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BackgroundDyschromia can be associated with increased production and/or reduced clearance of pigmentation in the skin. Multiple pathways are involved in causality. A novel topical product was recently developed, which contains actives that have been validated through in-vitro and clinical studies to counteract pigmentation related to photodamage, PIH, and melasma. This study further evaluates the safety and efficacy of this product for facial dyschromia during an additional 3-month extension period following the completion of the previous 12-week multi-center trial.  Study Design: Subjects from the previous multi-center trial with mild to severe facial dyschromia at baseline were eligible to participate in this 3-month extension study upon completion of that trial. This extension study evaluated the continued use of the novel topical product with PATH-3 Technology (Alastin Skincare, Carlsbad, CA) over a 3-month period. Subjects who were previously randomized to the novel topical product continued using it and for those previously randomized to hydroquinone 4% discontinued its use. Both cohorts continued daily sunscreen use. Blinded investigators assessed subjects at follow-up visits at 16, 20, and 24 weeks.ResultsTwenty-six (26) subjects completed the extension phase of the pivotal trial, with 13 subjects in each of the AL and HQ-BREAK cohorts. Significant improvements were seen within the AL cohort from weeks 12 to 24 for facial dyschromia (P=0.0158) and skin tone/clarity/evenness (P=0.0067), while there were no significant improvements seen in the HQ-BREAK cohort. The HQ-BREAK cohort had more subjects who worsened with facial dyschromia and skin tone/clarity/evenness. For the mMASI, the HQ-BREAK cohort demonstrated regression at week 24 compared to week 12, while the AL cohort instead experienced continued improvement. This difference was found to be significant (P=0.02). No study-related adverse events were reported for either cohort.  Conclusion: A novel topical product designed to counteract various steps in pigmentation pathways using PATH-3 Technology has been demonstrated to be safe and effective in treating facial dyschromia on a long-term basis. In contrast to the significant rebound experienced by subjects with HQ, the AL cohort continued to demonstrate ongoing improvement. J Drugs Dermatol. 2024;23(1):1266-1270.     doi:10.36849/JDD.7622.

ABSTRACT Background Objective Methods Conclusion 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. [ABSTRACT FROM AUTHOR]

Background: Melasma is a prevalent pigmented disease, yet its pathogenesis remains unclear, posing challenges for effective treatment. Bibliometric analysis, a novel approach to literature research, offers the opportunity to evaluate research trends through qualitative and quantitative methods. This study utilizes bibliometric methods to analyze the existing literature on melasma treatment, examining influential publications, institutions, countries, and authors through statistical analysis. Methods: In order to retrieve manuscripts related to the topic of melasma treatment, we conducted a search using the search formula: (TS = (melasma or Chloasma or "mask of pregnancy")) AND TS = (treatment or therapy). We searched through the Web of Science Core Collection database, covering publications from 2000 to 2023. VOSviewer, CiteSpace and the Bibliometric online site (https://bibliometric.com/app) were used to conduct this bibliometric analysis. Our analysis focused on various factors including publications, authors co‐authorship, institutions, countries, citation analysis, keywords co‐occurrence, references co‐citation and journal co‐citation. Results: A total of 943 articles and 200 reviews were published between 2000 and 2023, accumulating a total of 8628 citations. The average number of citations per item was 18.85, and the average number of citations per year was 292.69. The most prolific author, Sungeun Chang, contributed a total of 9 articles. Cario University emerged as the top research institution. The United States led in terms of article publications with a count of 276. In the past 5 years, the research trends in this field have primarily focused on tranexamic acid and epidermal melasma, as indicated by the burst analysis of publications and keywords. Conclusions: The United States continues to lead in terms of institutions and research output. The current emphasis is on the meticulous implementation of tranexamic acid and laser therapy. It is crucial to foster enhanced collaboration among countries, institutions, and authors to facilitate improved research. [ABSTRACT FROM AUTHOR]

