical practice. New randomized controlled trials are needed to test single products (dose, frequency of administration, efficacy and safety). Even infiltration of substances for dermo-cosmetic purposes must be guided by safety and efficacy tests before being proposed by mesotherapy. In this article, we put forth a preclinical and clinical research plan and a health technology assessment as a call to action by doctors, researchers and scientific societies to aid national health authorities in considering mesotherapy for prevention, treatment and rehabilitation paths., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/bIuRhGQsUjs

Background Androgenetic alopecia (AGA) is the most common form of alopecia in men, affecting 70% by the age of 20 years. The present study was conducted with the objective of comparing the efficacy of monotherapy with topical 5% minoxidil and its combination with intradermal platelet rich plasma (PRP), in male AGA. Methods This observational study was conducted at the dermatology department of a tertiary care hospital over a duration of 2 years. 100 patients with AGA were selected and divided randomly into 2 treatment arms: Group A (MM): received topical 5% Minoxidil monotherapy for 12 months and; Group B (M + PRP): received combination therapy of PRP and topical 5% Minoxidil for 12 months. The following parameters were subsequently analyzed on follow up: Physician-assessed global photography by a 4-point improvement scale and trichoscopic improvement of mean hair diameter. Results The combination was statistically superior to the monotherapy group in promoting hair growth in men with AGA for both measures of hair growth – photographic assessment and trichoscopic mean diameter. Conclusion We hereby conclude that intradermal PRP injections should be offered to all patients with AGA along with the existing therapeutic modalities, for faster hair regrowth and improved compliance.

BACKGROUND:Migraine is a prevalent disabling primary headache disorder that is classified into two major types: migraine without aura and migraine with aura. New therapeutic methods to reduce migraine headaches in the emergency department (ED) include intradermal mesotherapy.OBJECTIVE:Compare the efficacy of intradermal mesotherapy versus a systemic therapy in pain control in patients with headache related to migraine without aura.DESIGN:Prospective parallel-group randomized controlled trial.SETTING:University hospital in Turkey.PATIENTS AND METHODS:Patients 18 years of age and older who were admitted to the ED over a 15-month period with headache related to migraine without aura were eligible for inclusion if they had a VAS score of 4 or above. Patients were randomly allocated to one session of mesotherapy or intravenous dexketoprofen. Changes in pain intensity were measured by the score on a visual analog scale (VAS) at 30, 60, and 120 minutes and 24 hours after treatment. Efficacy was also assessed by the need for use of an analgesic drug within 24 hours, by readmission with the same complaint to the ED within 72 hours, and by adverse effect rates.MAIN OUTCOME MEASURE:Pain intensity on the VAS scale.SAMPLE SIZE:148 patients (154 enrolled and treated; 1 patient in the mesotherapy and 5 patients in the systemic therapy group lost to follow up).RESULTS:Pain intensity on the VAS scale decreased from a median score of 8 to 4 in the mesotherapy group and from 8 to 5 in the systemic therapy group. These differences were statistically significant from baseline for all time intervals (P=.001 to 30 minutes,P=.004 to 60 minutes,P=.005 to 120 minutes, andP=.002 to 24 hours). The need to use analgesics and the rate of readmission to the ED were higher in the systemic therapy group (P=.013 andP=.030, respectively). Adverse effect rates were minimal and similar in the study groups during the one-week follow-up period.CONCLUSIONS:Mesotherapy is more efficacious than intravenous dexketoprofen in the management of acute attack of migraine without aura in the ED.LIMITATIONS:Unblinded. Valid for assessing short-term pain relief, but not sufficient to predict long-term efficacy. Not generalizable because single center and small sample size.CONFLICT OF INTEREST:None.REGISTRATION:ClinicalTrials.gov(NCT04519346)

Vitamin C/Ascorbic acid inhibits tyrosinase enzyme causing melanin biosynthesis suppression. This study aimed to compare the efficacy of intra-mucosal injection (mesotherapy) with topical gel as non-surgical methods for managing gingival hyperpigmentation. Twenty healthy non-smokers with mild to severe hyperpigmented gingiva were randomly assigned for Mesotherapy (G1); intra-mucosal injection of ascorbic acid (1/week/3 weeks); or Gel (G2), topical ascorbic acid gel (1/day/3 months). Pigmentation index (DOPI), patient satisfaction, as well as histological analysis for Fontana-Masson-stained specimens were performed at baseline and after 6 months. Comparison between groups and changes by time were analyzed using Mann-Whitney and Friedman’s tests, respectively. The median DOPI significantly decreased after 1 month in G1 (P value < 0.001, r = 0.9) compared with non-significant change in G2. No pain experienced during or after treatment in both groups. G1 patients showed significantly higher satisfaction with treatment than G2. Mean area fraction of melanin forming cells was significantly reduced in both groups after 6 months, but the effect size was higher in G1 (r = 0.886) than in G2 (r = 0.797). Vitamin C mesotherapy showed better and early effect than topical gel, and both techniques were not painful and esthetically satisfying in managing gingival hyperpigmentation. Gingival melanin pigmentation causes esthetic concerns for significant number of patients. Investigating non-surgical depigmentation techniques to decrease postoperative complications and patient discomfort, pain and long healing period associated with surgical methods would be clinically significant.

Smooth and even skin possesses a form of magnetism, and people understand it as the external manifestation of a healthy lifestyle. New studies reveal the efficacy of mesotherapy in reducing external signs of ageing, such as wrinkles, large pores, sun damage and loss of glow, elasticity and firmness. The capacity of mesotherapy to stimulate and repair the mechanisms of the skin, creating a suitable environment for the fibroblasts to produce elastin and collagen, offers an effective long-lasting answer to most age-related skin concerns. The full practical aspects needed to perform mesotherapy treatments must be covered in training sessions in person, as the accuracy of mesotherapy depends on many considerations. To practice mesotherapy, practitioners need to have a deep theoretical understanding of the ageing process and of the techniques and materials that are used in mesotherapy.

