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Background: The challenging management of melasma highlights the inadequacies of conventional therapies and their high risk of recurrence. Integrating microneedling for device‐assisted drug delivery with tranexamic acid (TA), recognized for its melanin synthesis inhibition, presents a novel approach that warrants further investigation to fully assess its potential in enhancing melasma treatment efficacy. Methods: Fifty moderate to severe melasma patients participated in this randomized outcome‐assessor‐blinded controlled trial. Patients were randomly allocated into two main groups. Group A received a modified Kligman formula on one hemi‐face on alternate nights for 2 months (A1) and three sessions of microneedling with 10% topical TA on the other hemi‐face at 1‐month intervals (A2). Group B used the same modified Kligman formula on both sides of the face, with one side additionally receiving three sessions of microneedling with 4% TA (B1) and the opposite side with 10% TA (B2). Primary outcomes were % Modified Melasma Area and Severity Index (mMASI) and % visual analogue scale (VAS) change during 6 month follow‐up. Adverse events including post‐inflammatory hyperpigmentation (PIH) and treatment tolerability were recorded. Results: Compared to baseline, the mean mMASI reduction immediately after the final session was higher in A1, B1, and B2 (56.84%, 50.88%, and 55.87%, respectively) than in A2, which saw only a 13.16% reduction. Efficacy notably declined after the cessation of treatment across all groups. While the efficacy within groups A1, B1, and B2 was comparable, microneedling with 4% or 10% TA combined with the topical modified Kligman formula proved more potent in patients at a lower risk of PIH. Overall, 22% of patients reported PIH, particularly in the A2 group (28% of hemi‐faces), with its occurrence significantly associated with treatment during warmer seasons and in darker skin phototypes. Other adverse events were not observed in any patient. Patient satisfaction was highest in groups B1 and B2, where approximately 72% reported 'excellent' satisfaction. The lowest durability rate (16%) was observed in group A2, while the highest (72%) was seen in group B2, comparable with groups A1 and B1. Treatment tolerability was reported 100% in all groups. Conclusion: It was found that the modified Kligman formula outperformed microneedling‐TA alone. However, with optimal patient selection, particularly targeting those at lower risk for PIH with lighter skin phototypes and scheduling treatments during less‐sunny seasons, combining microneedling with 4% or 10% TA and the modified Kligman formula significantly enhanced efficacy and satisfaction rates compared to conventional topical treatment. [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]

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

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]

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]

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: Dark‐skinned individuals (DSI) present high rates of melasma and post‐inflammatory hyperpigmentation. The use of sunscreens with mineral filters is essential for prevention and treatment. Our objective was to determine the preferences of dermatologists and dermatology residents in the prescription of sunscreens for DSI. Methods: An anonymous survey of attendees at an online photoprotection event held on March 31, 2022, in Spain. Results: The survey was answered by 66.6% (221/332) of the attendees: 159 dermatologists (71.9%) and 62 dermatology residents (28.1%). Respondents reported recommending the use of sunscreen to a median of 80% of DSI [interquartile range (IQR), 50–90]. Physicians reported prescribing tinted sunscreens to a median percentage of 60% (IQR, 25–90) of DSI with acne; and to a median percentage of 90% (IQR, 58–99) of DSI with melasma. The most prescribed photoprotectors to DSI with melasma were organic broad‐spectrum sunscreens with antioxidants: 102/220 (46.4%) and mineral broad‐spectrum sunscreens (with iron oxides): 45/220 (20.4%). In DSI with melasma or other pigmentary disorders, the most preferred features of sunscreens were as follows: sun protection factor ≥ 30: 217/221 (98.2%), UVA protection: 214/221 (96.8%), color for camouflage: 150/220 (68.2%) and mineral filters such as titanium dioxide and zinc oxide: 151/220 (68.6%) or iron oxides: 131/220 (59.5%). Limitations: Online survey, potential inclusion bias. Conclusions: Respondents reported to prescribe sunscreens to the majority of DSI, and tinted sunscreens for the majority of DSI with pigmentary disorders. However, the most frequently recommended sunscreens for DSI were organic broad‐spectrum sunscreens with antioxidants. [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]

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]

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]

Xiaoyue Feng,1,&ast; Jianli Shang,1,&ast; Zhengping Gu,1 Junhua Gong,1 Yong Chen,1,2 Youting Liu1,2 1R&D Department, Beijing UPROVEN Medical Technology Co., Ltd., Beijing, Daxing, People’s Republic of China; 2Beijing UPROVEN Institute of Dermatology, Beijing, Daxing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Youting Liu, R&D Department, Beijing UPROVEN Medical Technology Co., Ltd., Yard 5, Tianhua Avenue, Beijing, Daxing, 102699, People’s Republic of China, Tel +86 18510256963, Email YtLiu.adpt@outlook.comAbstract: AZA is a non-phenolic, saturated dicarboxylic acid with nine carbon atoms, naturally produced by the yeast Malassezia. It has diverse physiological activities, including antibacterial, anti-keratinizing, antimelanogenic, antioxidant and anti-inflammatory effects. AZA is widely used in dermatology and is FDA-approved for treating papulopustular rosacea. It also shows significant efficacy in acne vulgaris and melasma. This review summarizes the mechanisms of action and clinical applications of AZA, aiming to provide theoretical support for its clinical and cosmetic use and to facilitate further research.Keywords: azelaic acid, mechanism, rosacea, acne, melasma, safety