Background: The picosecond 755‐nm alexandrite laser and topical tranexamic acid (TA) have shown promise in treating melasma. Aim: This aim of this study was to evaluate the efficacy and safety of combining to a picosecond 755‐nm alexandrite laser combined with topical TA for melasma treatment. Patients and Methods: Forty‐eight patients' facial halves with bilateral symmetrical melasma were randomized to receive either topical TA and picosecond laser treatment or laser monotherapy. All patients received three consecutive picosecond laser treatment sessions at 4‐week intervals, and additional one side facial received topical TA treatment twice daily until 4 weeks after the third treatments. Efficacy was assessed using the Modified Melasma Area and Severity Index (mMASI) score, VISIA (Canfield, USA) red area feature counts, and average pore volume as measured by Antera 3D®. Patient satisfaction was evaluated through questionnaires. Results: Thirty‐five patients completed the study. Post‐treatment, mMASI scores and VISIA red area feature counts were lower in combination therapy halves and laser monotherapy halves, and average melanin level was lower in the combination therapy halves (p < 0.05). Comparisons between the combination therapy halves and laser monotherapy halves after the third treatment revealed significant differences in mMASI scores, melanin levels, and VISIA red area feature counts (p < 0.05). After treatment, patient satisfaction rates in the combination therapy halves and monotherapy halves was 71.4% and 54.3%, respectively (p < 0.05). No obvious adverse effects were observed in the combination therapy halves; whereas, 10.42% (5/48) of participants in the laser monotherapy halves experienced temporary pigmentation, which resolved within 3 months. Conclusion: The picosecond 755‐nm alexandrite laser, when used independently and in combination with topical TA, has been proven to be effective in the improvement of melasma. However, the combined treatment approach showed a more pronounced improvement in melasma symptoms, with higher patient satisfaction, and was associated with a lower incidence of adverse effects. These findings strongly support that integrating topical TA with picosecond laser therapy as a superior therapeutic strategy for melasma management. Clinical Trial Registration: Chinese Clinical Trial Registry: ChiCTR2200057771. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions 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. [ABSTRACT FROM AUTHOR]

Melanized focal changes (MFCs) in the fillet of farmed Atlantic salmon is a major quality concern. The changes are thought to initially appear as acute red focal changes (RFCs) that progress into chronic MFCs. Recent findings have indicated that hypoxia may be important in their development, possibly leading to necrosis affecting not only myocytes but also adipocytes. Thus, the aim of this study was to investigate possible hypoxic conditions in RFCs and the subsequent inflammatory responses and lesions in the adipose tissue in RFCs and MFCs. A collection of RFCs, MFCs and control muscle samples from several groups of farmed salmon was studied. Using immunohistochemistry, we found induction of the hypoxia‐inducible factor 1 pathway in RFCs. Histological investigations of RFCs and MFCs revealed different stages of fat necrosis, including necrotic adipocytes, a myospherulosis‐like reaction and the formation of pseudocystic spaces. Accumulations of foamy macrophages were detected in MFCs, indicating degradation and phagocytosis of lipids. Using in situ hybridization, we showed the presence of tyrosinase‐ and tyrosinase‐related protein‐1‐expressing amelanotic cells in RFCs, which in turn became melanized in MFCs. In conclusion, we propose a sequence of events leading to the formation of MFCs, highlighting the pivotal role of adiposity, hypoxia and fat necrosis. [ABSTRACT FROM AUTHOR]