Background: Mesotherapy is a minimally invasive procedure which involves local intradermal therapy (LIT) with biologically active substances given in minor quantities to the area of pathology. Vitamin C is an important antioxidant agent which can modulate the attenuation of inflammatory process and enhance tissue repair. Aim: The aim of this study was to investigate the efficacy of local injections of Vitamin C for treating persisting inflammation of the gingiva. Materials and Methods: After phase I therapy was completed, five patients with persisting chronic inflammation of the gingiva were injected with the same dosages of Vitamin C into the gingival tissues. Patients were evaluated each week for resolution of gingival inflammation. Results: Clinical observation showed a significant improvement in inflammation of the injected sites during recall appointments. Conclusions: LIT with Vitamin C has a synergistic interaction along with scaling and root planing in the treatment of persistent gingival inflammation.

Although it appears to be a simple, easy, and financially attractive therapeutic modality, skin rejuvenation mesotherapy is a controversial cosmetic procedure and proof of its efficacy is still lacking. The authors have published a review about this therapeutic modality more than a decade ago. Few clinical studies evaluating its efficacy and safety were available then without any conclusive scientific evidence about its efficacy; nevertheless, mesotherapy has continued to be performed at a relatively high financial cost to patients by many nonmedical and medical professionals for antiaging purposes. The authors have published a review about this therapeutic modality more than a decade ago. The current review is an update aimed at identifying any evidence about the scientific validity and efficacy of this approach that has emerged since then. No clinical valuable new data and new information has been identified. As by American Society of Plastic Surgeons (ASPS) policy statement updated and approved in 2019, mesotherapy for skin rejuvenation is currently not Food and Drug Administration approved. Until more conclusive data is available, skin rejuvenation mesotherapy cannot be recommended for routine skin rejuvenation clinical application.

Introduction Corticosteroid-induced rosacea-like dermatitis (CIRD) is one of the cutaneous side effects of long and excessive application of topical corticosteroids, resembling rosacea that can present with a series of cutaneous manifestations. Most patients with CIRD undergo a variety of long-term treatments before their symptoms are relieved as there is no accepted standard therapy. We gave each of seven patients two sessions of platelet-rich plasma (PRP) mesotherapy before the routine treatment to restore their skin barrier function, and we were surprised to find that the patients’ symptoms and appearance were significantly improved without any further treatments. Here we report this unexpected finding in dealing with CIRD. Case Presentation Seven patients, one male and six female, who had history of applying topical corticosteroids on the face for more than 3 months continuously or intermittently for various reasons were diagnosed with CIRD, showing varying degrees of erythema, telangiectasia, and papules, with dry skin, pain, and burning or stinging sensation. We intended to use the restorative effect of PRP to restore the skin barrier function of the patients for further treatment such as tacrolimus ointment, intense pulsed light (IPL), or pulsed dye laser (PDL), so they were treated twice with PRP intradermal injections using a mesogun injector machine. We used the VISIA skin detector to photograph and compare the changes after the treatments. Clinical efficacy was also assessed by the Global Aesthetic Improvement Scale (GAIS). Patients’ assessments were recorded using three-point scale questionnaires. After two sessions of PRP treatment, before any further treatment, we were surprised to find that the patients' symptoms had improved significantly, as confirmed by VISIA skin detector and GAIS. All of the patients were satisfied with the outcomes, considering that mesotherapy was not painful and their appearance and symptoms had much improved. Conclusions PRP mesotherapy may mitigate sensitivity and inflammation in patients with CIRD by reducing erythema, telangiectasia, and papules. It is worth conducting large randomized controlled trials to verify its safety and efficacy in treating corticosteroid-induced rosacea-like dermatitis and maybe rosacea.

Intradermal injection of autologous platelet-rich plasma (PRP) is a non-surgical cosmetic therapy to rejuvenate the periorbital area pathologies of wrinkles, periorbital hyperpigmentation (POH), and photoaging. The past decade has seen the adoption of this novel therapy around the world. This is the first systematic review and meta-analysis evaluating PRP treatment of periorbital pathologies. This is a PRISMA compliant review that includes a comprehensive search of the databases Cochrane Library, Ovid Medline, Ovid Embase, and clinicaltrials.gov. The search was performed in June 2019 to obtain all peer-reviewed articles published in English that describe the application of PRP to periorbital pathologies. A meta-analysis of patient satisfaction was performed for randomized controlled trials. Nineteen studies treating 455 patients (95% female, age range 28–60) were included. Studies were categorized based on reported outcomes: wrinkles (11 studies), POH (7 studies), and photoaging (6 studies). Patients were treated a mean of 3 times (range 1–8) in mean intervals of 23 days (range 14–56 days). Follow-up averaged 3 months (range 1–6 months). Meta-analysis of 3 randomized controlled clinical trials (RCTs) shows that patients treated with PRP have increased satisfaction above controls of saline, platelet-poor plasma, mesotherapy, and as an adjunct to laser therapy (overall effect p = 0.001, heterogeneity I2 = 64%). PRP treatment of periorbital area pathologies results in histologic improvements of photoaging, subjective satisfaction score increases, and blind evaluator assessments of rejuvenated skin appearance. Future studies are needed to address limitations of the current literature and should include long-term follow-up, delineation of the POH etiology that is treated, RCTs with low risk of bias, and be absent conflicts of interest or industry sponsors. Trial registration: Prospero Systematic Review Registration ID: CRD42019135968