Leilei Zhao,1 Xinmeng Fu,2 Hongbin Cheng3 1School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People’s Republic of China; 2Traditional Chinese Medicine Department, Boao Yiling Life Care Center, Qionghai, Hainan Province, People’s Republic of China; 3Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People’s Republic of ChinaCorrespondence: Hongbin Cheng, Email chenghongbin@cdutcm.edu.cnAbstract: Melasma is a benign but emotionally distressing skin condition that reduces patients’ quality of life, with prevalence rates during pregnancy ranging from 36.4% to 75%. Troublingly, up to 30% of cases are reported to persist after delivery, even ten years later. And recurrence and aggravation are common in subsequent pregnancies. This review examines the risk factors and mechanisms associated with melasma during pregnancy and summarized corresponding preventive strategies. We emphasize the critical role of photoprotection, including the use of sunscreens from the first trimester, in reducing the incidence of melasma.Keywords: melasma, pregnancy, risk factors, prevention, photoprotection

Mayla Barbosa,1 Rebecca Perez de Amorim,1 Daniel Cassiano,2 Marina Dias,1 Ana Flávia de Abreu,1 Edileia Bagatin,2 Hélio Amante Miot,1 Ana Cláudia Cavalcante Espósito1 1Department of Dermatology, Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP, Brazil; 2Department of Dermatology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, BrazilCorrespondence: Ana Cláudia Cavalcante Espósito, Department of Dermatology, Faculdade de Medicina de Botucatu, UNESP Medical School, Botucatu, SP, Brazil, Email anaclaudiaesposito@gmail.comBackground: Nicotinamide has demonstrated efficacy in the treatment of melasma. Topical antioxidants and humectants may enhance its performance. Currently, there is no controlled trial on the combination of 10% nicotinamide, 5% magnesium ascorbyl phosphate, and 5% hyaluronic acid, a dermo-cosmetic compound, in comparison to 4% hydroquinone for the treatment of melasma. This study aimed to explore the tolerability and efficacy of the association of the combined product versus hydroquinone.Methods: A randomized, double-blind trial involving women with facial melasma was conducted. Participants were instructed to apply the combined product (NIC group) twice daily or 4% hydroquinone for 60 days (HQ group) at night and placebo in the morning. Evaluations were performed at inclusion, after 14 and 60 days of treatment, measuring the modified Melasma Area and Severity Index (mMASI), Melasma Quality of Life Scale (MELASQoL), and colorimetric luminosity. The Global Aesthetic Improvement Scale (GAIS) was assessed by a blinded evaluator.Results: Both interventions led to a progressive improvement in mMASI, MELASQoL, and GAIS, without a difference between them on D14 and D60 (p> 0.2). For NIC, the mean reduction (95% CI) in mMASI was 16% (8– 24%) on D14 and 32% (23– 41%) on D60, while for HQ, it was 10% (7– 24%) on D14 and 43% (34– 52%) on D60. Reduction in colorimetric luminosity was greater in the HQ group at D60 (p=0.01). No serious side effects were identified. Of the initially included 50 patients, one was lost to follow-up in the HQ group on D60, and one withdrew consent from the NIC group, both unrelated to treatment.Conclusion: The association of 10% nicotinamide, 5% magnesium ascorbyl phosphate, and 5% hyaluronic acid was safe and well-tolerated, although its overall clinical efficacy was numerically inferior to 4% hydroquinone. This regimen can be considered for patients with poor tolerability to hydroquinone.Clinical Trial Registration: &num;RBR-4mkfmr8.Keywords: melasma, hyperpigmentation, nicotinamide, hydroquinone, antioxidants

Background: The mainstay of treatment for melasma is topical hydroquinone or preparations containing hydroquinone. In recent years, cysteamine cream has gained popularity in the treatment of hyperpigmentation disorders. Objectives: This study aimed to compare the efficacy of combined hydroquinone/betamethasone to cysteamine in the treatment of melasma. Methods: Eighteen patients had completed this open-label controlled trial. Subjects received either 5% cysteamine cream or a combination of 4% hydroquinone cream and 0.06% betamethasone valerate for 12 weeks according to standardized protocols. Patients were assessed at recruitment, 4 weeks, and 12 weeks after treatment for Melasma Area and Severity Index (MASI) scores. Other parameters relating to skin complexions and patient satisfaction were also assessed. Results: Patients treated with hydroquinone (n = 7) and cysteamine (n = 11) both showed significant decreases in MASI score at week 12: 33.1% (P = 0.009) and 37.9% (P = 0.009), respectively. There was no statistically significant difference between the two treatment groups (P = 0.236). Melanin content at week 12 decreased by 8.8% (P = 0.016) in the hydroquinone group and 11.5% (P = 0.046) in the cysteamine group, with no significant difference between the groups (P = 0.253). No significant differences were observed between the groups for other parameters or patient satisfaction. Conclusion: Cysteamine cream may provide an alternative treatment option for individuals with melasma, offering fewer side effects while delivering comparable results.