Context • Pigmented dermatoses are skin diseases characterized by pigmentation changes in the skin’s surface due to abnormal melanocyte production. Photon-skin- rejuvenation technology can be effective for the management of facial pigmented dermatoses. Black Gold Delicate Pulse Light (DPL) Super Photon Skin Rejuvenation therapy is a new technology based on traditional photo rejuvenation. Objective • The study intended to evaluate the therapeutic efficacy of DPL therapy in the management of targeted pigmented skin diseases, such as melasma, solar lentigines, and postinflammatory hyperpigmentation. Design • The research team conducted a prospective cohort study. Setting • The study took place at Department of Dermatology, Affiliated Hospital of Shaoxing University, Shaoxing, China. Participants • Participants were 130 patients with facial pigmented dermatoses treated at the hospital between February 2021 and December 2021. Interventions • The research team assigned participants to one of two groups, with 65 participants in each group: (1) the control group, the intense pulsed light (IPL) group, who received IPL treatment, and (2) the intervention group, the DPL group, who received black gold DPL super photon skin rejuvenation. Both groups received the treatments once a month for 6 months. Outcome Measures • At baseline and postintervention for both groups, the research team: (1) collected 5 ml of fasting venous blood from participants and measured serum concentrations of melatonin (MEL), vascular endothelial growth factor (VEGF) and endothelin-1 (ET- 1) using enzyme-linked immunosorbent assay (ELISA); (2) assessed the degree of reduction of facial pigmentation using the Visia skin test and each participant’s clinical results and calculated total efficacy; and (3) monitored and recorded adverse events. Results • Compared to the IPL group, the DPL group: (1) had greater symptom mitigation of the facial pigmented dermatosis, as evinced by significantly lower serum MEL (P = .001) and ET-1 (P = .020) concentrations and higher VEGF levels (P = .001); (2) for participants with freckles (P = .045), cafe-au-lait spots (P = .021), or post-acne hyperpigmentation (P = .029), had a significantly higher total efficacy; and (3) had a lower incidence of adverse events (P = .041). Conclusions • Black Gold DPL Super Photon Skin Rejuvenation offers a significantly higher safety profile and treatment efficacy for pigmented-skin diseases compared to IPL treatment. These promising results suggest potential for its use in clinical practice, but clinical adoption requires future trials. [ABSTRACT FROM AUTHOR]

Melanosis in seafood is a natural post-mortem enzymatic process that results from the action of polyphenol oxidase from the animal’s own tissues. It reduces the organoleptic quality of the shrimp and their commercial value. This work concerns prevention of melanosis in pink shrimp (Parapenaeus longirostris) using the latest technology of enzymatic biosensor for sulphite detection. Three application methods (dipping, dusting, and spraying) with four commercial products were tested. Sulphite concentrations (1–3%) were applied for 1–10 min. Parameters measured included residual SO2 levels, pH, melanosis, and odour. Findings showed that the dusting method gave the best sensory scores, but had harmful residual SO2 values. The dipping method provided safe SO₂ levels below normative limits, when using products with 240 g Kg−1 SO₂ content applied at 1.25% bisulphite/seawater for 1 minute. Regarding the spraying method, the results remain promising. Nevertheless, further studies are necessary to understand its potential and limitations fully. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions Tumoral melanosis (TM) is a histological term to describe a nodular aggregation of macrophages containing melanin pigment (melanophages) that is devoid of viable melanocytes. It is most often identified in skin, where it may be appreciated clinically as a pigmented lesion; however, it can also be found in other organs such as lymph nodes. The presence of TM is usually thought to signify the presence of a regressed melanoma or other pigmented tumor. Until recently, it was a relatively uncommon finding; however, with the use of effective systemic therapies against melanoma, its occurrence in histological specimens is more frequent.We identified and reviewed all histopathological diagnoses of TM at any organ site reported at a single institution from 2006 to 2018. TM cases were paired with non‐TM cases of cutaneous melanoma through propensity score matching at a 1:2 ratio, and their survival outcomes were compared. The clinical outcomes examined included recurrence‐free survival (RFS), distant disease‐free survival (DDFS), melanoma‐specific survival (MSS), and overall survival (OS).TM was reported in 79 patients. Their median age was 65 years (range 22–88), with a 2:1 male predominance (51 out of 79, 65%). The most common organ involved was the skin (67%), with a third of all cases localized to a lower limb (36%). TM had a strong association with the presence of melanoma (91%) and regression at other sites of melanoma (54%), suggesting that it is part of a systemic immune response against melanoma. Most patients with TM either previously or subsequently developed histologically confirmed melanoma in the same anatomical region as the TM (89%). Thirty‐five TM patients were matched with 70 non‐TM cases. Patients with melanoma who developed TM without prior regional or systemic therapy showed improved MSS (p = 0.03), whereas no statistically significant differences were observed in terms of RFS, DDFS, and OS.TM usually occurs in the context of a previous or subsequent cutaneous melanoma and is associated with improved MSS. It is important that TM is recognized by pathologists and documented in pathology reports. [ABSTRACT FROM AUTHOR]