Introduction. The sufficiency of vitamin D is important for slowing down the aging of the skin, maintaining its hydration, elasticity and the ability to regenerate. Biologically active forms of vitamin D (including alfacalcidol) promote the activation of genes whose function is directly related to the maintenance of the structure of the skin, subcutaneous tissue, fascia and muscle fibers.The aim of the work was to assess the prospects for the inclusion of alfacalcidol (“Alpha D3”, 0.25 μg, 1 caps/day) in the rehabilitation programs of patients with age-related ptosis of the face (n = 40, age 47 ± 5 years).Materials and methods. 4 groups of patients with age-related facial ptosis (n = 40, average age 47 ± 5 years) were observed for 60 days; measurements were made before and after clinical trials. Group 1A (first treatment, n = 12) received the daily dose of Alpha D3, 0.25 mg, in the morning, for 60 days, during this period the patients received 4 cosmetic procedures (2 plastic face massages and 2 stimulation current therapies). Group 1B (first control, n = 8) received only 4 cosmetic procedures over 60 days (2 plastic face massages and 2 stimulation current therapies). Group 2A (second treatment, n = 12) received the daily dose of ALFA D3, 0.25 mg, for 60 days, during this period the patients received 4 DMAE (diethylaminoethanol) mesotherapy procedures. Group 2B (second control, n = 8) only received 4 DMAE (diethylaminoethanol) mesotherapy procedures.Results. Alfacalcidol intake significantly increased the concentrations of 25 (OH) D (from 17 ± 5 ng/ml to 27 ± 8 ng/ml, P = 0.001) and calcium (from 86 ± 10 mg/L to 96 ± 6 mg/L, P = 0.01) in serum. The positive dynamics of the concentrations of 25 (OH) D and calcium when taking alfacalcidol corresponded to an increase in the total bone mineral density (+ 0.03 ± 0.03 g/cm3, control: + 0.006 ± 0.03, P = 0.016) and T-criterion (+0.4 ± 0.5, control: -0.07 ± 0.2, P = 0.0002), which indicates compensation for vitamin D deficiency and an improvement in bone metabolism. An increase in the levels of 25 (OH) D and calcium when taking alfacalcidol was accompanied by a positive trend in skin condition according to bioimpedance measurements. Taking the drug significantly increased the moisture content of the facial skin (from 17 ± 14 points to 29 ± 14 points, P = 0.055, without changes in the control) and increased the amplitude of the muscle motor response to the stimulus (+ 0.24 ± 0.22, P < 0.02).Conclusions. Within the framework of a randomized design, it was shown that the addition of massage, microcurrent therapy, mesotherapy with alfacalcidol led to a significant increase in serum 25 (OH) D levels, an increase in skin elasticity and hydration, a decrease in visceral fat according to bioimpedance measurements, and an improvement in indicators of muscle contractility and neuromuscular signal transmission according to electromyography data and an increase in bone mineral density.

Hand eczema is a recurrent and resistant disease that seriously affects the quality of life of patients; currently, there are no ideal treatments for hand eczema. Here, we describe two patients who presented with hand eczema to illustrate the potential efficacy of mesotherapy with snake venom pharmacopuncture (SVP). A 23-year-old woman (Case 1) and a 47-year-old woman (Case 2) presented to the clinic with symptoms of pruritic rash, blis-ters, and itchiness on both the hands and the left hand, respectively. Both patients were diagnosed with hand eczema based on the physical examination of blisters and redness only on the hands. The patients underwent 1 month (Case 1) and 1 week (Case 2) of mesotherapy with SVP. After treatment, the lesions completely improved and did not recur at 1 year of follow-up. These outcomes suggest that mesotherapy with SVP may be effective for the resolution of hand eczema; however, further research is needed to confirm these findings.

The desire to maintain youth as long as it possible in modern society, especially among women of working age, is primarily due to the desire to be in demand, well-groomed and attractive. Currently, there are 5 main methods that contribute to improving the condition of the skin of the face, namely: the method using professional cosmetics, chemical peels, mesotherapy, treatment with an injection of botulinum toxin type A (BTA) and intradermal implants based on hyaluronic acid. The aim of the literature review was to analyze the latest scientific data on the possibility of botulinum therapy in cosmetology. Wrinkles of open areas of the body (primarily on the face and in the decollete) have a negative effect on the emotional background and quality of life of women. In this regard, recently there has been a significant increase in demand for aesthetic medicine services, one of the areas of which is botulinum therapy (BT). Botulinum toxin type A (BTA) is a powerful neurotoxin that inhibits the release of acetylcholine in the neuromuscular junction. Injections of small doses of botulinum toxin type A into targeted mimic muscles cause their relaxation, which smoothes the underlying layer of the skin, thereby regressing mimic wrinkles. Today, according to officially approved indications, it is used in cosmetology, botulinum therapy is used to correct mimic wrinkles in the upper third of the face, drooping corners of the mouth, in the complex correction of the face oval, in the treatment of axillary and palmar hyperhidrosis. Blocking a tear mediator like acetylcholine, not only the presynaptic membranes of neuromuscular synapses are rich, but also many anatomical structures, such as glandular tissue (sweat, other glands, etc.). This commonality of the mechanism of action on various physiological processes in our body allows us to make an assumption about the great potential of botulinum therapy in the treatment of a number of diseases associated with impaired neuromuscular conduction.

Background Achilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments. The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment. Results Forty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness. Conclusion ESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.