Background: Despite the availability of various treatment modalities, the treatment of melasma is often incomplete, with a high recurrence rate. The present study was undertaken to assess the efficacy and safety of oral tranexamic acid (TXA), modified Kligman’s formula (MKF), and a placebo cream in melasma. Materials and Methods: Ninety cases of melasma of both sexes were enrolled, and divided into three groups of 30 patients each. The baseline severity of melasma was graded by Melasma Area Severity Index (MASI) score. Group A, B, and C patients were treated with oral TXA 250 mg twice daily, daily MKF cream at night, and daily placebo cream at night, respectively, for 12 weeks. Improvement in MASI score was calculated after 4, 8, and 12 weeks. At each visit, adverse effects, if any, were noted. Statistical analysis was done using Chi-square test. Results: Based on intention to treat analysis, at the end of 12 weeks, the reduction in MASI score in oral TXA, MKF, and placebo groups was 9.94(65.91%), 6.12(54.78%), and 2.07(17.22%), respectively (P = 0.00). The difference in reduction of mean MASI scores after 12 weeks between oral TXA group and MKF group was not significant (P = 0.29). The efficacy of oral TXA and MKB was significantly higher than that of the placebo group (P = 0.01 and P = 0.03, respectively). Adverse effects in all groups were mild and self-limiting. Limitations: A limited sample size, non-blinded design, and absence of dermoscopic evaluation were the study limitations. Conclusion: In view of its excellent safety profile, oral TXA may be considered as a better option for moderate to severe melasma.

Linghong Guo,1,2 Xu Liu,1,2 Qingfeng Liu,1,2 Xiaoqin Xie,1,2 Xian Jiang1,2 1Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of ChinaCorrespondence: Xian Jiang; Linghong Guo, West China Hospital, Sichuan University, &num;37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, 610041, People’s Republic of China, Tel +86-028-85423315, Fax +86-028-85422560, Email jiangxian@scu.edu.cn; linhom.guo@foxmail.comObjective: This randomized, double-blind, placebo-controlled trial aimed to evaluate the efficacy of tranexamic acid essence combined with iontophoresis in treating melasma.Methods: Thirty participants were recruited and randomly assigned to the experimental (Group A) or control group (Group B). Group A received tranexamic acid essence iontophoresis treatment twice weekly for three months, while Group B received placebo treatment. Melasma Area and Severity Index (MASI) scores and skin luminance (L) values were assessed at baseline and weeks 4, 8, and 12.Results: No significant differences in baseline characteristics were observed between the groups. The mean MASI score reduction rate was significantly higher in Group A (− 0.10± 0.12%) compared to Group B (− 0.02± 0.09%) (p< 0.05). Skin L values significantly increased in Group A from 61.32± 3.53 to 63.32± 1.78, while slightly decreasing in Group B (p=0.037).Conclusion: Tranexamic acid essence combined with iontophoresis significantly improved MASI scores and skin luminance compared to placebo, demonstrating its effectiveness in treating melasma. Further research with larger sample sizes and longer follow-up is warranted to validate long-term effects and recurrence rates.Keywords: tranexamic acid, iontophoresis, melasma, clinical trial

Abstract Background Women are greatly affected by melasma as compared to men and has a significant negative impact on their quality of life. Thus far, there are no well‐conducted trials for melasma in Malaysia. Objectives This multicentre quasi‐experimental pilot study aims to determine the acceptability and feasibility of conducting a preliminary effectiveness trial for the Picopulse treatment effect on melasma severity and quality of life in Malaysian women. Methods Outcome measures were collected from 32 participants aged 18–65 years old presenting dermal melasma with Fitzpatrick skin type III–V from OneDoc Skin Centres in Klang Valley, Malaysia at baseline, 2 weeks, and 4 weeks after intervention. All preliminary effectiveness analyses were performed under the terms of intention‐to‐treat. Results Overall, the average score of Short Assessment of Patient Satisfaction (SAPS) was 22.2 (SD = 4.8), this demonstrated that the treatment was satisfied and well‐accepted by all patients. The recruitment and retention rates were 48.48% and 71.88%, respectively. Twenty‐five out of 32 patients completed all 10 treatments (78.13%). There were significant mean differences in Melasma severity index (MSI) score reported with partial eta square at 0.79 (p

