黄褐斑的分类及治疗

黄褐斑是影响美容的常见皮肤病，最重要的发病因素是阳光和遗传素质，黄褐斑临床上分为三型；根据伍氏灯和组织学检查黄褐斑可分为四型。治疗黄褐斑目前尚无效药效，但首先必须避免日晒和停止口服避孕药，现在通常使用２％～５％氢醌，０．１％维甲酸以及这两种药物的混合制剂，也可使用瓣的酚化合物，壬二酸和中等深度的化学剥脱术治疗黄褐斑，不得使用氢醌苄醚和汞水化合物治疗黄褐斑。     

黄褐斑的药物治疗进展

黄褐斑是临床常见的获得性色素沉着性疾病，病因不明，尚元特效疗法，目前以药物治疗为主，抑制黑素生成是主要的作用机制，包括抑制酪氨酸酶合成、抑制黑素小体转运、加速表皮更新等，其中以酪氨酸酶抑制剂使用最为广泛；植物萃取物在治疗黄褐斑方面仍缺乏足够证据。应用明确有效的治疗及安全合适的维持治疗方案是主要治疗原则。随着对黄褐斑发病机制的进一步研究及基因工程药物的出现可能为本病的治疗带来新思路。     

黄褐斑的组织病理学研究进展

黄褐斑是临床常见的一种获得性色素增加性疾病，常对称发生于曝光部位，严重影响患者的外观美容。目前，对于它的组织病理学表现尚存在很多争议；临床上尚无很好的治疗方法。文章通过对最近几年发表的有关黄褐斑组织病理学文章加以分析、归纳，对其组织病理学表现，以及组织病理学研究中存在的一些问题进行了探讨；希望能够对黄褐斑的治疗提供帮助。     

联合治疗黄褐斑的研究进展

黄褐斑是一种常见的皮肤色素代谢障碍性疾病,因病因及发病机制复杂,单药治疗疗效不佳或不良反应较大,而联合治疗因疗效佳、不良反应小受到医生的亲睐。目前黄褐斑的治疗多样,主要有口服、外用药物,激光或光子疗法,多种方案联合治疗等。黄褐斑的治疗需根据患者病因、病程、临床分型、既往治疗情况等制定个性化治疗方案。多重治疗、序贯治疗或补充治疗应纳入黄褐斑治疗中。     

黄褐斑的分类及治疗

黄褐斑是影响美容的常见皮肤病,最重要的发病因素是阳光和遗传素质。黄褐斑临床上分为三型;根据伍氏灯和组织学检查黄褐斑可分为四型。治疗黄褐斑目前尚无特效药,但首先必须避免日晒和停止口服避孕药。现在通常使用2％～5％氢醌、0.1％维甲酸以及这两种药物的混合制剂,也可使用新的酚化合物、壬二酸和中等深度的化学剥脱术治疗黄褐斑。不得使用氢醌苄醚和汞化合物治疗黄褐斑。     

色素障碍性皮肤病

黄褐斑患甲状腺功能的测定及意义，活血祛斑汤加面膜倒模治疗黄褐斑疗效观察，解毒消斑饮治疗黄褐斑50例疗效观察，中西医结合治疗黄褐斑160例效果探讨，中药治疗黄褐斑106例疗效观察，     

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。     

强脉冲光单独或联合其他疗法治疗黄褐斑的研究进展

【摘要】 黄褐斑病因复杂,目前治疗手段较多,但均无确切、满意的疗效。近年来,强脉冲光治疗黄褐斑取得了良好的疗效。本文综述近年来单用强脉冲光及联合激光、外用药和系统用药治疗黄褐斑取得的进展。     

抗氧化治疗在黄褐斑中的应用

黄褐斑是一种色素过度沉着疾病,可给患者生活带来巨大困扰.氧化应激水平变化是黄褐斑致病因素之一,其通过一氧化氮等途径影响黄褐斑形成.目前谷胱甘肽、中药药剂以及维生素C等抗氧化治疗手段通过调节氧化应激水平、抑制酪氨酸酶等均能改善黄褐斑症状.本文就氧化应激在黄褐斑发病中的作用以及抗氧化治疗在黄褐斑中的应用作一综述.     

黄褐斑的中医治疗研究进展

黄褐斑是一种常见的损容性皮肤病,目前尚无理想治疗方法,中医药治疗黄褐斑具有一定的优势,积累了丰富的经验。本文总结近几年来中医药治疗黄褐斑的临床及实验研究进展,分为内治法、外治法两个部分,以期为临床治疗提供更多思路和方法。     

Melasma: How hormones can modulate skin pigmentation

We described—along with a genetic predisposition and exposure to sunlight, as the main factors for melasma development—pregnancy, hormonal therapies, and oral contraceptive pills. Whilst hormonal alteration or therapies are frequently reported in literature in association with melasma, studies analyzing the laboratoristic correlation are limited. We review data published on hormones variations both in women and males with melasma and report some peculiar clinical cases that further demonstrate how the relationship between hormone secretion and melasma development is difficult to be defined.     