Relevance . Not only microvasculature and derma are involved in the involution processes. The involution also effects on the all components of skin resulting in its function and structure alterations. By this reason we can speak about the disturbances of microcirculatory tissue system. The aim of this work was a comparative assessment of cosmetic equipment (PDL, IPL), mesotherapy and external skin care therapy in cosmetology patients by the functional state of microcirculatory tissue system of facial skin. Materials and methods . 62 women after mesotherapy, equipment cosmetology and professional external therapy of facial skin were involved in the exploration. We used the laser Doppler flowmetry and laser fluorescence spectroscopy for assessment the microcirculation, lymph flow and the oxidative metabolism coenzymes. Results . Peripheral blood flow did not change significantly, as the lymph flow rate in the control and experimental groups. Nutritional blood flow increased significantly to 12,11 [11,17; 14,17] and 11,88 [10,59; 12,28] in patients after injection and external therapy (p

This study was aimed at evaluating the efficacy of Tranexamic Acid (TA) mesotherapy versus cysteamine 5% cream in the treatment of melasma. This single-blind, randomized clinical trial was conducted among 54 subjects between 2018 and 2019. Cysteamine 5% cream group was instructed to apply the cream on the melasma lesions 30 min before bed for 4 consecutive months. Conversely, 0.05 mL (4 mg/mL) TA mesotherapy was performed by a physician every 4 weeks until 2 months. The severity of melasma was evaluated using both Dermacatch® device and the modified Melasma Area Severity Index (mMASI). The most remarkable improvement rate was observed in the TA group at the third visit based on mMASI and Dermacatch® values at 47% and 15% in turn. The mMASI scores were substantially improved in both groups at the second visit (cysteamine vs TA 8.48 ± 2.34 and 7.03 ± 3.19; P = 0.359) and third visit (cysteamine vs TA 6.32 ± 2.11 and 5.52 ± 2.55; P = 0.952) as compared to baseline (cysteamine vs TA: 11.68 ± 2.70 and 10.43 ± 2.69). Dermacatch® values were significantly declined at the second and third visits (cysteamine vs TA 42.54 ± 12.84 and 38.75 ± 9.80, P = 0.365; 40.74 ± 12.61 and 36.17 ± 10.3, P = 0.123, respectively) compared with baseline (cysteamine vs TA 45.76 ± 13.41 and 42.41 ± 10.48), although the improvement rates between two groups were not significantly different. Findings suggest that none of the cysteamine and TA mesotherapy treatments measured by both mMASI and Dermacatch® methods have substantial advantages over the other; however, complications are less in the cysteamine than the TA mesotherapy group.

Introduction. Knee osteoarthritis (KOA) is one of the most common degenerative diseases that lead to pain and disability. Oral NSAIDs are effective drugs used to alleviate symptoms in patients with KOA, but they have several important complications, especially in the elderly. In this study, we evaluated the effectiveness of mesotherapy on pain reduction and improvement of functioning in patients with KOA. Methods. Sixty-two patients with KOA, grade 2-3 of the Kellgren–Lawrence scale, were randomized into two groups: the mesotherapy group, in which two injections were applied with piroxicam at a 10-day interval, and the oral group, in which piroxicam was prescribed for 10 days. The patients were evaluated before the treatment and 2, 4, and 8 weeks after it using the Visual Analogue Scale (VAS), Oxford Knee Scare (OKS), and Western Ontario McMaster University Osteoarthritis Index (WOMAC, Persian version). Results. There was no significant difference in demographic characteristics and baseline pain and function scores between the two groups. After 2, 4, and 8 weeks of follow-up, VAS, WOMAC, and OKS scores significantly improved in both groups (in the mesotherapy group: p value p value p value p value p value p value Conclusion. Mesotherapy is an effective and safe treatment modality in patients with mild-to-moderate KOA in the short term. This trial is registered with IRCT2017052434113N1.

Background: Fibromyalgia is the second most common disease encountered in rheumatology practice Aim: This study designed to assess the potential effect of mesotherapy in treatment of tender points in primary fibromyalgia (PFM) patients. Methods: Thirty PFM patients who fulfilled the American Colleague of Rheumatology 1990 criteria, joined this study. They were divided into 2 groups randomly according to the treatment program received; Injection mesotherapy group (Group I: No=15 patients) who received a mixture of 2 ml of Ketoprofen (100mg/2ml) added to 3 ml of Saline Solution, once cession per week for a total of 6 successive weeks and other 15 patients (Group II) who received Ketoprofen 100 mg Extended- Release capsules once daily for 2 successive weeks which represent the control group. Patients‟ pain severity, quality of life and depression were assessed using visual analogue scale (VAS), fibromyalgia impact questionnaire (FIQ) and the Hamilton Rating Scale (HDRS) respectively before treatment and after the 3rd & the 6th cession then data were recorded and compared. Results: We found significant improvements (p

There are two main processes that induce skin aging: extrinsic and intrinsic. Extrinsic aging is caused by environmental factors such as sun exposure, air pollution, smoking, and poor nutrition. Intrinsic aging reflects the genetic background especially in terms of cell viability and proliferation potential, and depends on time. It introduces unfavorable changes in the functioning of organs and in the external appearance of the body, especially visible on the skin. Wrinkles, discoloration and loss of facial contours can reduce the quality of everyday life and disrupt human social relationships. There are now a couple of theories of aging to explain this inevitable fact of being human like: genetic, Hayflick’s, mitochondrial, biochemical and protein impairments theories. Both surgical and non-surgical aesthetic procedures are used to maintain a beneficial appearance, rejuvenation and slow down skin aging. From year to year, public interest in the use of innovative anti-aging treatments increases, enabling the preservation of youthful appearance for a longer period than it results from the physiological life cycle. Non-surgical aesthetic treatments, delaying skin aging, activate natural mechanisms of cell renewal and accelerate their metabolism, stimulate the synthesis of fibroblasts to produce collagen, which is the main building element of the skin. The most effective treatments delaying skin aging currently include, among others lifting with polydioxane threads, skin regeneration with platelet rich plasma, microneedle and needle mesotherapy, plasmage lifting as well as dermabrasion and microdermabrasion treatments combined with chemical exfoliation. Professional and systematic stimulations of cells allow lengthening and restoring the beneficial appearance of the skin in all its layers. Treatments using polydioxane threads restore the distorted face oval and lift the skin around the eyes. The procedure using platelet-rich plasma activates cell growth factors, improving the regenerative processes of mature skin. A non-surgical face lift called plasmage, allows excess tissue to evaporate in order to reduce and eliminate wrinkles and drooping eyelids. Various types of mesotherapy and dermabrasion treatments affect the reconstruction of the skin structure, reduce fine wrinkles and stimulate fibroblasts to produce new collagen and elastic fibers.