Background: Response to the current available treatments of melasma, dermal type, in particular, is usually gradual and can result in possible side effects. Aim and Objectives: In this study, we aim to evaluate the efficacy of the combination of plasma rich in growth factors (PRGF) and topical 4% hydroquinone (HQ) in comparison with monotherapy using topical 4% HQ alone in the treatment of dermal type of melasma. Materials and Methods: This is a single-blinded, randomized, split-face clinical trial on twenty female patients with dermal type of melasma. Patients were asked to apply topical 4% HQ on both sides of their face at night for 6 months. In each participant, one side of the face was randomly chosen to receive monthly intradermal injections of PRGF for 3 sessions. Efficacy of the treatment was assessed using hemi melasma area and severity index (MASI) score, physician’s global assessment (PGA), and patients’ global assessment (PtGA). Results: Both groups revealed significant improvement in hemi-MASI score during the treatment course. Mean percentage of improvement at the end of study was 40.38 ± 6.04% and 33.42 ± 3.23% in the combination therapy and monotherapy groups, respectively (P = 0.31). PGA demonstrated excellent-to-marked improvement in melasma in 25% and 5% of patients in the combination therapy and monotherapy groups, respectively (P = 0.31). PtGA showed high levels of satisfaction in 15% of patients in the combination therapy group (vs. 0% in the monotherapy group) (P = 0.05). Conclusion: Differences between the two treatment groups in terms of hemi-MASI and PGA scores were not statistically significant; however, patients demonstrated higher satisfaction with combination of PRGF and topical 4% HQ compared with topical HQ alone. Thereby, combination of PRGF and topical 4% HQ can be suggested as a safe alternative therapeutic approach and may hold promise in the development of future therapeutic options for dermal type of melasma.

Melasma is an acquired chronic pigmentary disorder affecting millions of individuals worldwide. However, the pathogenesis of melasma remains unclear. This article provides a comprehensive review of the pathophysiological changes occurring in the skin microenvironment of melasma lesions, which can be summarized as follows: (1) skin barrier dysfunction and abnormal synthesis, transport, and intracellular distribution of melanin in the epidermis; (2) basement membrane damage; (3) solar elastosis, vascular changes, senescent fibroblasts, mast cell infiltration, and sebocyte participation in the dermis; and (4) systemic factors such as sex hormones and oxidative stress. Furthermore, potential therapeutic strategies are introduced to provide novel perspectives for fundamental and clinical research related to melasma. [ABSTRACT FROM AUTHOR]

Background Aims Methods Results Conclusion Photoactivation has been suggested to enhance the efficacy of platelet‐rich plasma (PRP) in conditions other than dermatological diseases.To evaluate the efficacy of photoactivated PRP (P‐PRP) treatment for melasma by comparing it with non‐photoactivated, classical PRP (C‐PRP).The study consisted of 38 female patients diagnosed with melasma between April 2022 and May 2023. The patients were randomized into the P‐PRP and C‐PRP groups. Three sessions of P‐PRP or C‐PRP were applied to the patients at 2‐week intervals. The Melasma Area and Severity Index (MASI) and Melasma Quality of Life Index (MELASQoL) scores were compared before and 2 weeks after treatment.The median age was 38 years, and the median disease duration was 60 months. Clinically, 94.7% of the cases were centrofacial and 5.3% were malar. According to Wood's lamp examination, 55.3% of the cases were epidermal, 13.2% were dermal, and 31.6% were mixed‐type. The median pre‐ and post‐treatment scores were 14.5 and 9, respectively, for MASI and 36.5 and 17, respectively, for MELASQoL. The post‐treatment MASI and MELASQoL scores of both groups significantly decreased (p < 0.001 for both). However, the intergroup difference was not significant. When all patients were evaluated together a moderate, positive, and significant relationship was detected between PRP and the pre‐ and post‐treatment MASI and MELASQoL scores (r = 0.494 and p = 0.002). No side effects associated with PRP were observed.PRP is an effective and safe treatment method for melasma. Further studies are needed to evaluate the contribution of photoactivation to PRP treatment in melasma. [ABSTRACT FROM AUTHOR]

Melasma is a challenging skin condition which involves both structural and functional skin alterations. Despite the availability of various treatment options, the management remains complex. This is the first study to investigate topical application of Rosa damascena stem cell exosomes when used concomitantly with microneedling in women and men with facial melasma. We recruited 20 subjects with Fitzpatrick skin types I-III, exhibiting melasma of varying severity. The modified Melasma Area and Severity Index (mMASI) and Global Aesthetic Improvement Scale (GAIS) were utilized to evaluate treatment response. The treatment protocol involved microneedling followed by exosome application over four or five sessions, at 4-week intervals. Ninety percent of subjects demonstrated a significant improvement in mMASI scores, while only 10% showed no change. GAIS assessment further supports overall improvement, with just 10% categorized as "not changed". Tolerability was favorable, with mild, transient side effects. Our findings suggest promising outcomes with this combined therapy, underscoring its potential as a safe and effective approach for treating melasma, particularly in severe and moderate cases. However, further research with larger sample sizes and control arms is warranted to validate these findings and explore long-term efficacy. [ABSTRACT FROM AUTHOR]