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

Background: Melasma is a persistent and recurrent pigmentation disorder. It is a skin condition that affects facial skin esthetics and can lower self-esteem, causing emotional distress, which can lower a person's quality of life (QoL). Aims and Objectives: To study the correlation of Hindi-Melasma Quality of Life Index (Hi-MELASQOL) in relation with Melasma Area and Severity Index (MASI) and to analyze the different patterns and influence of melasma on life quality. Materials and Methods: This was a cross-sectional study involving 100 subjects. Hi-MELASQOL questionnaire comprising 10 items was used to assess the patient's QoL. MASI score was used to determine the severity of melasma. All the collected data were recorded, processed, and statistically analyzed using Epi Info 2000 and SPSS Inc., 20.0. Results: A significant association was observed between the Hi-MELASQoL and MASI scores. It was evident that melasma had an adverse impact on the patients' QoL. The association between MASI score and type of melasma had P < 0.05 and hence showed a statistically significant association between them. However, the association between Hi-MELASQOL score (individually and total) and the type of melasma was statistically insignificant. The most common type was centrofacial (71%), followed by malar (25%) and mandibular (5%). Conclusion: There was a significant impairment in the QoL in our study population due to melasma as assessed by Hi-MELASQOL and MASI score. Utilization of Hi-MELASQOL scale should be considered in the evaluation of QoL of patients affected with melasma. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The Alma Hybrid™ not only bridges the gap between traditional ablative and non-ablative laser treatments but also introduces enhanced transdermal delivery through the Impact Handpiece, utilising ultrasound technology. This integration allows for the effective treatment of a wide range of dermatological concerns, including scar revision, skin rejuvenation, and resurfacing (Arellano-Huacuja, 2023; Arellano et al, 2023b). This article aims to provide an examination of the clinical evidence supporting the Alma Hybrid™ system, with a focus on its integration into treatment plans for aesthetic and dermatological practices. Through an analysis of patient case studies and a review of the literature, this paper will demonstrate how the Alma Hybrid™ can be employed to enhance patient outcomes, particularly in challenging cases such as hypertrophic and atrophic scars. Furthermore, we will explore the system's efficacy across diverse patient demographics, with an emphasis on its safety profile in treating different Fitzpatrick skin types. [ABSTRACT FROM AUTHOR]

