BACKGROUND Melasma is a common, recurrent, and refractory cause of facial pigmentation resulting in cosmetic disfigurement. Tranexamic acid (TA) has been used systemically and locally for clearance of pigmentation. OBJECTIVE To assess the clinical efficacy of topical TA (10%) with microneedling in melasma. METHODS A split face, prospective, randomized, open-label study with a sample size of 40. Left or right side of the face was chosen randomly and microneedling was done on both the sides, followed by 10% TA solution application on one side of the face (test side) and distilled water on the other side of face (control). The procedure was done at 2 weekly intervals (0, 2, 4, and 6 weeks). Clinical images were taken at each visit including modified Melasma Area and Severity Index (mMASI) scoring of each half of the face to assess the clinical response along with patient satisfaction scores and side effects. RESULTS On the test side, there was 65.92% improvement in the mean mMASI score compared with 20.75% on the control side of the face at the end of 8 weeks. CONCLUSION Tranexamic acid may be a promising therapeutic agent in melasma and the topical solution along with microneedling seems to be efficacious.

Age and sex interaction has significant effect on orthodontic pain during adolescence, and 14- to 17-year-old girls experienced maximum pain.

Objective:To investigate and compare the effects of superelastic nickel–titanium and multistranded stainless steel archwires on pain during the initial phase of orthodontic treatment.Design:A double-blind two-arm parallel design stratified randomized clinical trial.Setting:A single centre in India between December 2010 and June 2012. A total of 96 participants (48 male and 48 females; 14.1±2.1 years old) were randomized (stratified on age, sex and initial crowding) to superelastic nickel–titanium or multistranded stainless steel archwire groups using a computer-generated allocation sequence.Methods:We compared 0.016-inch superelastic nickel–titanium and 0.0175-inch multistranded stainless steel wires in 0.022-inch slot (Roth prescription) preadjusted edgewise appliances. The follow-up period was 14 days. Outcome was assessed with a visual analogue scale at baseline and 32 pre-specified follow-up points. Data was analyzed using mixed-effects model analysis.Results:One participant was lost to follow up and 10 were excluded from the analysis due to bond failure or incomplete questionnaire answers. Ultimately, 85 participants (42 males and 43 females; 14.1±2.0 years old) were analysed for the final results. No statistically significant difference was found for overall pain [F value = 2.65, degrees of freedom (df) = 92.6; P = 0.1071]. However, compared to multistranded stainless steel wires, pain in subjects with superelastic nickel–titanium archwires was significantly greater at 12 h (t = 2.34; P = 0.0193), as well as at day 1 in the morning (t = 2.21, P = 0.0273), afternoon (t = 2.11, P = 0.0346) and at bedtime (t = 2.03, P = 0.042).Conclusion:For overall pain, there was no statistically significant difference between the two wires. However, subjects with superelastic nickel–titanium archwires had a significantly higher pain at peak level.

Nonscarring DHL is a multifactorial condition with highest incidence in 21- to 40-year age group. Serum ferritin, serum vitamin B12, and D3 levels seem to have a contributing role in the pathogenesis of hair loss, and their supplementation may be needed for a faster regrowth of hair in all cases of hair loss irrespective of the pattern.

Superelastic NiTi performed significantly better than multistranded (coaxial) stainless steel wire in the Begg appliance. However, in PEA, there was no significant difference.

There is an improvement in the reporting quality. However, it is still suboptimal. To improve the reporting quality, the CONSORT guidelines should be followed strictly.

Platelet rich plasma (PRP) is an upcoming interventional therapy for the treatment of melasma. Its efficacy is due to the multiple growth factors present in it which decrease melanogenesis by various signal transduction pathways. The present study evaluated the efficacy of PRP as a standalone agent in treatment of melasma. This is an open labeled prospective trial. Forty patients were given intralesional PRP at once monthly interval. Three such PRP sessions were carried out and the patients were followed up for 3 months. Assessment was done by calculating the modified melasma area severity index score (mMASI) for each patient. Patients were also asked to selfevaluate their improvement based on a scale. There was an average 54.5% reduction in the mMASI score at the end of the study. There was no relapse in any patient. This reduction was irrespective of the skin type, gender, and type of melasma. Patients self-evaluation showed that more than 90% of the patients were pleased or very pleased with the results. There were no significant side effects. PRP appears to be a potential new therapy with significant efficacy in improving pigmentation of melasma, standalone as monotherapy.

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