Background Materials and Methods Results Conclusion Methimazole, an oral antithyroid drug, has recently gained attention for its skin‐brightening effects when applied topically to treat melasma. This study aims to develop, optimize, and characterize a methimazole microemulsion as a novel, safe approach for local melasma treatment.We prepared microemulsion formulations containing 3% methimazole by combining appropriate amounts of surfactants (Tween 80 and Span 20), propylene glycol cosurfactant, and an oil phase (oleic acid‐transcutol p at a 1:10 ratio). We then assessed droplet size, stability, viscosity, and skin permeation using rat skin models.The microemulsions' droplet sizes ranged from 7.06 to 28.13 nm, with viscosities between 120 and 254 centipoises. Our analysis identified droplet size, viscosity, and membrane release as significant independent variables. We determined the permeability parameters of the optimal formulation through rat skin, including steady‐state permeability rate (Jss), permeability coefficient (p), lag time (Tlag), and apparent diffusion coefficient (Dapp).We found that the microemulsions' characteristics, physicochemical properties, and in vitro release depended on the surfactant‐to‐cosurfactant ratio, water content, and oil content. We developed an optimal formulation with a high surfactant‐to‐cosurfactant ratio and low water and oil percentages. This formulation shows potential for commercialization and manufacturing of final products. [ABSTRACT FROM AUTHOR]

Melasma, a prevalent pigmentary disorder, is characterized by its complex etiology, propensity for recurrence, and resistance to treatment. However, there is currently no research on melasma through bibliometrics and visualisation. This study analyses the hotspots and trends in the field based on 2,709 publications from the Web of Science Core Collection (WOSCC). We carried out bibliometric analyses using Citespace software for different countries/regions, institutions, authors, and keywords. References were also analysed using VoSviewer. The results indicate that overall, there has been an increase in publications related to melasma since 2014. According to the analysis of the collaborative network diagram, the United States, Egyptian Knowledge Bank, and Benjakul Soottawat are the most contributing countries, institutions, and authors, respectively. Reference and keyword analyses have identified the pathogenesis and treatment of melasma as a prevalent topic in recent years. And how to find new treatment options and more effective therapeutic drugs is a future research trend. This is the first bibliometric and visual analysis of melasmarelated literature to explore research hotspots and trends. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The severity and treatment response of acne, melasma, and rosacea may be influenced by various currently unclear internal and external factors. This study aimed to provide evidence to the influencing factors for the mentioned conditions through a real‐world case–control study.An online survey consisting of 60 questions was implemented, collecting information on demographics, socioeconomics, genetic factors, lifestyle habits, environmental exposures, and skin care behaviors. Then we constructed univariate and multivariate logistic regressions. Furthermore, we analyzed the dose–response relationship between exposure and outcome.A total of 399 individuals, including 94 acne patients, 107 melasma patients, and 91 rosacea patients were included. Acne and melasma were positively correlated with screen time (acne: odds ratio [OR]: 2.24, 95% confidence interval [CI]: 1.25–4.02; melasma: OR: 1.59, 95% CI: 1.09–2.31), while exercise exerted a protective effect on both acne (OR: 0.31, 95% CI: 0.13–0.77) and melasma (OR: 0.42, 95% CI: 0.22–0.80) in a dose–response relationship. In addition, males were associated with an elevated risk of acne (OR: 6.62, 95% CI: 1.01–43.26). Aging (OR: 1.15, 95% CI: 1.07–1.24) and irregular bowel movements (OR: 2.99, 95% CI: 1.11–8.08) were independent risk factors for melasma. Rosacea was positively associated with BMI (OR: 1.17, 95% CI: 1.01–1.35).In our study, we highlighted exercise as an independent protective factor for both acne and melasma in a dose–response trend. Inversely, extended use of electronic equipment was independently associated with higher risks of acne and melasma. Rosacea, however, was more likely to be related with BMI. [ABSTRACT FROM AUTHOR]

Introduction: Melasma is a chronic hyperpigmentation disorder, and its treatment poses a challenge to dermatologists due to its chronicity and resistance to conventional therapies. Oral isoniazid is used for the treatment of tuberculosis. One of us had previously showed that topical isoniazid exerts a strong depigmenting action in animal models. In this clinical trial, we assessed the therapeutic effect of topical isoniazid on melasma. Methods: Twenty female patients suffering from epidermal melasma were enrolled and divided equally into two groups. The treatment group received topical isoniazid 10%, and the control group received the cold cream vehicle as the placebo. All participants were advised to avoid sunlight and used SPF 50 sunscreen. Patients applied topical agents once daily at night for 3 months. The melanin and erythema indices were measured by colorimetric evaluations at baseline and after 4, 8, and 12 weeks of treatment. At these time points, the (mMASI) score was also determined, as was the subjective evaluation through Melasma Quality of Life Scale (MELASQOL) scores. Blood tests were performed to evaluate CBC and the liver enzymes. Results: All patients completed the 12‐week study. In the treatment group, a significant decrease in melanin index from 63.77 ± 6.27 at baseline to 55.92 ± 5.79 was recorded (p = 0.001). Very minimal clinical changes were also seen in the control group and melanin index was decreased from 62.65 ± 2.23 to 61.25 ± 2.34 (p = 0.004). Clinically significant differences were observed in the rate of changes between both groups. These findings indicate that topical isoniazid has significant depigmenting effects compared to the placebo (p = 0.001). The erythema index remained unchanged in both groups. In the treatment group, the mMASI score was 5.63 ± 3.28 at baseline and 2.13 ± 1.71 at the last follow‐up, significantly reduced compared to the control group (p = 0.002). The MELASQOL score indicated a significant improvement in the quality of life in the treatment group. Conclusion: This clinical trial shows for the first time that topical isoniazid is effective in treating melasma. Further clinical trials are necessary to confirm the efficacy and tolerability of topical isoniazid in comparison with other skin‐depigmenting compounds. [ABSTRACT FROM AUTHOR]