Treatment of melasma with low fluence, large spot size, 1064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of melasma in Fitzpatrick skin types II-IV

Melasma is a common condition affecting over six million American women. Treatment of dermal or combined melasma is difficult and does not respond well to conventional topical therapies. Various light sources have been used recently in the treatment of melasma including fractionated ablative and non-ablative lasers as well as intense pulse light. We report the use of low fluence, large spot size Q-switched, Nd:Yag laser for the treatment of melasma in skin types II-IV.     

The treatment of melasma: a review of clinical trials

Melasma is an irregular brown or grayish-brown facial hypermelanosis, often affecting women, especially those living in areas of intense UV radiation. The precise cause of melasma remains unknown; however, there are many possible contributing factors. Because of its dermal component and tendency to relapse, melasma is often difficult to treat. The use of broad-spectrum (UVA + UVB) sunscreen is important, as is topical hydroquinone, the most common treatment for melasma. Other lightening agents include retinoic acid (tretinoin) and azelaic acid. Combination therapies such as hydroquinone, tretinoin, and corticosteroids have been used in the treatment of melasma, and are thought to increase efficacy as compared with monotherapy. Kojic acid, isopropylcatechol, N-acetyl-4-cysteaminylphenol, and flavonoid extracts are other compounds that have been investigated for their ability to produce hypopigmentation, but their efficacy, safety, or trial design indicates that the interventions would need further study before they could be recommended. Chemical peels, laser treatments, and intense pulsed light therapy are additional therapeutic modalities that have been used to treat melasma.     

Treatment of Melasma with low fluence,large spot size, 1064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of melasma in Fitzpatrick skin types II–IV

Abstract

Melasma is a common condition affecting over six million American women. Treatment of dermal or combined melasma is difficult and does not respond well to conventional topical therapies. Various light sources have been used recently in the treatment of melasma including fractionated ablative and non-ablative lasers as well as intense pulse light. We report the use of low fluence, large spot size Q-switched, Nd:Yag laser for the treatment of melasma in skin types II–IV.     

Treatment of Melasma with Topical Agents, Peels and Lasers: An Evidence-Based Review

Background

Melasma is an acquired disorder of hyperpigmentation occurring on the face and predominantly affecting women of childbearing age. It is a chronic, often relapsing condition with a negative impact on quality of life. Current treatments for melasma are unsatisfactory.

Objective

The aim of this article was to conduct an evidence-based review of interventions available for the treatment of melasma.

Methods

A systematic literature search was performed using PubMed and the keywords ‘melasma’ or ‘chloasma’ in the title. The search was further refined by using a filter for ‘controlled clinical trials’ and ‘randomized controlled trial’. The included studies were used to develop recommendations for treatment.

Results

The electronic search yielded a total of 80 citations. Forty studies were included in this review, which had a total of 2,912 participants. Three different therapeutic modalities were investigated—topical agents, chemical peels, and laser and light therapies. Topical depigmenting agents were found to be the most effective in treating moderate-to-severe melasma, with combination therapies, such as triple-combination therapy (hydroquinone, tretinoin, and fluocinolone acetonide), yielding the best results. Chemical peels as well as laser and light therapies were found to have moderate benefit but more studies are needed to determine their efficacy and long-term safety. Adverse events associated with treatment were mild and short-lasting and included skin irritation, dryness, burning, and erythema. The data could not be statistically pooled because of the heterogeneity of treatments and lack of consistency across study designs.

Conclusions

Topical combination therapies were found to be more effective than monotherapy. Triple combination therapy was found to be the most effective, but approximately 40 % of patients develop erythema and peeling. Chemical peels and laser and light therapies produced mixed results, with increased risk of irritation and subsequent hyperpigmentation, particularly in darker-skinned individuals. Hence, current treatments available for melasma remain unsatisfactory. Many of the studies lacked long-term follow-up. Limitations of current literature include the heterogeneity of study designs, small sample sizes, and poor follow-up rates. Additional evidence for the effects and role of sunscreens is needed. Categorization or stratification of demographic data should also be included in future studies, such as age, melasma type, and duration of melasma prior to initiation of treatment. Patient’s perception of improvement versus investigator’s assessment of improvement should also be included in future studies and standardized methods of study design and assessment of outcomes are needed to form definitive conclusions on the efficacy of different treatment modalities.     

