二花鲜汁膜治疗黄褐斑的实验研究

目的：观察二花鲜汁膜对紫外线照射致黄褐斑模型小鼠皮肤中黑色素细胞的分布和数量及超氧化物歧化酶（SOD）活性和丙二醛（MDA）含量的影响。方法：紫外线照射法制作黄褐斑小鼠模型；检测应用二花鲜汁膜后，小鼠皮肤中SOD和MDA的含量、黑色素细胞的分布及数量。结果：实验组皮肤中SOD活性较对照组明显升高，MDA含量降低，黑色素细胞的数量及分布也明显减少。结论：二花鲜汁膜对黄褐斑有明显的抑制作用。     

计算机图像分析系统评价斑克治疗黄褐斑疗效

目的:研究探索计算图像分析系统评价斑克治疗黄褐斑的临床疗效和方法。方法:应用计算机皮肤数字图像分析系统,采用平均光密度、面积二项指标,评价斑克治疗黄褐斑的临床效果。结果:通过计算机数字图像分析系统分析表明,经斑克治疗后5周较治疗前的平均光密度明显下降和皮损面积明显缩小,经统计学处理有显著性差异(P<0.05)。结论:计算机图象分析系统的疗效评价更具有客观性,斑克治疗黄褐斑的临床效果好。     

A double-blind controlled study of a nonhydroquinone bleaching cream in the treatment of melasma

Background Melasma is an acquired hypermelanosis predominantly affecting the face of women. It is often recalcitrant to treatment with hypopigmenting agents. Objective To assess the efficacy of a nonhydroquinone cream (Amelan M^®) vs. another (Mela‐D^®) as treatment for melasma. Methods Twenty‐two French women with bilateral epidermal and/or mixed melasma were enrolled in a split‐faced prospective trial lasting 4 months during summer season weeks. Twelve patients applied once‐daily Amelan M^® to one side of the face with sun‐protective factor 60 UVA sunscreen each morning and Mela‐D^® once‐daily to the other side of the face. Pigmentation was measured objectively using a mexameter and the melasma area and severity index (MASI) were measured subjectively. Results The mean decrease of pigmentation was statistically significant on the MASI with both cream and only with Amelan M with the mexameter. Some adverse side effects were observed. Conclusions Amelan M^® is really more effective than Mela D^® cream on melasma. Even though some side effects were observed patients preferred the Amelan M‐treated side.     

Oral intake of proanthocyanidin-rich extract from grape seeds improves chloasma

Chloasma (melasma), an acquired hypermelanosis, is often recalcitrant to various treatments and an amenable, as well as safe, pigment-reducing modality is needed. We investigated that the reducing effect of proanthocyanidin, a powerful antioxidant, on chloasma in a one-year open design study. Proanthocyanidin-rich grape seed extract (GSE) was orally administered to 12 Japanese woman candidates with chloasma for 6 months between August 2001 and January 2002 and to 11 of these 12 for 5 months between March and July 2002. Clinical observation, L* value (lightening) and melanin index, and size (length and width) measurements of chloasma were performed throughout the study period. The first 6 months of GSE intake improved or slightly improved chloasma in 10 of the 12 women (83%, p < 0.01) and following 5 months of intake improved or slightly improved chloasma in 6 of the 11 candidates (54%, p < 0.01). L* values also increased after GSE intake (57.8 +/- 2.5 at the start vs 59.3 +/- 2.3 at 6 months and 58.7 +/- 2.5 at the end of study). Melanin-index significantly decreased after 6 months of the intake (0.025 +/- 0.005 at the start vs 0.019 +/- 0.004 at 6 months) (p < 0.01), and also decreased at the end of study (0.021 +/- 0.005) (p < 0.05). GSE is effective in reducing the hyperpigmentation of women with chloasma. The beneficial effects of GSE was maximally achieved after 6 months and these was no further improvement after this period. The latter GSE intake for 5 months may prevent chloasma from becoming worse prior to the summer season. GSE is safe and useful for improving chloasma.     

Topical therapies for melasma and disorders of hyperpigmentation

ABSTRACT: Facial hyperpigmentation is usually a reflection of an increased amount of melanin either within the epidermis, the dermis, or both (mixed pattern). The increase in melanin content is due to an increased number of functioning melanocytes (melanocytosis), an increased amount of melanin production without a numerical alteration of melanocytes (melanosis), or both. Topical hypo/depigmenting agents are most effective in those disorders where the increased melanin pigment (secondary to melanocytosis or melanosis) is within the epidermis. In patients with melasma, one of the more common causes of facial hyperpigmentation, two major groups of hypo/depigmenting agents have been used: phenolic derivatives and nonphenolic compounds. Hydroquinone, a phenolic derivative, has been used most extensively. It is applied to areas of involvement, either alone or in combination with one or two of the following: tretinoin, salicylic acid, glycolic acid, or corticosteroid. Phenolic thioethers are a new class of phenolic derivatives, and they exhibit both cytocidal and cytostatic effects selectively on melanocytes. Nonphenolic depigmenting agents include azelaic acid and kojic acid. If the facial hyperpigmentation is not improved by first-line topical therapies, chemical peels may be used in combination. The precise cause of melasma is not known, and multiple factors have been implicated. However, a genetic predisposition and exposure to ultraviolet (UV) light are very important factors. Avoidance of direct exposure to sunlight and application of broad-spectrum sunscreens are required during and after the period of active treatment. In addition to melasma, other causes of facial hyperpigmentation include Riehl's melanosis, photocontact dermatitis, the sequelae of inflammatory diseases such as acne vulgaris and cutaneous lupus, and nevus of Ota.     

