UV and visible light avoidance are critical to prevent flares and exacerbation of melasma. Comparison of the Efficacy of Melasma Treatments: A Network Meta These nonfacial areas are most commonly observed in menopausal women. Neither study demonstrated long-term complications. Their effect in melasma is, however, poorly documented. The treatment of melasma should include a multimodality approach that incorporates photoprotective agents, antioxidant treatments, skin lighteners, exfoliants, and resurfacing procedures, as needed. Adverse events were reported in 40 patients (7.1%), and most side effects were mild. Nonetheless, physicians have enormous variability in prescribing practices for hydroquinone, so there is no universal standard of treatment. Other energy sources, such as monopolar radiofrequency (RF), have been used to treat melasma. Cases of depigmentation caused by hydroquinone are rare. To view enhanced content for this article go to http://www.medengine.com/Redeem/C1E8F0602EB3D30A. It has now been correlated to the Melasma Severity Score, which is a global score that incorporates both objective data and patients subjective assessment. Vachiramon V., Suchonwanit P., Thadanipon K. Melasma in men. JAMA Dermatol 2013; 149:981. Bhattar P.A., Zawar V.P., Godse K.V., Patil S.P., Nadkarni N.J., Gautam M.M. This review will provide an up-to-date overview of the current literature on melasma, including clinical diagnosis, pathogenesis, and treatments including discussion of new topical, oral, and procedural therapies. Therapeutic interventions for melasma include a multimodality approach incorporating photoprotection agents, topical and oral skin lighteners, and resurfacing procedures. Epidemiology of skin diseases in ethnic populations. Pigment-correcting serum contains TA, tetrapeptides, plankton extracts, niacinamide, phenylethyl resorcinol, and undecylenol phenylalanine. Mandry Pagan R, Sanchez JL. An immunohistochemical study of the epidermis and dermis of affected and unaffected neighboring skin found significantly increased expression of the progesterone receptor in the epidermis of affected skin [35]. Seckin HY, Kalkan G, Bas Y, Akbas A, Onder Y, Ozyurt H, et al. Increased expression of stem cell factor, c-Kit, and -melanocyte-stimulating hormone have been reported in the lesional skin (Kang et al., 2006, Lee et al., 2017). Tranexamic acid, a synthetic version of lysine and a hemostatic agent, has been increasingly used in the topical, oral, and injectable forms to treat melasma. Promising oral therapies for melasma include tranexamic acid, Polypodium leucotomos, and glutathione. J Am Acad Dermatol. Kim S.J., Park J.Y., Shibata T., Fujiwara R., Kang H.Y. Given the global negative impact of melasma on the quality of life, a quest to find more efficacious treatments that offer sustained long-term remission for patients with this frustrating and therapeutically challenging disorder is ongoing. Huh SY, Shin JW, Na JI, Huh CH, Youn SW, Park KC. In addition, malondialdehyde, which is a measure of oxidative stress, decreased and glutathione (GSH) levels increased and suggest significant improvement in oxidative stress. Lim JT. Hydroquinone is used globally for melasma (De Caprio, 1999, Grimes, 2009, Nordlund et al., 2006, Tse, 2010), and although used for more than 60 years, it remains our most efficacious topical agent. The Bowman-Birk inhibitor. Methimazole is an oral anti-thyroid medication used to treat patients with hyperthyroidism and has been shown to cause depigmentation when applied topically. Globally, the prevalence of melasma has also varied. Non-ablative lasers are preferred for the treatment of melasma over ablative lasers given the tendency to cause less inflammation and subsequently less post-inflammatory pigment alteration (PIPA). Ahmed A, Lopez I, Perese F, Vasquez R, Hynan LS, Pandya AG. The .gov means its official. In addition to topical therapies, oral therapies are emerging as additional treatment options for this disorder. This is proposed as one of the mechanisms for the increased activity of melanocytes in melasma [30, 31]. Kim E.H., Kim Y.C., Lee E.S., Kang H.Y. Ritter CG, Fiss DV, Borges da Costa JA, de Carvalho RR, Bauermann G, Cestari TF. A detailed history should be taken for each patient to exclude individuals at risk for untoward complications. Epub 2017 Feb 27. A double-blind, placebo-controlled randomized trial of Serratula quinquefolia folium, a new source of beta-arbutin, in selected skin hyperpigmentations. In addition, individuals who are occupationally exposed to long-term hydroquinone have not demonstrated myelotoxic changes (De Caprio, 1999, Tse, 2010). Patients experience significant emotional impact and often feel bothered, frustrated, embarrassed, and depressed about their skin appearance (Ikino et al., 2015). 