Melasma is a frequent condition worldwide, and it represents one of the most challenging disorders to treat in cosmetic dermatology. One of the critical factors for treatment prognosis is the assessment of the depth and distribution of pigment within the hyperpigmented area. Nowadays, non‐invasive skin imaging techniques, such as reflectance confocal microscopy (RCM), have been used to estimate pigment distribution and depth within different skin layers. This article aims to provide a systematic review of RCM applications in melasma, providing terminology and investigating characteristics of melasma at baseline and after medical and laser treatment. Our results support the recognition of two main types of melasma, epidermal and mixed type, thanks to the role of RCM in highlighting the precise pigment depth location in the skin non‐invasively. RCM treatment monitoring enables the objectification of pigment variations after treatment and the identification of prognostic factors for different treatment modalities. After the era of the application of RCM as a technique applied strictly to skin cancers, additional cosmetic applications are emerging, such as the application of melasma treatment monitoring. [ABSTRACT FROM AUTHOR]

Melasma, also known as chloasma and the "mask of pregnancy", is a common acquired pigmentary disorder characterized by irregular, hyperpigmented brown-to-grey patches primarily situated on the face. It typically affects women of reproductive age, especially those exhibiting Fitzpatrick skin types III to V. The precise etiopathogenesis of melasma is complex and has not been fully elucidated; however, ultraviolet radiation, hormonal factors, and genetic predispositions significantly contribute to the melanin production increase associated with this condition. Due to the multifactorial aetiology, resistance to various therapeutic options, and high recurrence rate, treating melasma is challenging. Hydroquinone has long been considered a gold standard in melasma treatment due to its ability to inhibit tyrosinase; however, it has faced scrutiny after concerns about its adverse effects. Current treatment strategies include various topical and systemic therapies, procedural interventions, as well as combinations of these methods. For optimal results, both photoprotection and a treatment plan that targets different pathogenic mechanisms should be used. Additionally, treatment should be tailored to patient characteristics, such as skin type, the severity of the condition, and compliance. This review summarises current treatment options, focusing on long-term therapy and the latest advancements in managing this challenging condition. [ABSTRACT FROM AUTHOR]

Melasma is a pathology with multifactorial causes that results in hyperpigmentation of sun-exposed areas, particularly facial skin. New treatments targeting the different factors regulating this condition need to be effective with and have limited adverse effects. Here, we describe a novel combination of two natural compounds (apigenin and phloretin) that has synergistic effects regulating melanogenesis in vitro. Both compounds inhibit Wnt-stimulated melanogenesis and induce autophagy in melanocytes. Apigenin induces DKK1, a Wnt pathway inhibitor, and reduces VEGF, a melanogenesis and proangiogenic factor, in fibroblasts. Moreover, apigenin induces miR-675, a melanogenesis inhibitor miRNA that is reduced in melasma skin in melanocytes. Both compounds showed senomorphic effects by regulating extracellular-matrix-related genes in senescent fibroblasts. Topical application of the compounds also showed significant melanin reduction in a reconstructed human epidermis after 7 days. Thus, the combination of apigenin and phloretin shows promising results as an effective topical treatment of skin hyperpigmentation conditions. [ABSTRACT FROM AUTHOR]

Background Melasma is a chronic relapsing hyperpigmentary disorder. As the entire etiopathogenesis of melasma is not well understood, there are chances of development of new therapeutic modalities. Tranexamic acid (TXA) has been used in a variety of formulations; nevertheless, there are few research, data and opinions regarding the optimal dosage of intralesional TXA in melasma. Methods Total 32 patients were enrolled in our study from January 2023 to June 2023. Injection TXA (0.05 ml) was given intralesionally 1cm apart on entire facial melasma lesion and repeated after every 4 weeks till lesions cleared or a maximum of 6 sessions. Follow up was done at every visit and after 3 months of last session for relapse. Clinical improvement was measured by percentage reduction in mMASI at baseline, at every session and at follow up. Results More than 50% patients showed good to very good response with significant reduction in mMASI from 8th week onwards as compared to baseline. Most of the patients were satisfied with their recovery following therapy and reported no significant adverse effects. Conclusion TXA was found to be efficacious in all types of melasma. Better response was seen in epidermal and mixed types in comparison to dermal melasma. We recommend a dosage of 50mg/ml at monthly intervals as optimal dosage for an effective therapy in all types of melasma. [ABSTRACT FROM AUTHOR]

