Natural options for management of melasma,a review

A blemish free, even-toned skin is universally associated with healthy skin. This reasoning makes people desire to have a flawless skin. Melanin is a naturally occurring pigment in humans. This pigment is responsible for skin, hair, and eye color, therefore determines our race and phenotypic appearance. On darker skin types, it is common that melanin production processes malfunctions. These malfunctions often lead to overproduction and secretion of melanin. As a result, unwanted pigmentary problems such melasma occur. Due to unknown etiology and its recurrence in nature, melasma is challenging to treat. The current available melasma treatment options often produce undesired side effects and suboptimum results. First-line topical treatments usually involve hydroquinone or topical steroids. Apart from the irritant reactions, this treatment mode is not suitable for all skin types. Skin care specialists are in search of an effective long-term cosmetics and cosmeceuticals to address hypermelanosis problems. Understanding of naturally occurring depigmenting agents provides an opportunity for more effective ways to manage melasma in all skin types. This review considers the benefits of naturally occurring ingredients which could help address skin pigmentation problems and broaden the choice for skin-lightening treatments.     

富血小板血浆联合氨甲环酸治疗黄褐斑疗效观察

目的探讨富血小板血浆(PRP)联合氨甲环酸片治疗黄褐斑的临床疗效及安全性。方法将入选的79例患者随机分为两组,对照组(39例)单纯口服氨甲环酸片治疗,疗程为3个月,治疗组(40例)在对照组基础上,联合PRP治疗,每月1次,共3次。治疗结束后比较两组临床疗效及不良反应,6个月后观察复发情况。结果3个月后,治疗组和对照组mMASI评分较治疗前均有显著降低(P均<0.05),治疗组mMASI评分较对照组差异有统计学意义(P<0.05)。治疗组有效率(77.50%)高于对照组(56.41%),差异有统计学意义(P<0.05)。两组患者均未见明显不良反应。6个月后,两组复发率比较,差异有统计学意义(P<0.05)。结论富血小板血浆联合氨甲环酸片治疗黄褐斑疗效及安全性均较好,复发率低。     

A prospective randomized comparative study on 60 Indian patients of melasma,comparing pixel Q-switched NdYAG (1064 nm), super skin rejuvenation (540 nm) and ablative pixel erbium YAG (2940 nm) lasers,with a review of the literature

Background: Treating melasma is a challenge due to suboptimal efficacy and recurrence encountered with most modalities. There is inadequate literature regarding the use of lasers for melasma in Indian skin. We compared three modalities SSR (Super Skin Rejuvenation 540 nm), PQSNDY (pixel Q-switched Nd: YAG 1064 nm), and ablative pixel-Er: YAG (2940 nm) laser in melasma, amongst Indian patients.

Materials/Methods: Sixty patients of recalcitrant melasma were enrolled and randomized into three groups with 20 patients each. These were treated with SSR, low fluence PQSNDY, and pixel-Er: YAG, respectively, for five sessions at 3-week intervals. Results were evaluated using Modified melasma area severity index (mMASI) by blinded comparison of digital photographs at baseline, each visit and 6 months (i.e. 2 months after the last session).

Results: All groups showed a highly significant reduction in the mMASI score (p < .001). Pixel-Er: YAG maximally reduced mMASI and homogeneity (p < .001), while the other groups showed a more uniform fading. Epidermal melasma had best results with SSR and PQSNDY (p < .001), while recalcitrant cases of dermal and mixed melasma with pixel-Er: YAG laser (p < .001). There was no persistent or rebound pigmentation observed.

Conclusions: All three modalities are effective and safe for melasma in Indian patients. Fractional technology, low fluences, adequate recovery time between sessions and a sound maintenance plan ensure efficacy and safety.     

针灸治疗黄褐斑的取穴规律探讨

目的:总结和分析针灸治疗黄褐斑的临床用穴规律,为针灸治疗黄褐斑的临床取穴提供理论依据。方法:检索了近10年针灸治疗黄褐斑的文献近50篇,对其取穴规律进行了总结与分析。结果:在合格文献中,治疗黄褐斑的主要穴位有15个,分布于八条经脉上,其中以足太阳膀胱经穴的使用最多。结论:针灸治疗黄褐斑以足三里、三阴交、曲池、血海为基本主方;配穴以辨证取穴为主;局部取穴与全身取穴相结合。     

养颜青娥丸对小鼠B-16黑素瘤细胞株黑素合成和酪氨酸酶的影响

目的：研究养颜青娥丸对小鼠B－16黑素瘤细胞株细胞增殖、黑素合成的影响及对细胞内酷氨酸酶的影响。方法：四甲基偶氮唑蓝（MTT）比色法测定养颜青娥丸对细胞增殖的影响；酶学方法研究养颜青娥丸对酷氨酸酶活性的作用；470nm比色法测定合成黑素含量A值。结果：研究发现养颜青娥丸对黑素细胞增殖及酷氨酸酶活性有抑制作用，对合成黑素含量有降低作用；组方单味药中杜仲、沙苑子、制首乌对黑素细胞增殖及酷氨酸酶活性有抑制作用，对合成黑素含量有降低作用；补骨脂、核桃肉对黑素细胞增殖及酷氨酸酶活性有促进作用，对合成黑素含量有增加作用。结论：养颜青娥丸对黄褐斑可能有一定的治疗作用，但治疗机制不能单纯用生化学、酶学改变来解释。     

Efficacy of 577 nm pro-yellow laser in the treatment of melasma: a prospective split-face study

ABSTRACT

We aimed to study the effectiveness of 577 nm pro-yellow laser in the treatment of melasma. A total of 82 patients with melasma were included in this comparative study. A detailed medical history, examination, and calculation of Melasma Area and Severity Index were done for all patients. All participants were treated with topical sunscreen and hydroquinone 4% cream on both sides of the face. In addition, the left side of the face was subjected to a single pass of 577-nm pro-yellow laser at a monthly interval for three sessions. Follow up was done by comparing the Melasma area and severity index at 0, 3 and 6 months. At baseline, there is no significant difference in the Melasma area and severity index score between both sides of the face. At 3 months, MASI score was statistically significantly decreased on both sides of the face compared to pretreatment (P < .05). At 6 months, the mean MASI score at the laser-treated side was statistically significantly decreased compared to the non-laser-treated side (P < .05). we concluded that the addition of 577 nm pro-yellow laser in the treatment of melasma leads to maintain the improvement and reduction of the recurrence rate.     

基于中医传承辅助平台的中医药辨治黄褐斑的用药规律

目的:基于中医传承辅助系统分析与总结近5年间中医药治疗黄褐斑的用药及组方规律,为今后黄褐斑的临床治疗提供参考价值。方法:检索2015—2019年国家知识基础设施数据库(CNKI)中医药治疗黄褐斑的相关文献,使用中医传承辅助系统进行数据挖掘构建数据库,并对相关数据进行统计与分析,总结出中医药治疗黄褐斑的处方特点及用药规律。结果:筛选出129篇文献,其中方剂共有204条;共有179味中药,其中频次最高为当归。药性以温为主。药味以甘为主;归经多见于肝经。熵层次聚类算法得出新方12个。结论:目前黄褐斑发病主要以肝郁、气滞、血瘀为主要病因,治疗应以疏肝解郁,活血化瘀为主,兼以扶正。