Objective: To observe the clinical effect of mesotherapy with nanochip for facial rejuvenation.Methods: 24 volunteers with aging skin were treated with a polycomponent formulation – NCTF® BOOST 135...

Atrophic scars, a permanent complication of severe acne, have negative effect on psychology in adolescent. The treatment of atrophic scar is depended on types of scar and it is difficult to improve by a single treatment. Mesenchymal stem cell is a scientific approval for surgery scar treatment and wound healing. We present a case report of female presented with atrophic acne scar distributed on both cheeks. The case aims to prove that the combination of MSCs and aqueous human placenta extract (RGF&#174) contained bioactive therapeutic molecules obviously promoted the improvement of skin scar to reach the optimal outcomes. We first found that MSCs-contained human placenta extract solution combination subcision improves the atrophic acne scar and skin complexity by enhancement of skin cell regeneration.

Introduction Vitiligo is one of the most common hypomelanoses. Current treatments include ultraviolet, topical corticosteroids, calcineurin inhibitors. Orally administered vitamins, acting as anti-oxidants and in combination with ultraviolet light have also demonstrated skin re-pigmentation. In our pilot study of seven patients, we injected skin affected with vitiligo intra-dermally with a complex of vitamins and minerals and assessed the outcome. Aim The aim of this study was to evaluate a novel treatment modality for vitiligo. Methods We present a pilot study of seven patients; each having been diagnosed with generalized progressive vitiligo. In all cases, multiple therapies had been previously attempted. All patients were subjected to intradermal injections of biorevitalizant NCTF 135 (3 mls) in the hypo-pigmented areas of skin, once a week for 5 weeks. A 30Gx13 mm needle was used for the 0.025 mls intradermal injections to create micro-papules with a 1 cm distance between the injection sites. The results were assessed at 2 weeks and 5 weeks and were considered successful if partial or complete repigmentation was achieved. Results Partial or complete skin re-pigmentation post-treatment was observed in vitiligo macules of all patients (100%). No significant side effects, or exacerbation of vitiligo were observed during or after treatment with NCTF 135 in the following 6 months (five patients) and 12 months (two patients). Discussion Increasing the armamentarium of new treatments of vitiligo is important. Previous studies showed the effectiveness of oral and intramuscularly injected multivitamins in the treatment of vitiligo, explaining the results by the antioxidative qualities of the above. Our study demonstrated that intradermal mesotherapy injections of NCTF135, rich with vitamins and other antioxidants are well tolerated and effective in achieving significant re-pigmentation of de-pigmented skin in all patients studied, including five who had been resistant to previous standard therapies.

Resumo Introdução: a alopécia ligada a fatores hormonais androgênicos é algo que há muito tempo tem sido alvo de estudos e aplicações de conhecimento científico em todo mundo. Este padrão de perda capilar, principalmente ligada ao sexo masculino dispõe de terapias que atualmente se limitam à interrupção da queda de fios com leve progressão de crescimento em alguns casos. Neste tocante, uma nova técnica de microagulhamento, com ou sem terapias adjuvantes, associado a métodos já consagradas como minoxidil tem levado o tratamento desta alteração estética para melhores níveis de resultado. Objetivo: conduzir uma investigação sobre os resultados atuais de pesquisas que envolvam o microagulhamento associado ao uso de Minoxidil, plasma rico em plaquetas e/ou mesoterapia. Metodologia: foram feitas pesquisas no banco de dados da PubMed e Scielo em abril de 2021 buscando-se os termos “minoxidil AND microneedling”. Resultados e Discussões: os resultados obtidos têm convergido para a proposta de que a associação do método de rolagem (microagulhamento) com a aplicação tópica do vasodilatador (minoxidil) apresenta um padrão de crescimento capilar nunca alcançado pela terapia convencional disponível, e que, se acrescentar plasma rico em plaquetas e/ou soluções através da mesoterapia, os resultados podem ser ainda mais vantajosos. Conclusão: novos estudos são necessários para abranger as vertentes ainda não elucidadas para o tratamento da alopecia, contudo, os resultados até aqui obtidos são promissores para o sucesso da reposição capilar. Palavras chave: Microagulhamento, Minoxidil, Alopecia Abstract Introduction: alopecia linked to androgenic hormonal factors is something that has long been the subject of studies and knowledge applications worldwide. This pattern of hair loss, mainly related to males, has therapies that are currently limited to interruption of hair loss with slight growth progression in some cases. In this regard, a new microneedling technique, with or without adjuvant therapies, associated with well-established methods such as minoxidil has led the treatment of this esthetic alteration to better levels of results. Objective: to conduct an investigation into the current results of research involving microneedling associated with the use of Minoxidil, platelet-rich plasma and/or mesotherapy. Methodology: searches were conducted in the PubMed and Scielo database in April 2021, searching for the terms “minoxidil AND microneedling”. Results and Discussions: the results obtained have converged to the proposal that the association of the rolling method (microneedling) with the topical application of a vasodilator (minoxidil) presents a pattern of hair growth never achieved by the available conventional therapy, and that, if added platelet-rich plasma and/or solutions through mesotherapy, the results can be even more advantageous. Conclusion: further studies are needed to cover aspects that have not yet been elucidated for the treatment of alopecia, however, the results obtained so far are promising for the success of hair replacement. Keywords: Microneedling, Minoxidil, Alopecia