Facial-Skin Hyperpigmentation： Histological and Computer Geometric Assessment

Hyper-pigmentation is a common, acquired dermatological skin-disorder manifesting and identifiable as irregular brown or greyish-brown facial discolouration, and sometimes referred to as melanosis, melasma or hypermelanosis. Purpose and Objective： To identify the site of melanin deposition in skin-layers regarding facial hyper-pigmentation, based on a histological study of full-thickness skin-facial biopsies in aged Caucasian-cadavers. Hypothesis： Recalcitrant hyper-pigmentation, is chiefly characterised by hyper-melanosis restricted to the dermal-layer of the integument. Method： The histological features of facial hyper-pigmentation and solar-lentigenes were evaluated in a pilot-study of 5-randomly selected Caucasian-cadavers with pigmentation （15 facial biopsies）, ranging in age between 75 and 102 years （mean 77-years）. Selection-criteria included, both genders, age 〉 75, focal and confluent hyper-pigmented lesions, involving sun-exposed areas of skin （centrifacial, scalp, malar, mandibular and cervical）. Study groups included （Grp-1： Control skin-histology in otherwise normal aged, human-cadavers; Grp-2： Histology of pigmented facial skin-lesions in man; Grp-3： Comparative histological skin-controls in non-human primates）. No obvious hepatic disease was evident in the cohort studied. Twenty-five histological controls were obtained from non-pigmented areas. Histological evaluation of full-thickness skin-biopsies （including the lesion, edge and peri-]esion skin）, was under a Leitz~-light-microscope, and staining included H＆E, Masson-trichrome, Masson-fontana, Alcian-blue and Verhoef technology. Histological-scoring used was on histological deposition of melanin in skin-layers： epidermal, dermal, mixed, and indeterminate melanin-deposition （score 1-4）. Controls included cadaveric skin-biopsies of human races of colour and non-human primate, Cercopethicus Aethiops （latter is known to have predominantly dermal-melanin deposition）. Pigmented and non-pigmented areas were compared in both species. Results： The majority of clinically visible individual and confluent areas of hyper-pigmentation studied were maeroscopically present on the forehead, frontal scalp in hair-receded cadavers, molar and temporal zones. Histologically, documented features of age-related changes without pigment were present in almost all the embalmed cadaver-skins, with a melanin-score of 1. Computer enhanced skin geometry and biometrics confirmed the presence of an aged-skin, pigmentation and features of solar damage. The human embalmed-tissue was well preserved and minimal autolytic changes were present. Special stains of full-thickness biopsies （Masson-Fontana）, showed that melanin in the subhuman-primate is lodged in the deep dermis （reticular dermis）, within the extra-cellular matrix （ECM） and superficial to the hypodermal adipose-tissue （melanin-score 3）. Fifteen pigmented lesions studied in five （5） aged-cadavers （forehead, molar and mandibular areas） all showed predominantly epidermal-deposition of melanin in the basal, suprabasal and stratum corneum with tiny focal areas of dermal melanosis in single-cell macrophages in the papillary-dermis but not reticular-dermis （melanin-score 2）. A melanin-deposition localization ratio of epidermis to dermis was approximately 98 to 2% in cadavers with hyper-pigmentation. Conclusion： The skin-strata localization of the melanin with regards hyper-pigmentation of the face and forehead in this aged, human adult Caucasian, cadaveric-study, was predominantly in the epidermis and sparse in the papillary dermis.     

Q开关红宝石激光联合氨甲环酸治疗黄褐斑的疗效评价及对黑素代谢的作用

目的 观察Q开关红宝石激光联合氨甲环酸治疗黄褐斑的疗效及对黑素代谢的作用.方法 将60例黄褐斑患者随机分为3组:药物组(口服氨甲环酸500 mg/d,疗程6个月)、激光组(Q开关红宝石激光,每2周1次,疗程2个月)、联合组(激光联合氨甲环酸,方法及疗程同其他两组),比较治疗后三组黄褐斑面积及严重程度评分(MASI)、疗...     

长脉宽1064nm Nd：YAG激光治疗黄褐斑疗效观察

目的：探讨长脉宽1064nm Nd：YAG激光治疗黄褐斑的临床疗效和安全性。方法：选取12例面部黄褐斑患者,采用长脉宽1064nm Nd：YAG激光,光斑直径5mm,脉宽0.3～0.4ms,能量13～15J/cm2,频率7～10Hz,全面部每次扫描约6000～12000个脉冲,共治疗10次,每2周1次,术后严格防晒。每次治疗前采用MASI评分和前后照片比较改善效果。结果：12例经过10次治疗,黄褐斑患者均获得不同程度改善,其中3例的改善率达到了60%,5例达到50%以上的改善。无1例出现严重副反应,同时还有改善皮肤质地的作用,80%以上的患者表示满意。结论：长脉宽1064nm Nd：YAG激光治疗黄褐斑疗效确切,安全性高,无明显副作用,是一种治疗黄褐斑安全、有效的新方法。