The most common cause of facial melanoses is melasma. There is no universally efficacious melasma therapy and the gold standard therapy (triple combination cream) has multiple long term adverse effects. Topical glutathione is a relatively novel drug acting on key melasma pathology features. Objectives: This is first study to compare efficacy, safety and quality of life (QoL) impact of topical glutathione (2%) with topical tranexamic acid (TA) (3%) in adult melasma patients. Design: Randomized, prospective, parallel and open label. Methods: This study compared topical glutathione (2%) (Group A, n = 30) with topical TA (3%) (Group B, n = 30) in 60 adult melasma patients for 3 months. Evaluation of efficacy was done through Modified Melasma Area Severity Index (mMASI score) & Physician Global Assessment (PGA) score on 30, 60 and 90 days. QoL was assessed through Melasma Quality of Life score (MELASQOL) and photographs were taken at 0 &90 days. Adverse effects were reported every 30 days. Results: Both groups exhibited improvement in mMASI & PGA score at 30 days, but statistically significant improvement (p <0.001) was observed from 60 to 90 days. Group A was significant over Group B in improving mMASI (p <0.001) and PGA score (p <0.001) from 60 days to 90 days. Both groups had a comparable safety profile (p > 0.05) with no serious adverse effects. Conclusion: Topical glutathione showed better efficacy, QoL improvement and comparable safety to topical TA over 3 months in melasma. [ABSTRACT FROM AUTHOR]

Background: Response to the current available treatments of melasma, dermal type, in particular, is usually gradual and can result in possible side effects. Aim and Objectives: In this study, we aim to evaluate the efficacy of the combination of plasma rich in growth factors (PRGF) and topical 4% hydroquinone (HQ) in comparison with monotherapy using topical 4% HQ alone in the treatment of dermal type of melasma. Materials and Methods: This is a single‑blinded, randomized, split‑face clinical trial on twenty female patients with dermal type of melasma. Patients were asked to apply topical 4% HQ on both sides of their face at night for 6 months. In each participant, one side of the face was randomly chosen to receive monthly intradermal injections of PRGF for 3 sessions. Efficacy of the treatment was assessed using hemi melasma area and severity index (MASI) score, physician’s global assessment (PGA), and patients’ global assessment (PtGA). Results: Both groups revealed significant improvement in hemi‑MASI score during the treatment course. Mean percentage of improvement at the end of study was 40.38 ± 6.04% and 33.42 ± 3.23% in the combination therapy and monotherapy groups, respectively (P = 0.31). PGA demonstrated excellent‑to‑marked improvement in melasma in 25% and 5% of patients in the combination therapy and monotherapy groups, respectively (P = 0.31). PtGA showed high levels of satisfaction in 15% of patients in the combination therapy group (vs. 0% in the monotherapy group) (P = 0.05). Conclusion: Differences between the two treatment groups in terms of hemi‑MASI and PGA scores were not statistically significant; however, patients demonstrated higher satisfaction with combination of PRGF and topical 4% HQ compared with topical HQ alone. Thereby, combination of PRGF and topical 4% HQ can be suggested as a safe alternative therapeutic approach and may hold promise in the development of future therapeutic options for dermal type of melasma. [ABSTRACT FROM AUTHOR]

The integration of skincare into medical practice can enhance patient care. Understanding the anatomy and physiology of the skin is the foundation for effective skincare interventions. Genetic and inflammatory conditions play a significant role in aesthetic skin physiology. There are key active ingredients that are pivotal in addressing various skin concerns. Sunscreens provide crucial protection against UV radiation, while pigment control agents such as hydroquinone, kojic acid, and arbutin target the melanin pathway. Exfoliating agents and skin turnover enhancers such as retinoids and hydroxy acids promote skin renewal and rejuvenation. In addition, ingredients such as hyaluronic acid, ceramides, niacinamide, antioxidants, peptides, and botanicals contribute to improving skin quality. Adding skincare to medical practice requires careful product selection, patient education, and marketing strategies. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study is to systematically review randomized controlled clinical trials (RCTs) studying various types of regenerative medicine methods (such as platelet-rich plasma, stromal vascular fraction, cell therapy, conditioned media, etc.) in treating specific dermatologic diseases. Rejuvenation, scarring, wound healing, and other secondary conditions of skin damage were not investigated in this study. Method: Major databases, including PubMed, Scopus, and Web of Science, were meticulously searched for RCTs up to January 2024, focusing on regenerative medicine interventions for specific dermatologic disorders (such as androgenetic alopecia, vitiligo, alopecia areata, etc.). Key data extracted encompassed participant characteristics and sample sizes, types of regenerative therapy, treatment efficacy, and adverse events. Results: In this systematic review, 64 studies involving a total of 2888 patients were examined. Women constituted 44.8% of the study population, while men made up 55.2% of the participants, with an average age of 27.64 years. The most frequently studied skin diseases were androgenetic alopecia (AGA) (45.3%) and vitiligo (31.2%). The most common regenerative methods investigated for these diseases were PRP and the transplantation of autologous epidermal melanocyte/keratinocyte cells, respectively. Studies reported up to 68.4% improvement in AGA and up to 71% improvement in vitiligo. Other diseases included in the review were alopecia areata, melasma, lichen sclerosus et atrophicus (LSA), inflammatory acne vulgaris, chronic telogen effluvium, erosive oral lichen planus, and dystrophic epidermolysis bullosa. Regenerative medicine was found to be an effective treatment option in all of these studies, along with other methods. The regenerative medicine techniques investigated in this study comprised the transplantation of autologous epidermal melanocyte/keratinocyte cells, isolated melanocyte transplantation, cell transplantation from hair follicle origins, melanocyte–keratinocyte suspension in PRP, conditioned media injection, a combination of PRP and basic fibroblast growth factor, intravenous injection of mesenchymal stem cells, concentrated growth factor, stromal vascular fraction (SVF), a combination of PRP and SVF, and preserving hair grafts in PRP. Conclusion: Regenerative medicine holds promise as a treatment for specific dermatologic disorders. To validate our findings, it is recommended to conduct numerous clinical trials focusing on various skin conditions. In our study, we did not explore secondary skin lesions like scars or ulcers. Therefore, assessing the effectiveness of this treatment method for addressing these conditions would necessitate a separate study. [ABSTRACT FROM AUTHOR]