Background Although energy devices and botulinum toxin A (BTX-A) can alleviate age-related laxity, ptosis, and platysmal bands, they have limited efficacy on horizontal neck lines. Objectives The purpose of this study was to investigate the efficacy, safety, and subject satisfaction of a combined treatment of non–cross-linked hyaluronic acid (HA) compound filling plus mesotherapy for the correction of horizontal neck lines, in comparison with BTX-A. Methods This multicenter, randomized, evaluator-blinded, prospective study enrolled female patients with moderate-to-severe horizontal neck lines corrected with either 2 or 3 sessions of of non–cross-linked HA compound filling plus mesotherapy or 1 session of BTX-A injection. Improvement of the neck lines grades, Global Aesthetic Improvement Scale (GAIS), patient satisfaction, and adverse events (AEs) were evaluated and compared at 1, 3, 6, and 10 months after the final treatment. Results Twenty-five patients received HA filling plus mesotherapy and 23 received BTX-A injection. Compared with BTX-A, the HA compound filling plus mesotherapy significantly improved the horizontal neck lines grades on all follow-up visits (P = 0.000). Cases of different baseline grades (2, 2.5, and 3) demonstrated similar outcomes. The GAIS and patients’ satisfaction ratings were significantly higher for the HA filling plus mesotherapy treatment group (P = 0.000). Significantly higher pain ratings, higher incidence, and longer recovery of AEs (erythema, edema, and ecchymosis) were noticed in the combined treatment group (P Conclusions Compared with BTX-A, combined treatment with HA compound filling plus mesotherapy significantly improved moderate-to-severe horizontal neck lines and achieved a high level of patient satisfaction. Level of Evidence: 4

“Injection lipolysis” or “mesotherapy” is done for introducing various substances into deeper layers of the skin with the aim to dissolve subcutaneous fat. However, the safety profile of these chemicals is poorly regulated. Therefore, they may cause side effects or long-term sequelae that can be disastrous for the patient. We present such a case that required surgical management to salvage it and to give an aesthetically acceptable result.

Microneedling can accelerate skin repair through numerous complex processes triggered by micro-injuries it produces on the skin surface with very thin needles. The current growth in the application of microneedling in the treatment of cutaneous diseases can be explained by its numerous effects on the skin as reported in the literature. Despite the numerous studies conducted on the application of microneedling in the treatment of skin lesions, its effects on pigmented skin lesions have remained relatively unexplored. The present review comprises an examination of the evidence for the application of microneedling in skin diseases in general and a comprehensive review of the applications of microneedling in pigmentation disorders. The review involved a search of all clinical studies, including trials, case reports, and case series, in the databases MEDLINE/PubMed and Google Scholar using the following keywords: "microneedling", "dermal needling", "percutaneous collagen induction", "skin needling", "dermaroller", and "dermatology disorder". Pertinent data were extracted from all relevant articles published from 1990 to April 2021, and focused on the application of microneedling in the treatment of pigmented skin lesions. Despite the limited number of available studies, evidence suggests the effectiveness and safety of microneedling in treating vitiligo, melasma, and periorbitalhypermelanosis. It is noteworthy that the combination of any type of non-aggressive needing technique with other effective therapies (especially topical agents and mesotherapy) yields more promising therapeutic results than single therapy for melasma, dark cycles and vitiligo as the prototype of pigmentary disorders. However, single needling therapy is significantly effective, too. This article is protected by copyright. All rights reserved.

Axillary web syndrome (AWS) is defined as a visible and palpable network of cords in the skin of the axillary cavity that are tensed by shoulder abduction following surgery for breast cancer, causing significant functional limits of the ipsilateral upper limb (UL) and pain. The purpose of this narrative review is to discuss rehabilitation approaches for greater efficacy with respect to pain and novel suggestions. AWS is a frequent complication of axillary lymphadenectomy that necessitates a thorough follow-up in the medium to long term. Physiotherapy is effective in the treatment of functional limb deficits, the management of pain, and the treatment of upper limb disability. The best management approach involves the use of soft tissue techniques to slow the natural course of the syndrome, in association with therapeutic exercises for functional recovery and muscle strengthening. AWS is linked secondary lymphedema, requiring integration with manual lymphatic drainage. The physiotherapy management of AWS is currently fragmented, and insufficient information is available on the nature of the disease. Thus, randomized and controlled studies that compare rehabilitation approaches in AWS are desirable, including the possibility of using mesotherapy in the treatment of axillary and upper limb pain.

Alopecia after mesotherapy with dutasteride is an extremely rare complication. Dutasteride is a second-generation 5a-reductase enzyme inhibitor that decreases serum dihydrotestosterone levels by 90%. It inhibits both type 1 and 2 enzymes, whereas finasteride inhibits only type 2. Mesotherapy with dutasteride is a novel treatment for hair fall which involves microinjection of the drug into the dermis with negligible systemic absorption. Frequent mild transitory side effects in the site of injection are described in medical literature, but few cases of secondary alopecia have been reported. This stands out given that mesotherapy is becoming such an increasingly common procedure with a great number of patients treated with this technique. We present 2 cases of patchy alopecia after mesotherapy with dutasteride in a male and a female with androgenetic alopecia. One of them developed skin atrophy on the affected areas without improvement at short term follow-up. These cases highlight the possible paradoxical side effects of mesotherapy as a therapeutic technique for hair loss.

Introduction: Mesostyle is a needle free mesotheraputic device that is able to insert analytical pure active substance to the deep layers of skin within cell levels using the most modern electroporation procedure. Objectives: this study aimed to assess electroporation "as a method of transdermal administration of medications" in treatment of corticosteroid induced striae in systemic lupus erythematosus patients. Methods: Twenty female Systemic lupus erythematous (SLE) patients suffering from corticosteroid induced striae in different body parts, were included in this study. Patients were subjected to full history taking, complete clinical examination, and assessment of disease activity using systemic lupus erythematosus disease activity index (SLEDAI) score. Each patient received treatment in the form of six weekly successive cessions using electroporation device "Mesostyle" and photos were obtained after each cession. Results: We found marked improvement of striae appearance with noticeable patients’ satisfaction without any adverse effects. Conclusion: This study supports the role of electroporation which is safe, tolerable, non-invasive, and effective method for transdermal administration of medications.

