Topical 3% tranexamic acid enhances the efficacy of 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser in the treatment of melasma

Background: A QS-NdYAG laser (QSNYL) and topical tranexamic acid (TA) have been widely used. However, no study has yet reported the efficacy of using both QSNYL and TA as a combined treatment for melasma. Objectives: To evaluate the efficacy and adverse effects of topical 3% TA combined with 1064-nm QSNYL as a treatment for melasma. Methods: A randomized, prospective, split-face, controlled trial was conducted. A 1064-nm QSNYL was performed on the entire face at baseline and 4 weeks later. The participants were randomly selected for application of topical 3% TA on one side of the face and the vehicle treatment on the other side of the face for 8 weeks. Clinical responses were determined by mMASI scores, Mexameter?, and participants’ evaluation. Results: Twenty-five participants completed the study. At the end of the study, the mMASI score significantly decreased in the combination treatment (p < 0.05), while no significant changes were observed in the laser-alone treatment. More than 80% of the participants noticed a >50% improvement on the side with combination therapy at every follow-up visit. No serious adverse events were reported. Conclusion: Topical TA as an adjuvant demonstrated trends of better outcomes than QSNYL alone for the treatment of melasma.     

Low-power Fractional Carbon Dioxide Laser Followed by Jessner's Peel versus Jessner's Peel Alone for the Treatment of Melasma

BACKGROUND: A number of treatments have been used to treat melasma, with varying degrees of success and side effects. OBJECTIVE: We sought to compare the efficacy of a single session of low-power fractional CO₂ (10,600 nm) laser followed by Jessner’s solution peeling against that of Jessner’s solution peeling alone for the treatment of melasma by way of a prospective cohort comparative study performed at Alexandria Main University Hospital in Alexandria, Egypt. This study included 40 Egyptian female patients diagnosed with melasma. Group A received a single session of low-power fractional CO₂ laser followed by Jessner’s solution peeling for up to six sessions, while Group B received up to six sessions of Jessner’s solution peeling alone. Responses were evaluated using the modified Melasma Area and Severity Index (mMASI) score. RESULTS: There was a statistically significant (p≤0.001) difference between mMASI score between before and after treatment in both groups. There was no intergroup significant difference in mMASI score improvements. CONCLUSION: Both low-power fractional CO₂ laser combined with Jessner’s solution and Jessner’s solution peeling alone were safe and effective for the treatment of melasma in patients with different skin types, especially in dark skin types (Fitzpatrick Skin Types III and IV).     

大光斑低能量Q开关Nd:YAG激光治疗黄褐斑的疗效分析

目的 探讨大光斑低能量Q开关Nd∶YAG激光治疗黄褐斑的疗效,分析黄褐斑皮损激光治疗前后共聚焦激光扫描显微镜(CLSM)特征.方法 收集45例黄褐斑患者,使用大光斑低能量调Q开关Nd∶YAG 1064 nm激光治疗,并在治疗前后对其行CLSM检查.结果 45例患者,治疗结束后基本治愈8例(17.78％),显效25例(55.56％),好转11例(24.44％),无效1例(2.22％),有效率为73.33％.CLSM下可见黄褐斑皮损处较周围正常皮损处表皮全层黑素颗粒增多,激光治疗后表皮处黑素颗粒显著减少.结论 大光斑低能量调Q 1064 nm激光治疗黄褐斑疗效确切,安全性高,CLSM可用于判断激光治疗疗效.     

左归饮合逍遥散加减方治疗黄褐斑48例疗效观察

目的:观察左归饮合逍遥散加减方治疗黄褐斑的临床疗效。方法:将89例患者随机分为两组,治疗组48例,以左归饮合逍遥散加减方治疗;对照组41例,以口服维生素C、维生素B6、维生素E治疗。两组均以1个月为1疗程,3个疗程后评定疗效。结果:总有效率治疗组为83.3%,对照组为51.2%,两组比较,差异有统计学意义(P<0.05)。结论:左归饮合逍遥散加减方治疗黄褐斑疗效较好,值得推广应用。     

Inhibitory effects of progestogens on the estrogen stimulation of melanocytes in vitro

Background

The use of oral estrogen-progestogen contraceptives may cause melasma, an epidermal hyperpigmentation in sun-exposed areas of the face. It is assumed that elevated estrogen levels lead to the activation of melanocytes, while the role of the gestagen component of contraceptives in pigmentation remains unclear and may vary between the different progestogens. In this study, we analyzed the distinct effects of progesterone and chlormadinone acetate (CMA) on melanocytes in comparison with estrogen.