2015;72(1):18990 e1. Myriad quality-of-life studies report on the emotional turmoil and psychological devastation that is experienced by affected individuals (Balkrishnan et al., 2003, Ikino et al., 2015, Pawaskar et al., 2007). Vazquez M, Sanchez JL. Inhibitory effect of magnesium L-ascorbyl-2-phosphate (VC-PMG) on melanogenesis in vitro and in vivo. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). These pathways include melanocyte activation, melanosome development, melanin synthesis, melanosome transfer, and keratinocyte differentiation and desquamation. Mahmoud BH, Ruvolo E, Hexsel CL, Liu Y, Owen MR, Kollias N, et al. Lee HI, Lim YY, Kim BJ, Kim MN, Min HJ, Hwang JH, et al. Disclaimer. J Cosmet Dermatol 2008; 7: 164-168. Flutamide is a nonsteroidal antiandrogen that blocks the action of endogenous and exogenous testosterone by binding to the androgen receptor. Picardo M., Carrera M. New and experimental treatments of cloasma and other hypermelanoses. Methimazole was well tolerated with minimal cutaneous side effects. A small open-label study found that 3050% GA peels at 3-week intervals for 6months in addition to AA 20% twice-daily regimen resulted in superior MASI scores when compared to AA 20% alone [45]. The treatment of melasma with fractional photothermolysis: a pilot study. Bookshelf There has been enormous recent publicity with regard to the use of intravenous GSH for general skin lightening (Sonthalia et al., 2016). Before MeSH Given the variability of presentation, assessing melasma severity can be challenging. Other topical natural compounds used, such as lignin peroxidase, arbutin, and soy, have also been used to treat melasma in small studies with favorable results [63, 6870]. Concomitant use of various topical therapies with different mechanisms of action are preferred to monotherapy. Kang W.H., Yoon K.H., Lee E.S., Kim J., Lee K.B., Yim H. Melasma: Histopathological characteristics in 56 Korean patients. Kim SJ, Park JY, Shibata T, Fujiwara R, Kang HY. Deo K.S., Dash K.N., Sharma Y.K., Virmani N.C., Oberai C. Kojic acid vis-a-vis its combinations with hydroquinone and betamethasone valerate in melasma: A randomized, single blind, comparative study of efficacy and safety. Melasma: a clinical and epidemiological review. 2011;158241. Melasma Home Remedies: Aloe Vera, Glutathione, Tranexamic Acid - Healthline In vivo reflectance confocal microscopy detects pigmentary changes in melasma at a cellular level resolution. Development and clinical assessment of a comprehensive product for pigmentation control in multiple ethnic populations. Arjinpathana N, Asawanonda P. Glutathione as an oral whitening agent: a randomized, double-blind, placebo-controlled study. Alterations in the Wnt pathway and abnormal barrier function have also been documented (Lee, 2015). Polypodium leucotomos. Given the multifactorial etiology of melasma, it is important to have a multimodal therapeutic approach that addresses factors such as photoprotection, inflammation, vascularity, pigmentation, and hormonal influences. Histologically, melasma can display increased epidermal and/or dermal pigmentation, enlarged melanocytes, increased melanosomes, solar elastosis, dermal blood vessels, and, occasionally, perivascular lymphohistiocytic infiltrates. 2022 Sep 24;19(19):12084. doi: 10.3390/ijerph191912084. Combination peels have also been explored in recent studies. Griffiths CE, Finkel LJ, Ditre CM, Hamilton TA, Ellis CN, Voorhees JJ. Adalatkhah H., Pourfarzi F., Sadeghi-Bazargani H. Flutamide versus a cyproterone acetate-ethinyl estradiol combination in moderate acne: a pilot randomized clinical trial. She recommends patients ingest polypodium leucotomos orally twice daily to improve melasma. Balkrishnan R, McMichael AJ, Camacho FT, Saltzberg F, Housman TS, Grummer S, et al. Melasma: an Up-to-Date Comprehensive Review Differences in visible light-induced pigmentation according to wavelengths: a clinical and histological study in comparison with UVB exposure. Kimbrough-Green CK, Griffiths CE, Finkel LJ, Hamilton TA, Bulengo-Ransby SM, Ellis CN, et al. During pregnancy, the prevalence likely increases, which was seen in a cross-sectional study in Tehran with a 15.8% prevalence amongst pregnant women. Nestor M.S., Bucay V.W., Callender V.D., Cohen J.L., Sadick N., Waldorf H. Niwano T., Terazawa S., Sato Y., Kato T., Nakajima H., Imokawa G. Glucosamine abrogates the stem cell factor+endothelin-1-induced stimulation of melanogenesis via a deficiency in MITF expression due to the proteolytic degradation of CREB in human melanocytes. the contents by NLM or the National Institutes of Health. It is a fern extract from Central and South America that is believed to activate p53, inhibit COX-2, and, thus, produce an antioxidant effect when taken orally. Treatment efficacy can vary due to several factors including variability in clinical presentation and response to treatment amongst different genders, skin phototypes, and ethnicities. Clinicopathologic efficacy of copper bromide plus/yellow laser (578nm with 511nm) for treatment of melasma in Asian patients. 