The incidence of nontuberculous mycobacterial infections is increasing worldwide; by 2017, more than 190 species and subspecies have been documented. Although classically associated with immunosuppression, the recognition of these etiological agents in diseases affecting immunocompetent individuals and in healthcare-associated infections, such as after surgical and cosmetic procedures, makes the study of the epidemiology and pathogenesis of these microorganisms relevant in medical practice. Mycobacterium lentiflavum is slow-growing and rarely affects the skin. A case of cutaneous mycobacteriosis caused by M. lentiflavum is reported in an immunocompetent patient after subcutaneous injection of a lipolytic compound, treated with clarithromycin and levofloxacin.

A 28-year-old white female patient presented with multiple erythematous-to-violaceous, painful, suppurative nodules on the buttocks and thighs that appeared after two weeks of mesotherapy with deoxycholate, caffeine, sunflower liposomes, and sinetrol for localized fat. She was treated for atypical mycobacteriosis, but with no satisfactory response after antibiotic therapy. Bacterial, mycobacterial, and fungal culture were all negative. Histopathologic examination of the biopsy showed noninfectious suppurative panniculitis. It resolved after treatment with methotrexate, prednisone, and hydroxychloroquine. This report highlights the rarity of this complication, the importance of its early recognition, and differentiation with atypical fast growing mycobacterioses.

Mycobacterium abscessus is a rapidly growing nontuberculous mycobacterium existing extensively in water, soil, and dust that causes infections of skin, soft tissue, respiratory, and central nervous system by direct contact with contaminated material or water.1 The incidence of cutaneous M abscessus infection has increased in the past decade. Most reported cases were associated with trauma, surgery, or cosmetic procedures, including autologous fat injection, mesotherapy, tattooing, and even hair transplantation.2,3 We report 2 cases of M abscessus infection associated with facial injection of botulinum toxin (BTX) in patients who were immunocompetent.

Background Mesotherapy can be included as an ancillary treatment in the management of localized pain in rehabilitation, but there are no definitive treatment protocols for this approach. Objectives The purpose of this review was to examine new indications for more standard protocols of mesotherapy in rehabilitation. Materials and methods This systematic review was performed using the following resources: PubMed, Cochrane, PEDro, Scopus, and Google Scholar. The following algorithm was developed, based on the PICO acronym, to evaluate the effects of mesotherapy, with pain as the primary outcome (MESH terms): [mesotherapy AND pain], [mesotherapy AND musculoskeletal], [mesotherapy AND musculoskeletal disorder], [intradermal therapy AND pain], and [intradermal therapy AND musculoskeletal disorder]. Results Seven articles (N=7) satisfied the inclusion criteria and were considered in the review: two of them treated osteoarthritis of the knee (3 sessions) and pes anserine (9 sessions) emphasizing a good efficacy of mesotherapy. Five studies analyzed spine diseases (specifically, two was about chronic and nonspecific neck pain, two about acute low back pain and one about chronic spinal pain): the results of mesotherapy treatment are encouraging both for the resolution of acute and chronic musculoskeletal vertebral pain from one to five sessions. Conclusion Mesotherapy showed a good effect to reduce acute and chronic musculoskeletal pain and, also, it is a well-tolerated treatment. Nonetheless future randomized controlled trials should be desirable for more uniform treatment protocols.

Any cosmetic procedure, which is accompanied by damage to the skin barrier, carries the risk of attaching not only bacterial, but also fungal or viral infections. According to a number of authors, most often these complications occur after intradermal injections, mesotherapy, ablative laser procedures, tattooing, and account for about 5 % of the total number of manipulations. Objective: to evaluate the effectiveness and safety of using Tetraderm® cream in patients with infectious and inflammatory complications after various cosmetic procedures. Material and methods. The study included 28 patients (24 women and 4 men) aged from 18 to 65 years with infectious and inflammatory complications (excluding herpes infection) after various procedures performed according to indications: involutive skin changes, acne, rosacea, hyperpigmentation, scarring of the skin All patients received Tetraderm cream 2 times a day - 7 days. Performance evaluation was carried out taking into account the index DISHC, VAS, DIQoL. Results. The DISHC index decreased by 83.5 %, from 12.7 ± 1.3 points to 2.1 ± 0.3 points (p ® cream is highly effective, tolerable and comfortable to use.

Hyperpigmentation is a common skin problem in a woman. Prolonging topical use of skin whitening may cause hyperpigmentation such as ochronosis whose condition is a challenge for treatment. An aqueous human placenta extract (RGF&#174) contains bioactive therapeutic molecules. There is evidence of human placenta extract showing that melanin synthesis is inhibited by placenta extract in melanocytes. We first reported the case of the hyperpigmentation improvement following face skin mesotherapy human placenta extract treatment.

Mesotherapy is a minimally invasive technique for the administration of drugs in different layers of the skin, using several described techniques. Commonly are used drugs acting as analgesics, miorelaxants, vasodilators, vitamins or active substances as bee venom and botulinum toxin. Mesotherapy consist of low-dose injections in to selected place (receptor points, trigger points, periarticulary acupuncture points) causes stimulation of the repair mechanisms (anti-inflamatory mediators, growth factors), as well as the activation by needling, endogenous opioids (reflex effect). The technique is used in the treatment of pain syndromes in musculoskeletal disorders, vascular problems, sports medicine, neuralgia and others as a part of multidimensional approach. Case report of use mesotherapy to treat arthritis metatarsal pain as a result of overloading and degenerative changes accompanied by swelling of the soft tissues is presented. After 10 sessions of the application of the MD Tissue (collagen) the pain intensity was reduced from VAS 100 to VAS 30 and walking distance increased from 100 m to 1000 m. Mesotherapy procedure is usually well tolerated and can be an alternative to systemic therapy with the same result without risk of side effects.