Novel technique to treat melasma in Chinese: The combination of 2940-nm fractional Er:YAG and 1064-nm Q-switched Nd:YAG laser

Melasma is one of the most common pigmented lesions in Chinese women. Although topical therapies are the mainstay treatment, lasers are being used increasingly to treat pigmented lesions. Laser treatment of melasma is however still controversial. This is because lasers have not been able to produce complete clearance of melasma and recurrence rates are high. Laser treatments also cause complications such as hypopigmentation and post-inflammatory hyperpigmentation. In this article, we report on a novel technique using a combination of fractional 2940-nm Er:YAG and 1064-nm Q-switched Nd:YAG lasers. We achieved a rapid improvement in two cases of melasma in Chinese type III skin. The improvement was seen rapidly within a month of treatment. Follow-up at 6 months showed sustained results with no complications. This novel technique is able to safely confer excellent and sustained clearance within a short treatment time.     

Utilizing fractional resurfacing in the treatment of therapy-resistant melasma.

BACKGROUND: Multiple treatment modalities have been employed for the management of melasma with minimal to no success. OBJECTIVE: We propose fractional resurfacing as a new treatment modality for melasma. METHODS: A 31-year-old Caucasian female with facial epidermal and dermal melasma, resistant to multiple courses of topical therapies, was treated with two sessions of full-face fractional resurfacing (Fraxel(TM) Laser; Reliant technologies, San Diego, CA), separated by a three-week interval. Clinical improvement was assessed by Wood's Lamp examination as well as parallel and cross-polarized comparative photography at baseline and 6 months later. RESULTS: Marked reduction in epidermal and dermal facial pigmentation was observed at the six-month follow-up visit. CONCLUSION: Fractional resurfacing may prove to be an effective and safe treatment modality for lightening of the epidermal and dermal pigmentation of melasma. Further studies with long-term follow-up periods and multiple patients with diverse skin phototypes and different variants of melasma are warranted.     

Melasma: systematic review of the systemic treatments

Currently available treatment options for melasma include prevention of UV radiation, topical lightening agents, chemical peels, and light‐based and laser therapies. However, none have shown effective and sustained results, with incomplete clearance and frequent recurrences. There has been increasing interest recently in oral medications and dietary supplements in improving melasma. We sought to evaluate the efficacy and safety/tolerability of oral medications and dietary supplements for the treatment of melasma. Multiple databases were systematically searched for randomized clinical trials (RCTs) evaluating the use of oral medication for treatment of melasma alone or in combination with other treatments. A total of eight RCTs met inclusion criteria. Oral medications and dietary supplements evaluated include tranexamic acid, Polypodium leucotomos extract, beta‐carotenoid, melatonin, and procyanidin. These agents appear to have a beneficial effect on melasma improvement. In conclusion, oral medications have a role in melasma treatment and have been shown to be efficacious and tolerable with a minimal number and severity of adverse events. Therefore, dermatologists should keep oral medications and dietary supplements in their armamentarium for the treatment of melasma.     

Lasers,lights, and compounds for melasma in aesthetics

Melasma is a chronic and relapsing skin condition. Although melasma is usually asymptomatic, it can be associated with immense psychosocial stress and greatly impact a patient's quality of life. Over the years, many different treatments have been used, ranging from daily photoprotection, topical lightening creams, and oral agents to laser and light-based therapies; however, efficacy is often limited with such treatments, and there is currently no effective modality to prevent recurrence. Although treatment strategies had originally centered on the use of hydroquinone, newer modalities now include oral tranexamic acid and lasers. We examined previous and ongoing debates related to melasma treatments and have reviewed the current efficacy and safety of available treatments. Critical components essential to the successful management of melasma are the setting of patient expectations and assurance of treatment compliance.     

Skin hyperpigmentation index in melasma: A complementary method to classic scoring systems

Background

Due to relapsing nature of melasma with significant impact on quality of life, an objective measurement score is warranted, especially to follow-up the patients with melasma and their therapy response in a quantitative and precise manner.

Aims

To prove concordance of skin hyperpigmentation index (SHI) with well-established scores in melasma and demonstrate its superiority regarding inter-rater reliability. Development of SHI mapping for its integration in common scores.

Methods

Calculation of SHI and common melasma scores by five dermatologists. Inter-rater reliability was assessed by intraclass correlation coefficient (ICC) and concordance by Kendall correlation coefficient.

Results

Strong concordance of SHI with melasma area and severity index (MASI)-Darkness (0.48; 95% CI: 0.32, 0.63), melasma severity index (MSI)-Pigmentation (0.45; 95% CI: 0.26, 0.61), and melasma severity scale (MSS) (0.6; 95% CI: 0.42, 0.74). Using step function for mapping SHI into pigmentation scores showed an improvement of inter-rater reliability with a difference in (ICC of 0.22 for MASI-Darkness and 0.19 for MSI-Pigmentation), leading to an excellent agreement.

Conclusion

Skin hyperpigmentation index could be an important additional cost-and time-conserving assessment method, to follow-up the patients with melasma undergoing brightening therapies in clinical studies, as well as in routine clinical practice. It is in strong concordance with well-established scores but superior regarding inter-rater reliability.