BACKGROUND: The development of microfocused ultrasound and fractional radiofrequency-based devices has expanded the range of cosmetic treatment options for patients with skin of color. Fractional non-ablative laser treatments can also be safely performed in skin types III-VI with appropriate settings and adjunctive topical treatments. OBJECTIVE: We sought to review the available literature on the use of energy-based devices for treatment of facial skin conditions in skin types III-VI. METHODS: A PubMed search was performed on studies from 2010-2021 assessing safety and efficacy of fractional ablative and non-ablative lasers, radiofrequency, and microfocused ultrasound-based treatments for conditions such as acne scars, melasma, benign pigmented lesions, rhytids, and skin laxity in skin types III-VI. RESULTS: Seven randomized trials, fourteen prospective cohort studies, and six retrospective reviews were included. Combination treatment with fractional radiofrequency and non-ablative laser has demonstrated efficacy in the treatment of acne scars in skin of color with minimal adverse effects. Laser-assisted drug delivery with low-density 1927-nm thulium or diode lasers has been shown to reduce the number of treatments required for significant clearance of melasma as compared with other modalities. Microfocused ultrasound has been shown to safely treat skin laxity in skin of color. LIMITATIONS: There is a paucity of studies which include patients with skin type VI, limiting our overall understanding of the safety of these treatments in skin of color. CONCLUSION: There are numerous available studies demonstrating safety and efficacy of energy-based devices for the treatment of facial skin conditions in skin types III-VI, but the significant variation among their designs, methods of assessment, and study populations highlights the need for larger meta-analyses to further interpret their results. [ABSTRACT FROM AUTHOR]

Background: The diverse causes of hyperpigmentation and complex nature of melanogenesis make it a challenge to manage. Current approaches either fail to deliver effective pigmentation control or have undesirable safety profiles that preclude their long‐term use. Aims: To evaluate the capacity of a cosmetic gel serum comprising tranexamic acid, niacinamide, 4‐butylresorcinol, phytic acid, and a mixture of hydroxy acids that was designed to target the biological processes regulating skin melanogenesis to attenuate melanin production in vitro and reduce hyperpigmentation clinically. Methods: Capacity to reduce melanin production in vitro was determined in melanocyte‐containing reconstructed human epidermis (RHEm). Clinical efficacy and skin tolerability following twice daily application were assessed in 35 subjects with slight to moderate facial hyperpigmentation by instrumental (VISIA®‐CR, Mexameter®) and clinical (mMASI, clinical score, IGA for hyperpigmentation) evaluation on D14, D28, D56, and D84. Maintenance of pigmentation control was followed up 1 month after cessation of treatment on D112. Results: In RHEm in vitro, melanin production was reduced by 50.0% from baseline (D0) on D14 (p < 0.001) and by 67.0% on D21 (p < 0.001). Clinical reductions from baseline in brown spots count (−9.0%; p < 0.05), brown spots area (−16.7%; p < 0.001), and the melanin index (−11.4%; p < 0.001) were observed within 14 days of use. Statistically significant improvements in all clinical parameters were achieved by D28. By the end of treatment on D84, the number and surface area of brown spots were reduced by 28.4% and 40.3% compared to D0, respectively (p < 0.001, both), the melanin index was reduced by 31.1% (p < 0.001), mMASI was reduced by 63.0% (p < 0.001), and skin luminosity was increased by 79.0% (p < 0.001). IGA was reduced from 2.3 on D0 to 1.3 on D84 (p < 0.001). Improvements to all these parameters were maintained until D112, 1 month after termination of treatment. The product also demonstrated very good skin tolerability. Conclusion: A gel serum comprising tranexamic acid, niacinamide, 4‐butylresorcinol, and hydroxy acids, designed to target the biological processes regulating skin melanogenesis, demonstrates rapid, robust, and sustained pigmentation control in this cohort. [ABSTRACT FROM AUTHOR]

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

Hydroquinone has been used for years for multiple conditions, including melasma, post-inflammatory hyperpigmentation, dyschromia from photoaging, and solar lentigines. It is known to be a very effective lightening agent, but several concerns have been raised about this widely used agent. The recent U.S. ban on over-the-counter skin lightening products containing hydroquinone has prompted further questioning of the safety of this widely used agent. While there have been prior informative, large-scale reviews on the safety of hydroquinone, new findings have since been reported. Here, we provide an updated review of studies published in the past 15 years on hydroquinone safety. [ABSTRACT FROM AUTHOR]