Objectives To conduct a systematic review of randomized controlled trials about the safety (number and severity of adverse events) and efficacy (pain reduction and functional improvement) of mesotherapy in musculoskeletal disorders, and to compare them with other therapeutic options, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Methods A search of PubMed, Cochrane Library and Scopus database resulted in an initial total of 16,253 records. A total of 931 articles were included in the study. A final total of 7 articles, published from 1 Jan 1999 until 30 Apr 2020 were selected. Two independent reviewers selected potentially relevant studies based on the inclusion criteria for full-text reading. They evaluated the methodological quality of each study and included only studies of high methodological quality, according to the Physiotherapy Evidence Database scale. Results Seven studies were included in the meta-analysis, and visual analogue scale scores before and after mesotherapy were considered. A statistically significant reduction in visual analogue scale score in the mesotherapy group was reported in comparison with the control group in all except 1 of the trials. Mesotherapy was found to be a safe procedure with mild and temporary side-effects, such as nausea, fatigue, numbness, sweating, headache, ecchymosis, bleeding, pain and local reaction at the injection site. Conclusion Mesotherapy proved to be more effective than systemic therapy in the treatment of local pain and functional limitations caused by a variety of musculoskeletal conditions. However, because of the heterogeneity of the analysed studies in terms of injected drugs, administration technique, associated treatments, frequency and total number of sessions, more randomized controlled trials are needed, comparing a standardized mesotherapy protocol with a systemic treatments.

BACKGROUND Cosmetic injection-induced nodules are tricky to handle in the clinic. AIMS We reported a case of injection-induced nodule receiving the experimental treatment of hyperbaric oxygen therapy (HOT). PATIENT A woman presented with multiple red solid nodules on the neck after receiving mesotherapy conducted by syringe. Ultrasound examination showed multiple thickened inflammatory skin tissues on the neck. Pathological biopsy results showed epithelioid granulomas in the dermis, within which there were degenerative necrosis and foreign bodies in the center and multinucleated giant cells around. The bacteria tests remained negative. Diagnosed with foreign body granuloma, the patient rejected the resection or steroids, but willingly took the experimental treatment of HOT instead. After one month, the patient's ultrasound examination showed that the lesion's local hardness got significantly reduced, and the local blood flow increased, indicating the condition improved. RESULTS Although the patient's nodule has not been eliminated, some improvements have been achieved. So far there has no case report on HOT treating injection-induced nodules in the literature. CONCLUSION HOT may be considered as a potential alternative when other treatment options cannot be implemented. More research is needed in this field.

Drugs injected intradermally spread slowly into the underlying tissues and produce a drug-saving effect. The Italian society of mesotherapy suggested that intradermal therapy obtains analgesic effect on localized pain, with a lower risk of systemic drug interactions. We report a case of post-herpetic pain successfully treated by this technique. This case confirms that the intradermal administration technique (mesotherapy), which is based on the pathophysiology of the disorder, according to the recommendations, can contribute to the management of patients who do not tolerate standard therapies.

Androgenetic alopecia (AGA) with its precursor miniaturization of anagen phase (MA) and telogen effluvium (TE) represent nonscarring hair loss diseases which causes moderate to severe aesthetic and psychologic discomfort in affected people. Several therapeutic approaches have been tested through the latest decades, with different degree of success. In this study we aim to analyze the efficacy and outcome of an innovative therapeutic protocol, named TRICHOBIOLIGHT, a combination of active principles conveyed by mesotherapy directly on the scalp with a subsequent photobiostimulation session with LED light (630 nm). About 107 patients (49 women, 58 men, mean age 45-year-old) with clinical and trichoscopic diagnosis of MA, AGA, and TE have been enrolled at Skin Center of L'Aquila, Avezzano and Pescara (Italy) and subsequently treated with the TRICHOBIOLIGHT protocol. 4 patients dropped out at the beginning of the study: 2 patients because of an histological diagnosis of scarring alopecia and lichen scleroatrophicus, and 2 patients dropped out because of adverse reaction to the treatment. Excellent to good outcome have been reached in the 82.5% of patients (85/103), 9 patients (8.7%) reached a sufficient result while 7 patients (6.8%) partially respond to the treatment. Two patients (2%) did not respond at all. TRICHOBIOLIGHT is a promising protocol, working through the combined action of the active principles and the photobiostimulation, that lead to a strengthening and thickening of the residual hair, giving an optical thickening effect that provides high quality aesthetic results and, consequently, appreciable psychological results.

Melasma is a recalcitrant pigmentary disease with a complex pathogenesis. Monotherapy often results in unsatisfactory results with high recurrence rate. In this review article, we evaluate efficacy of energy-based devices combination therapy for melasma. We reviewed published literature since 2010 up to November 2020 regarding adjuvant therapy of energy-based devices with other treatment modalities in the treatment of melasma. After final selection, we assessed 49 articles. Energy-based devices include lasers, non-coherent lights, radiofrequency, iontophoresis, sonophoresis, microneedling, and microdermabrasion. Adjuvant therapies other than energy-based devices were lightening agents, chemical peels, platelet rich plasma (PRP) and mesotherapy. Combination of Q-switched neodymium-doped: yttrium, aluminum, and garnet (QSNY) with either intense pulsed light therapy (IPL) or pulsed-dye laser (PDL) are recommended in recalcitrant melasma in patients with light skin photo types and with dilated skin vessels (especially with PDL). Combination of fractional microneedling radiofrequency or microneedling with QSNY leads to promising results and is a safe treatment modality, especially in darker skin types. Application of topical lightening agents in combination with laser therapy leads to higher efficacy with less adverse effects (post-inflammatory hyperpigmentation) and rebound of melasma. Combination of ablative techniques with QSNY is not recommended, due to the high risk of permanent adverse effects such as guttate hypopigmentation and exacerbation of melasma.