A split-face,investigator-blinded comparative study on the efficacy and safety of Q-switched Nd:YAG laser plus microneedling with vitamin C versus Q-switched Nd:YAG laser for the treatment of recalcitrant melasma

Background: High recurrence has previously been reported in the treatment of melasma with low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminium garnet (QS-Nd:YAG) laser. On the other hand, the efficacy and safety of the QS-Nd:YAG laser plus microneedling with vitamin C have not been evaluated in patients with mixed-type melasma. Material and methods: Sixteen patients with recalcitrant dermal- or mixed-type melasma were included in the study. One side of patients’ face was treated with QS-Nd:YAG laser plus microneedling with vitamin C (Group A) and the other side with QS-Nd:YAG laser alone (Group B) for four sessions at four-week intervals. Melasma Area Severity Index (MASI) scores and clinician’s evaluation of clinical response were assessed monthly. Results: Group A had a significantly lower mean MASI score and better treatment response than Group B according to clinician’s evaluation. According to MASI scores, in Group B, two patients had a good response while 12 were unresponsive to treatment. Good or very good improvement was reported by 10 patients in Group A and three patients in Group B. Adverse effects and recurrence rates were similar in Groups A and B (31.3 and 43.8%, respectively). Discussion: QS-Nd:YAG increases the blood circulation in the dermis, thereby enhancing the mechanical effect of microneedling to promote the penetration of vitamin C. Conclusion: Vitamin C application with microneedling immediately after treatment with QS-Nd:YAG laser is a promising adjunctive method for the treatment of recalcitrant melasma.     

Salicylic acid peeling combined with vitamin C mesotherapy versus salicylic acid peeling alone in the treatment of mixed type melasma: A comparative study

Introduction: Melasma is a distressing condition for both dermatologists and patients. We evaluated the effectiveness of salicylic acid (SA) peel and vitamin C mesotherapy in the treatment of melasma. Materials and methods: Fifty female patients were divided into two groups. All patients were treated with 30% SA peel every two weeks for two months. In addition, after SA peeling Group A was intradermally administered 10 vitamin C on the melasma lesion at 1-cm intervals. All patients were followed up for 6 months, during which the recurrence rates were evaluated. Digital photographs of the melasma site were taken and patients’ Melasma Area and Severity Index (MASI) scores were assessed. After the treatment, the patients were asked to complete the melasma quality of life questionnaire (MelasQoL) to evaluate their satisfaction with the treatment. All the adverse effects were noted. Results: The MelasQoL and MASI scores of patients in both groups significantly decreased after the treatment. Apart from a burning sensation, no adverse event was observed and all patients tolerated the treatment well. Discussion: SA peel combined with vitamin C mesotherapy is a safe and effective alternative for the treatment of melasma with no significant side effects and minimal downtime.     

Hautveränderungen in der Schwangerschaft

Zusammenfassung In der Schwangerschaft kann es durch temporäre hormonelle, metabolische und immunologische Umstellungsprozesse zu physiologischen Hautveränderungen kommen. Diese äußern sich vor allem in einer Zunahme der Haut- und Schleimhautpigmentierung, dem Auftreten von Striae distensae, Haar- und Nagelveränderungen, vaskulären Veränderungen, Akne und Pruritus.     

女性黄褐斑患者的血清酶学及血液流变学初步分析

为了了解黄褐斑与氧自由基，血液流变学的关系，本研究对４８例女性黄褐斑患者和４０例正常对照组血清过氧化脂质（ＬＰＯ）水平，红细胞超氧化歧化酶（ＳＯＤ）活性，全血谷胱甘肽过氧化物酶（ＧＳＨ－Ｐｘ）过氧化氢酶（ＣＡＴ）活性以及血液流变学进行了检测。发现病例组全血ＣＡＴ活性低于对照组（Ｐ〈０．０１），血清ＬＰＯ水平，红细胞ＳＯＤ活性，全血ＧＳＨ－Ｐｘ活性与对照组无显著性差异（Ｐ〉０．０５），日晒对血清酶学     

