Melasma is an acquired disorder of hyperpigmentation affecting millions of individuals worldwide. It is mostly observed in the facial area of darker-complexioned individuals (skin types IV-VI) exposed to intense ultraviolet (UV) radiation 1 and shorter wavelengths of visible light (VL). 2 At least 90% of those affected are women. 1 Melasma is characterized by symmetrically oriented hyperpigmented macules and patches, with varying presentations including blotchy, irregular, arcuate, and polycyclic. 3 One way of dividing the disorder into different subtypes is based on the distribution pattern: centrofacial (the most common), malar, and mandibular. Another division is
Background: Melasma is an acquired disorder of hyperpigmentation, affecting a million individuals worldwide. Energy-based devices (EBDs) employed to treat melasma include various types of lasers, intense pulsed light (IPL), and radiofrequency (RF).Recent studies have attempted to address recalcitrant and recurring melasma by combining energy-based devices with topical or oral medications.Objective: This article reviews EBDs-based augmented treatment for melasma and suggests practical pathogenesis-oriented treatment regimens. Treatment algorithms are proposed to address various components of melasma.Methods: A systematic PubMed search was conducted acquiring information from various studies on combination treatments of melasma involving EBDs. Results:The 286 retrieved articles were filtered by title to contain at least one type of energy-based modality such as laser, IPL, or RF along with at least one other treatment method. Based on their subject matter, combinations were further categorized into the subheadings: laser plus medication, laser plus laser, and IPL-and RF-containing treatment methods. Conclusion:There are many energy-based combination treatments that have been explored for mitigation of melasma including laser therapy with medication, multilaser therapies, IPL, RF, and microneedling devices. Melasma is an exceedingly difficult condition to treat, however, choosing the appropriate tailor-made treatment combination can improve the final outcome.
Hepatocellular carcinoma (HCC) treatment is variable and depends on the size, location, and presence of extra hepatic metastasis and vascular invasion. HCC treatment options have advanced significantly over the past few decades and include surgical and non-surgical methods. In the past, systemic chemotherapy was the non-surgical treatment and there was no significant increase in overall survival rate. Nowadays sorafenib, a molecular targeted drug, is the treatment of choice and has shown proven benefits in increasing survival time; other systemic therapies did not show longer statistical superiority. However, surgical treatments, such as liver transplantation and surgical resection, are still the only methods offering a curative opportunity; however, these are not free of adverse effects and recurrence of the tumour. Non-surgical techniques including ablative treatment, radiotherapy, transarterial chemoembolisation, and percutaneous ethanol injection also show some benefit in the survival of patients with HCC. Future molecular targeted drugs are currently under investigation in different stages of clinical trials, and there are positive expectations regarding their benefit in treating HCC.
Clinical presentation of hepatocellular carcinoma (HCC) can vary from asymptomatic patients to patients presenting variable symptoms such as pain, lethargy, jaundice, hepatic encephalopathy, anasarca, ascites, variceal bleeding, diarrhoea, paraneoplastic symptoms, cutaneous manifestations, and abnormal laboratory values. Diagnosis of HCC is based on computed tomography (CT), magnetic resonance imaging (MRI), and tumour markers. The most commonly used is alpha fetoprotein.1,2 MRI is the imaging method of choice, although it has decreased sensitivity in detecting lesions <2 cm.3 Other possibilities include biomarkers such as embryonic antigen, protein antigen, enzymes and isoenzymes, cytokines, and genetic biomarkers. Liver biopsy is used in selected patients who do not present typical features of HCC on CT or MRI. Surveillance by ultrasound is recommended every 6 months in cirrhotic patients. The Barcelona Clinic Liver Cancer (BCLC) scoring system has been proposed for staging of HCC, and numerous scoring systems have been developed to evaluate progression and determine treatment possibilities; they take into account the clinical as well as the laboratory and pathological criteria, biomarkers, biopsy, and imaging methods.
This review will cover the epidemiology, risk factors, pathogenesis, and pathology of hepatocellular carcinoma (HCC). HCC is the fifth most commonly diagnosed cancer in males and second most frequent cancer-related cause of mortality worldwide. In females, it is the seventh most frequently diagnosed malignancy and sixth leading cause of death. The incidence of HCC is higher among males in less developed countries and reaches a peak around the age of 70 years. The rates of liver cancer are twice as high in males compared to females.1,2 Various risk factors, including environmental, infectious, nutritional, and metabolic, are associated with HCC; among them viral infection has been linked to being the highest risk factor for developing HCC. HCC is a highly vascular tumour and its pathogenesis consists of increasing angiogenesis by overexpression of various growth factors. Another cause of HCC development is thought to be mutations in different signalling pathways that lead to proliferation of the tumour cells.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.