Study Design

Human melanocytes were exposed to different concentrations of 17β-estradiol and progestogens and analyzed for proliferation by a fluorometric cell viability assay and for pigmentation by a ³H-labeled tyrosine assay. Subgroups of cells were additionally irradiated with UVA or UVB.

Results

Proliferation of melanocytes was induced by 17β-estradiol (0.1 and 1 nM) in approximately half of the experiments, while progesterone (100 nM) and CMA (100 nM) reduced the proliferation rate by 38% and 27%, respectively. The pigmentation activity was slightly stimulated by 17β-estradiol, whereas progestogens had no effect on the tyrosinase activity.

Conclusions

Our data suggest that progesterone and CMA can inhibit proliferation of human melanocytes, which counteracts the stimulatory effects of estrogen. This may be of relevance for the choice of progestogen in oral contraceptives to prevent the development of melasma.     

强脉冲光联合Q开关倍频Nd：YAG激光治疗黄褐斑临床观察

目的观察强脉冲光联合Q开关倍频Nd：YAG激光治疗黄褐斑的临床疗效。方法选取120例患者,随机均分为3组,治疗组使用IPL和Q开关倍频Nd：YAG激光联合治疗,对照组分为仅使用IPL治疗组和仅使用Q开关倍频Nd：YAG激光治疗组。以色素消退≥90%为痊愈,色素消退60%-89%为显效,色素消退30%-59%为有效,色素消退〈30%为无效。结果联合治疗组中有效者18例,显效者17例;单纯IPL治疗组中痊愈者11例,显效者7例;单纯Q开关Nd∶YAG激光治疗组中痊愈者13例,显效者8例,3组总有效率分别为87.5%,45.0%,52.5%,差异具有显著统计学意义（χ2=17.415,P〈0.001）。所有患者均未出现色素加重、瘢痕等,仅1例出现暂时性色素减退。结论强脉冲光联合Q开关倍频Nd：YAG激光可安全有效地治疗黄褐斑,且治疗效果优于单纯使用IPL及Q开关倍频Nd：YAG激光治疗效果。     

低能量密度1064nm QS Nd:YAG激光治疗黄褐斑疗效观察

目的观察低能量密度Q开关Nd:YAG激光治疗面部黄褐斑的疗效和安全性。方法应用波长为1064nm的Q开关Nd:YAG激光低能量密度治疗17例面部黄褐斑患者,1次/w,10次为一疗程,治疗结束后随访12周。根据患者MASI评分降低值和患者满意度对疗效进行评价。结果 17例患者中,9例(52.9%)患者达到显著改善及痊愈。平均皮损改善级别为2.53级,起效平均次数3.18次,MASI评分平均降低了6.55分,患者满意率82.3%。部分患者在术中轻微灼痛、术后数十分钟有轻至中度红斑。结论低能量密度Q开关Nd:YAG激光治疗面部黄褐斑疗效确切,不良反应轻。     

化学外科治疗面部色素性皮损的疗效观察

应用无痛酚液对１１３例面部皮肤色素痣、雀斑、黄褐斑及咖啡癍等四种皮损进行化学外科治疗观察。结果痊愈８５例，显效４例，有效率为８７．７％，治疗时无痛苦，痊愈后不留疤痕，皮肤变得细嫩平滑。     

桂枝茯苓丸加味对血瘀型黄褐斑患者血清一氧化氮的影响

目的观察桂枝茯苓丸加味治疗血瘀型黄褐斑患者的临床疗效及对患者血清一氧化氮水平的影响。方法 77例血瘀型黄褐斑患者随机分为两组,治疗组口服桂枝茯苓丸加味,对照组口服维生素C及维生素E,两组均外涂氢醌霜。治疗3月后检测两组患者血清一氧化氮水平及临床症状积分。结果治疗组治愈率34.14%,有效率87.70%,对照组治愈率11.11%,有效率55.57%,两组比较差异均有统计学意义(P0.05)。治疗组一氧化氮水平明显低于治疗前水平,两组比较差异有统计学意义(P0.05)。结论桂枝茯苓丸加味能调节一氧化氮水平,抑制酪氨酸酶活性,减少黑色素的形成,从而起到消除和减轻黄褐斑的作用。     

Two cases of melasma with unusual histopathologic findings

We reported two cases of clinically typical melasma presenting with unusual histopathologic findings. In one case, the epidermal melanocytes were markedly increased in number and protruded into the dermis, and in the other case, increased epidermal pigmentation as well as dermal melanocytosis were found. We suggested that the various treatment modalities of melasma should be applied depend on its histopathologic finding.