颧部褐青色痣与黄褐斑和太田痣的临床、组织学初探

目的探讨颧部褐青色痣为不同于黄褐斑和太田痣的一种独立的疾病。方法对颧部褐青色痣、黄褐 斑及太田痣的临床、组织病理、免疫组化、超微结构进行分析研究。结果颧部褐青色痣在临床及组织学上不同于黄褐斑 和太田痣。结论颧部褐青色痣是一种独立的色素痣。     

红宝石点阵激光联合氨甲环酸治疗黄褐斑临床观察

目的 对红宝石点阵激光联合氨甲环酸片治疗黄褐斑进行临床疗效观察。方法 激光治疗:采用点阵模式,能量密度2.5～3.5J/cm2,每隔2周治疗1次,2个月为1个疗程;同时口服氨甲环酸片500mg,1次/d,2个月为1个疗程,连续治疗3个疗程;对患者进行黄褐斑皮损面积和严重程度指数(MASI)评分,采用自身治疗前/后对照法进行疗效观察,记录起效时间、复发情况及不良反应等。结果 120例患者经过半年的治疗后,并随访半年至1年,118例患者出现了不同程度的色斑减轻,有效率为65.84%。停止治疗后8例患者出现色斑复发,7例患者在服药期间感觉月经量减少,未发现明显炎症后色素沉着及其他不良反应的发生。结论 红宝石点阵激光联合氨甲环酸片治疗黄褐斑是一种疗效显著,且安全性高的治疗方法。     

Fractional photothermolysis treatment for resistant melasma in Chinese females

Background: Melasma is a common disorder of pigmentation which is common in women of Asian and Latina descent. Melasma lesions are resistant to numerous laser therapies, but have responded well in clinical studies to fractional photothermolysis. Objective: To determine whether Chinese women with resistant melasma will respond to fractional photothermolysis. Methods: Six female patients (Fitzpatrick skin types III-IV) were treated with fractional photothermolysis at approximately 4 week intervals. Three to four treatments were performed for each patient. Before and after photos were taken of each patient in order to identify the degree of improvement of the pigmented lesions treated. Results: All patients who participated in the study experienced at least 20% improvement in the appearance of their melasma lesions. Three patients obtained 50% improvement, two obtained 30% improvement, and one obtained 20% improvement. Conclusion: Fractional photothermolysis is a useful treatment modality for Chinese women who have resistant melasma.     

连建伟治疗黄褐斑验案举隅

连建伟临证多从脾胃、调补气血着手治疗黄褐斑。妇人罹患黄褐斑多由饮食劳倦失常、产后将息不当、流产过多致使脾胃损伤,气血匮乏,又常兼夹肝郁、血瘀。虚与邪相间为患,气血不能上荣于面部,故面生黑斑。善用八珍汤,兼瘀则加丹参、桃仁、红花等化瘀通络、调和气血;气血虚弱较甚且阳气亦有不足见畏寒者,改用十全大补汤加减;心脾气血俱虚,则用归脾汤或人参养荣汤加减;中气下陷,则用李东垣补中益气汤加味;肝郁较重,则用逍遥散加减;补益气血、调补脾胃的基础上,并常加入薏仁等化湿健脾之品。循守岳美中所云"治疗慢性病要有方有守"。     

Laser toning for melasma: A single-centre experience with 38 970 cases

Melasma is a common pigmentation in Asian women. Lasers have been used to lighten melasma, although with variable outcomes and complications. In Asia, laser toning is a common technique used to safely lighten melasma. However, no large studies have been performed to validate efficacy. In our study, we demonstrate that in 38?970 Asian women, at least 35?890 patients (92.1%) had noticeable to excellent improvement in their melasma.     

中国黄褐斑诊疗专家共识（2021版）

【摘要】 目前认为黄褐斑的发病与遗传、日光、性激素等有关，涉及黑素合成增加、皮损处血管增生、炎症反应及皮肤屏障受损等机制。诊断主要依据临床表现和无创检测技术。该指南结合近年研究新进展，全面阐述了黄褐斑的病因及发病机制、临床表现、分期与分型、诊断及治疗等，旨在提高中国皮肤科医师对黄褐斑的诊治水平。