Background: Melasma is a disorder of hyperpigmentation and vascularization often found in women between the ages of 20 and 40. The pathogenesis is unknown, but melasma often occurs in sun-exposed areas of the face, forearms, and back. Risk factors include family history, increased estrogen/progesterone, certain medications, and UV exposure. Melasma is typically treated with topical hydroquinone (HQ); however, it is often refractory to treatment. Tranexamic acid (TXA) is a plasmin inhibitor used off-label in the treatment of melasma. TXA can be administered orally, topically, or intralesionally. Aims:The purpose of this review is to characterize the wide variety of TXA delivery methods for melasma treatment and the efficacy of these methods compared with traditional treatments.Patients/Methods: A comprehensive PubMed and Embase search was conducted in May 2022 using the phrases tranexamic acid and melasma. Forty-six articles were included in this review.Results: Oral, intralesional, and topical TXA is safe and effective treatments for melasma. They have been studied in a variety of randomized controlled trials and have been compared with several traditional treatments. Overall, MASI scores in patients using TXA in any form improved. Conclusions:Oral TXA was found to be the most effective, especially in cases of refractory melasma; however, it caused GI upset and menstrual irregularities in many patients. The pro-thrombotic nature of this drug must be considered before safely prescribing to patients. Intralesional injections and microneedling with topical TXA were found to be effective alternatives to oral treatment. Lastly, topical TXA alone was found to be the least effective method but can be combined with other cosmeceuticals to improve outcomes. Topical TXA was also found to be better tolerated than hydroquinone, a traditional topical melasma treatment.
Pentoxifylline was initially marketed for use in patients with intermittent claudication due to chronic occlusive arterial disease of the extremities but has since been shown to have several off-label uses. It can be described chemically as 1-(5-oxohexyl)-3, 7-dimethylxanthine, which is a tri-substituted xanthine derivative. 1 Pentoxifylline has a variety of mechanisms of action (Figure 1). In its original purpose, it was used because of its rheological modifying properties, such as increasing the deformability of erythrocytes
While broad reviews on laser-assisted drug delivery (LADD) have been published in the past, an updated focused examination of its utility in the context of common, treatment-resistant, dermatologic conditions has not been published. We conducted a comprehensive scoping review of the potential benefits of LADD compared to laser or drug monotherapy for the treatment of 3 such conditions: scars, rhytids, and melasma. A PubMed (National Institutes of Health, Bethesda, MD) search was conducted using keywords including “laser-assisted drug delivery”, “scar”, “rhytid”, and “melasma”. Out-of-scope studies were excluded. To evaluate the efficacy of LADD for the treatment of scars, we categorized relevant articles by scar type; hypertrophic/keloid, atrophic, and hypopigmented. LADD, with both ablative and non-ablative laser types, was studied in combination with corticosteroids, Botulinum Toxin-A (BTX-A), 5-Fluorouracil (5-FU), 5-Aminolevulinic acid (ALA) photodynamic therapy (PDT), stem-cells, Platelet-rich plasma (PRP), and prostaglandin analogs for the treatment of scars. Some randomized controlled trials demonstrated efficacy with LADD, while others showed no significant differences in clinical outcomes, but demonstrated reduced adverse effects. Regarding rhytids, laser has been combined with varying cosmeceuticals, Polylactic acid (PLLA), topical retinaldehyde, and topical BTX-A. The studies reviewed supported the use of LADD with these drugs compared to monotherapy. Some studies showed that LADD was effective for the absorption of drugs like PLLA and BTX-A which are often not effective topically. For melasma treatment, LADD with tranexamic acid and hydroquinone was superior in some studies, but not significantly different than monotherapy in other studies. LADD with certain drugs could be considered to treat scars, rhytids, and melasma.
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