Hyperpigmentation is a skin disorder characterized by excessive production of melanin in the skin and includes dyschromias such as post-inflammatory hyperchromias, lentigens, melasma and chloasma. Topical products containing depigmenting agents offer a less aggressive treatment option for hyperpigmentation compared to methods like chemical peels and laser sessions. However, some of these agents can cause side effects such as redness and skin irritation. Encapsulating these actives in nanosystems shows promise in mitigating these effects and improving product safety and efficacy. In addition, nanocarriers have the ability to penetrate the skin, potentially allowing for targeted delivery of actives to the affected areas. The most commonly investigated nanosystems are nanoemulsions, vesicular nanosystems and nanoparticles, in which different materials can be used to generate different compositions in order to improve the properties of these nanocarriers. Nanocarriers have already been widely explored, but it is necessary to understand the evolution of these technologies when applied to the treatment of skin hyperchromias. Therefore, this literature review aims to present the state of the art over the last 15 years on the use of nanosystems as a potential strategy for encapsulating depigmenting actives for potential application in cosmetic products for skin hyperchromia. By providing a comprehensive overview of the latest research findings and technological advances, this article can contribute to improving the care and quality of life of people affected by this skin condition. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Methods Results Conclusion Melasma is a therapeutically challenging hyperpigmented skin condition. Currently, there is a lack of in vivo observation regarding changes in melanin and dendritic melanocytes after laser treatment.To investigate alterations in melanin and melanocytes in melasma before and after laser treatment using optical coherence tomography (OCT).Eight female melasma patients were enrolled in Taiwan. Based on the baseline OCT scans, the patients were categorized into either epidermal‐type or mixed‐type melasma and were assigned different treatment protocols accordingly. Sequential OCT images were collected from melasma lesions and normal skin at baseline, Week 4 and Week 8.After 8 weeks of laser treatment, the mean Melasma Area Severity Index (MASI) score improved from 10.92 to 6.30. Results from OCT showed no significant changes in the normalized density, area, or intensity of melanin in both lesional and normal skin. At baseline, the mean length of dendritic melanocytes in the affected skin was 15% longer than those in normal skin; at Week 8, the mean length of lesional dendritic melanocytes became the same as those in normal skin. Additionally, the mean width of dendritic melanocytes decreased from being 4% wider to only 2% wider than those in normal skin.After 8 weeks of treatment, an improvement of MASI score was noted, mainly attributable to a reduction in lesional area. OCT showed no notable change regarding melanin, but a decrease in length and width of dendritic melanocytes was noted in the lesional skin of melasma patients. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Prospective investigation to determine the prevalence of ocular melanosis in adult Cairn Terriers within the United Kingdom using a previously established staging scheme.Ophthalmic assessment was performed on adult Cairn Terriers, recruited from various geographic locations within the United Kingdom. Examination included gonioscopy, rebound tonometry, slit lamp biomicroscopy, and indirect ophthalmoscopy, performed by one examiner (AM).A total of 93 dogs were examined, including 52 females and 41 males, aged between 15 months and 16 years 4 months. Sixty of 93 dogs (64.5%) were >7 years of age. Nine of 93 dogs (9.6%) demonstrated changes consistent with ocular melanosis. Four of 9 (44.4%) had Stage 1 disease and 5 of 9 (55.6%), Stage 2. Stages 3 or 4 were not identified in any dogs. Mean intraocular pressures in affected and unaffected dogs were 14.7 mmHg (range 12–17 mmHg) and 12.8 mmHg (range 5–21 mmHg), respectively. Incomplete pupil dilation was noted in affected dogs following pharmacologic mydriasis.Ocular melanosis was identified in approximately 10% of examined dogs, over half were dogs of breeding age (<7 years of age). It is possible that Grade 1 disease could go undetected, prior to obvious scleral pigment accumulation (Grade 2 disease). It is therefore recommended that dogs undergoing pre‐breeding screens have pre‐dilation assessment of the anterior segment using slit lamp biomicroscopy with subsequent gonioscopy to clearly assess for circumferential thickening of the iris base that might otherwise go undetected. Additionally, regular reassessment of breeding dogs is advised as disease progression could be rapid. [ABSTRACT FROM AUTHOR]

Melasma is a prevalent and challenging skin condition that affects the face and causes distress in many patients and physicians. Tranexamic acid (TA) has been found to be effective for treating melasma and can be administered through multiple routes. This review details the mechanisms of action of TA in treatment of melasma and assesses the efficacy and safety associated with different administrations, which can contribute to selecting appropriate melasma treatment plan for different patients. [ABSTRACT FROM AUTHOR]

Background: There is controversy on the efficacy and safety of chemical peels used to treat Hispanic women with melasma. Studies evaluating superficial peels for melasma are limited due to lack of controls, blinding or objective assessment tools, poor inclusion of darker phototypes, and small sample number. Objectives: We sought to evaluate the safety and efficacy of trichloroacetic acid (TCA) peels when added to hydroquinone and tretinoin in the treatment of melasma in Hispanic women. Methods: A single blinded, prospective, split-face trial of superficial TCA peels was performed on Hispanic women with melasma. Topical hydroquinone and tretinoin were used on both sides. A total of four monthly peels were performed on one side. The relative reduction of melasma severity was evaluated using narrowband reflectance spectrophotometry (NRS), Modified Melasma Area and Severity Index (mMASI), and Global Melasma Severity Assessment (GMSA). Adverse events were monitored. Results: Thirty-three patients completed the study. Pigment intensity was reduced on both sides based on all measures. A greater improvement of mMASI and GMSA was achieved on the peeled side. Limitations: Limitations include the single-center study design with one blinded investigator. Conclusion: Based on our results, TCA peels appear to be safe and effective in augmenting treatment response on melasma patients with phototypes III and IV treated with hydroquinone and tretinoin. [ABSTRACT FROM AUTHOR]