2014 Mar;7(3):13-7. Kang HY, Bahadoran P, Suzuki I, Zugaj D, Khemis A, Passeron T, et al. Topical flutamide, an antiandrogenic agent, has also been studied in comparison to HQ 4%, and was found to have statistically significant MASI scores and patient satisfaction; however, no difference in the mexameter melanin assay was observed between the two groups [62]. Federal government websites often end in .gov or .mil. Prevalence rates vary from 1% to 50% in high-risk populations (Grimes, 1995, Grimes, 2009, Halder et al., 1983, Kim et al., 2007, Moin et al., 2006, Werlinger et al., 2007). In a randomized, double-blind comparison trial of 43 patients, pigment-correcting serum was compared with hydroquinone 4% and showed overall comparable efficacy to hydroquinone in patients with melasma and postinflammatory hyperpigmentation (Makino et al., 2016). A Randomized, Double-Blinded, Placebo-Controlled Trial of Oral Polypodium leucotomos Extract as an Adjunct to Sunscreen in the Treatment of Melasma | Cancer Screening, Prevention, Control | JAMA Dermatology | JAMA Network Lasers can utilize thermal energy to selectively target various chromophores in the skin. In an investigator-blinded randomized study with 260 Asian patients, TCT with HQ 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01% was superior to HQ 4% monotherapy in improving melasma [72]. Gene and protein expression of oestrogen-beta and progesterone receptors in facial melasma and adjacent healthy skin in women. government site. Alexis AF, Blackcloud P. Natural ingredients for darker skin types: growing options for hyperpigmentation. The effect of melasma on self-esteem: a pilot study. Although the general accepted female to male ratio is 9:1, a more recent large, multicenter study of 953 melasma patients in Brazil found a 39:1 ratio [6, 20]. Pandya AG, Hynan LS, Bhore R, Riley FC, Guevara IL, Grimes P, et al. The major clinical pattern in 5080% of cases is the centrofacial pattern, which affects the forehead, nose, and upper lip, excluding the philtrum, cheeks, and chin [2, 3]. In recent years, naturally occurring compounds have been investigated for their therapeutic activity against pigmentation. The group treated with PL achieved a significantly greater reduction in MASI score at 56 and 84 days of treatment (Goh et al., 2018). Bagherani N, Smoller BR. The latter is thought to occur in older individuals and may be more related to severe photodamage [4]. The Melasma Area and Severity Index (MASI) is a validated scale used to measure the extent of facial hyperpigmentation. Oral tranexamic acid (TA) in the treatment of melasma: a retrospective analysis. Of these treatments, hydroquinone remains the gold standard. Kasraee B., Handjani F., Parhizgar A., Omrani G.R., Fallahi M.R., Amini M. Topical methimazole as a new treatment for postinflammatory hyperpigmentation: Report of the first case. Comparative study of trichloroacetic acid versus glycolic acid chemical peels in the treatment of melasma. An official website of the United States government. Deo KS, Dash KN, Sharma YK, Virmani NC, Oberai C. Kojic acid vis-a-vis its combinations with hydroquinone and betamethasone valerate in melasma: a randomized, single blind, comparative study of efficacy and safety. Glowka A., Olejnik A., Nowak I. Prevention of melasma relapses with sunscreen combining protection against UV and short wavelengths of visible light: a prospective randomized comparative trial. Several studies have evaluated oral and topical GSH for general skin lightening. The topical formulation of tranexamic acid, however, has had limited success and less efficacy than when used in oral form. Epidermal pigmentation may be accentuated with a Woods lamp which may help distinguish epidermal and dermal subtypes. The efficacy of a broad-spectrum sunscreen in the treatment of melasma. The active and placebo groups were also treated with a broad spectrum sunscreen and hydroquinone 4% daily. HHS Vulnerability Disclosure, Help