Melasma is a common acquired hyperpigmentation disorder that predominantly affects females with skin of colour. It is difficult to treat and impacts on people's quality of life, owing to its predilection for the face. In addition to helping make the correct diagnosis, dermoscopy can assist in the exclusion of differential diagnoses, to inform treatment decision-making and to recognize treatment-related adverse effects. [ABSTRACT FROM AUTHOR]

Objective: Melasma is a multifactorial, chronic, acquired skin disorder of hyperpigmentation. Terminalia chebula Retz. (T. chebula) has shown antioxidant, anti-inflammatory and tyrosinase enzyme inhibitory activities. So, the present study was designed to evaluate the efficacy of T. chebula 5% cream compared to hydroquinone 2% cream in treating patients with melasma. Materials and Methods: The formulation of T. chebula 5% cream was prepared. The stability and release study of the cream were performed. In this randomized, controlled, triple-blind clinical trial, participants with facial melasma were randomly assigned to receive T. chebula 5% cream or hydroquinone 2% cream at bedtime for 12 weeks. Modified Melasma Area and Severity Index (mMASI) scores were recorded for all the participants at the baseline and 4, 8, and 12 weeks after initiating the study. Results: No statistically significant differences regarding mMASI scores were detected between T. chebula and hydroquinone groups at each time point. The reduction in mMASI scores was statistically significant (p<0.05) in T. chebula group 4, 8, and 12 weeks after initiating the study. However, it reached statistical significance (p<0.05) in hydroquinone group 8, and 12 weeks after the study initiation. The frequencies of side effects especially skin irritation were significantly (p<0.05) lower in T. chebula group. Conclusion: T. chebula 5% cream could be as effective as hydroquinone 2% cream in treating melasma with fewer side effects. [ABSTRACT FROM AUTHOR]

Melasma is a chronic, acquired disorder of focal hypermelanosis that carries significant psychosocial impact and is challenging for both the patient and the treating practitioner to manage in the medium to long term. Multiple treatments have been explored, often in combination given the many aetiological factors involved in its pathogenesis. Therapeutic discoveries to treat melasma are a focal topic in the literature and include a range of modalities, with recent developments including updates on visible light photoprotection, non-hydroquinone depigmenting agents, oral tranexamic acid, chemical peels, and laser and energy-based device therapy for melasma. It is increasingly important yet challenging to remain up-to-date on the arsenal of treatments available for melasma to find an efficacious and well-tolerated option for our patients. [ABSTRACT FROM AUTHOR]

Background: The exact pathogenesis of melasma is not yet known, and its treatment remains challenging. Mesotherapy with tranexamic acid (TXA) and vitamin C was both reported to have certain effects on melasma. In spite of that several articles have compared the efficacy and safety of the two drugs on melasma, most of them were clinical study with small sample size. Aims: To evaluate the efficacy and safety of mesotherapy with TXA versus vitamin C in treating melasma through meta‐analysis and systemic review. Methods: The authors searched PubMed, Web of Science, Springer, and ScienceDirect for studies that compared mesotherapy with TXA versus vitamin C as a treatment for melasma. Primary outcomes were change in melasma area and severity index (MASI) before and after the treatment. Results: Finally, five studies with a total of 127 patients were included in the systematic review. There was no statistic difference in the change in MASI score between the TXA and vitamin C groups (mean difference, 0.16; 95% CI, −0.79 to 1.11). Conclusions: Mesotherapy with both TXA and vitamin C is safe and effective in the treatment of melasma. [ABSTRACT FROM AUTHOR]

Background: Clobetasol has demonstrated remarkable results in treating melasma within a short time frame; however, its use is limited because of the risk of local side effects. To date, there is no controlled trial on sequential clobetasol/hydroquinone for melasma. This study aimed to investigate the tolerability and efficacy of 0.05% clobetasol followed by 4% hydroquinone (CLOB‐HQ) in comparison to the isolated use of 4% hydroquinone (HQ). Methods: A double‐blinded, randomized clinical trial involving 50 women with facial melasma was performed. They were directed to apply 0.05% clobetasol every night for 14 days, followed by 4% hydroquinone for 46 days (CLOB‐HQ group), or the use of hydroquinone for 60 days (HQ group). Evaluations were carried out at inclusion, and after 14 and 60 days of treatment, measuring modified Melasma Area and Severity Index (mMASI), Melasma Quality of Life scale (MELASQoL), and colorimetry. The Global Aesthetic Improvement Scale (GAIS) was assessed by a blinded evaluator. Results: There was no difference in the main outcomes at D14 and D60 (P > 0.1). For CLOB‐HQ, the mean (CI 95%) reduction in mMASI was 13.2% (5.1–21.3%) and 43.1% (32.2–54.0%) at D14 and D60, and for HQ, they were 10.6% (5.9–27.5%) and 44.8% (33.2–52.3%). The MELASQoL, colorimetric luminosity, and GAIS showed a progressive improvement for both groups despite no difference between them. No severe side effects were identified. No cases of telangiectasias, atrophy, or perioral dermatitis were associated with the use of CLOB. Conclusion: The sequential CLOB‐HQ regimen was safe and well tolerated, even though its efficacy was not different from HQ after 14 or 60 days of treatment. Based on these findings, the use of clobetasol 14 days before hydroquinone is not advisable for the treatment of melasma. [ABSTRACT FROM AUTHOR]

Background: Melasma is a common pigmentary and photoaging disorder. Although various treatments, including 1,064‐nm Q‐switched neodymium‐doped yttrium aluminum garnet (QS‐Nd: YAG) laser toning, are available for melasma, results are often unsatisfactory. Objective: We aimed to determine the efficacy and safety of 532‐nm QS‐Nd: YAG laser (shortwave toning) in patients with melasma and facial rejuvenation. Methods: Fifty‐two patients were recruited to receive either 1,064‐nm QS‐Nd: YAG laser or 532‐nm QS‐Nd: YAG laser every 2 weeks for 8 sessions and a 2‐month follow‐up visit in a randomized controlled double‐blinded study. The primary outcome measure was the Melasma Area and Severity Index (MASI) score. Dermoscope and high‐frequency ultrasound (HFUS) were used to assess the improvement of melasma and photoaging. Results: 532‐nm QS‐Nd: YAG laser achieved significantly higher improvement in the MASI score (P = 0.000). The Dermoscopic melasma score (DMS) displayed significant change and confirmed the improvement. HFUS showed a significant decrease in the thickness of the subepidermal low‐echogenic band (SLEB) and increases in dermal thickness and dermal density in both groups (P = 0.000 for all). The rate of very satisfied responses was significantly higher in the 532‐nm laser group (P = 0.001). There was no significant difference in the visual analog scale pain assessment score (P = 0.248) and recurrence rate (P = 0.734) between the two groups. Conclusion: 532‐nm QS‐Nd: YAG laser (shortwave toning) proved to be an effective and safe treatment for melasma and rejuvenation. Shortwave toning was significantly better for pigmentation clearance, while 1,064‐nm laser showed better improvement in skin rejuvenation. [ABSTRACT FROM AUTHOR]

Melanosis coli occurs with the administration of stimulant laxatives for the relief of constipation. However, the duration of macroscopic improvement of melanosis coli after discontinuation of anthracene laxatives is not well understood. We describe the case of an 81-year-old female diagnosed with melanosis coli via colonoscopy who had been taking senna laxatives for 5 years. Seven months after cessation of senna laxatives, colonoscopy showed no melanosis coli in the colon. This impressive report describes the observation of melanosis coli with colonoscopy; 7 months after the withdrawal of senna stimulant laxatives, melanosis coli resolved. [ABSTRACT FROM AUTHOR]

Antarctic krill (Euphausia superba) is a vital species in the Antarctic ecosystem, boasting substantial reserves and high nutritional value. It has emerged as a significant commercial fishery resource in the Southern Ocean. However, because of its exceptionally high autolytic enzyme activity, it is susceptible to autolysis and blackening during processing, storage, and transportation, resulting in a decline in the sensory quality and nutritional value of raw materials. Shrimp melanosis is caused by a series of enzymatic reactions mediated by phenoloxidase (PO) within the body. PO facilitates the oxidation of phenolic substances, leading to the formation of highly unstable quinone compounds, which further react to produce melanin. The accumulation of melanin significantly affects the appearance of Antarctic krill, thereby reducing its commercial value. On account of their cost-effectiveness and potent anti-blackening effects, sulfites are commonly used as shrimp anti-black agents. Sodium metabisulfite is one of the compounds whose use is allowed for shrimp preservation under GB 2760-2014 regulations. It not only inhibits PO activity, but also reduces quinone compounds to prevent blackening. However, excessive sulfite use can lead to discomfort and health issues such as gastrointestinal problems, liver disturbances, dyspnea, vomiting, diarrhea, and headaches. Therefore, GB 2760-2014 regulations stipulate that the residual SO2 content should not exceed 0.1 g/kg. Currently, the use of sodium metabisulfite in production is widespread but lacks standardized requirements, with limited guidance available on how to regulate its usage. Therefore, to assess the impact of sodium metabisulfite on blackening control in Antarctic krill and refine the treatment process, experiments were conducted to measure the changes in SO2 residue and PO activity in Antarctic krill subjected to various concentrations of sodium metabisulfite solutions and soaking times. Furthermore, observations and analyses were conducted to monitor the blackening of Antarctic krill during cold storage and frozen storage. The results demonstrated a positive correlation between the SO2 residue in Antarctic krill and the concentration of sodium metabisulfite solution. A concentration of 1 g/L sodium metabisulfite solution resulted in a SO2 residue of 0.065 g/kg in Antarctic krill, which is below the national standard limit of 0.1 g/kg. However, treatment with a 2 g/L solution led to a SO2 residue of 0.166 g/kg in shrimp, exceeding the national standard limit. Treatment with a 3 g/L solution resulted in a SO2 residue of 0.254 g/kg in shrimp, which significantly surpassed the national standard limit. Consequently, we recommended using 1 g/L or 2 g/L sodium metabisulfite solutions to prevent blackening in Antarctic krill while maintaining the SO2 residue below 0.1 g/kg. Under these conditions, the treatment time for a 1 g/L sodium pyrosulfite solution could be extended to 300 s, with a relative PO activity of 21.2%. For a 2.0 g/L sodium pyrosulfite solution, a treatment time of 30 s was suitable, yielding a relative PO activity of 34.5%. During storage, the control group exhibited noticeable blackening after storage at 4 ℃ for 24 h and frozen storage for 6 months, predominantly in the head, chest, abdomen, and tail sections, and slight variations were observed in the blackening process among individuals. Compared with the control group, the sodium metabisulfite treatment group displayed significantly lower blackening scores during storage (P < 0.05). Specifically, the 1 g/L sodium metabisulfite solution with 300 s treatment group and the 2 g/L sodium metabisulfite solution with 30 s treatment group showed obvious blackening at 48 h and 72 h of cold storage, respectively, and after 12 months of frozen storage, indicating that higher concentrations of sodium metabisulfite solution during treatment led to a better control effect on the blackening of Antarctic krill during storage. Notably, PO activity is just one of the factors influencing the melanosis process. Although the 1 g/L sodium metabisulfite solution with treatment for 300 s could better inhibit PO activity, the anti-blackening effect of this group was not as pronounced as that of the 2 g/L sodium metabisulfite solution with treatment for 30 s during storage. In summary, soaking in 1 g/L sodium metabisulfite solution for 300 s and 2 g/L sodium metabisulfite solution for 30 s resulted in relative PO enzyme activities of 21.2% and 34.5%, respectively. Simultaneously, the SO2 residues in shrimp were measured at 0.094 g/kg and 0.096 g/kg, respectively, meeting the GB 2760-2014 limit of SO2 residue not exceeding 0.1 g/kg. Compared with the control group, sodium metabisulfite treatment effectively delayed the blackening process of Antarctic krill during cold storage and frozen storage, with the 2 g/L sodium metabisulfite solution soaking for 30 s exhibiting superior anti-blackening effects. This suggests that a high concentration of sodium metabisulfite solution and a short treatment period had a better blackening inhibition effect. These findings offer a theoretical foundation and technical guidance for maintaining the quality of Antarctic krill during storage and transportation.