Chemical peels in melasma: A review with consensus recommendations by Indian pigmentary expert group

Sarkar, Rashmi; Arsiwala, Shehnaz; Dubey, Neha; Sonthalia, Sidharth; Das, Anupam; Arya, Latika; Gokhale, Narendra; Torsekar, R G; Somani, V K; Majid, Imran; Godse, Kiran; Ravichandran, G; Singh, Mohan; Aurangabadkar, Sanjeev; Salim, Thais Rocha; Shah, Swapnil; Sinha, Surabhi

doi:10.4103/ijd.ijd_490_17

Cited by 18 publications

(25 citation statements)

References 19 publications

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“…The chemical peel is a well‐known modality for treating melasma. It causes controlled epidermal dyscohesion and subsequent regeneration to remove epidermal melanin and suspend the transfer of melanosomes . However, the result is unsatisfactory, especially in Asian patients with Fitzpatrick skin types III‐IV due to high risk of post‐inflammatory hyperpigmentation (PIH).…”

Section: Therapeutic Implicationsmentioning

confidence: 99%

Melasma: Updates and perspectives

Kwon

Choi

et al. 2018

Experimental Dermatology

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Management of melasma is highly challenging due to inconsistent treatment results and frequent relapses. However, recent studies revealed that melasma may not only be a disease of melanocytes, but also a photoaging skin disorder. Herein, we attempt to validate that melasma is indeed a photoaging disorder by presenting the histopathologic findings of melasma: solar elastosis, altered basement membrane, increased vascularization and increased mast cell count. We also provide some therapeutic implications based on these findings and a discussion on the latest updates and perspectives regarding treatment.

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Section: Therapeutic Implicationsmentioning

confidence: 99%

Melasma: Updates and perspectives

Kwon

Choi

et al. 2018

Experimental Dermatology

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“…Melasma is an acquired type of hyperpigmentation that is displayed as asymptomatic symmetric reddish‐brown or gray‐blue macules or patches mainly localized in the sun‐exposed body areas, namely chin, cheek, forehead, and upper lip . As the sun‐exposed sites are also the visible ones, melasma is reported to negatively affect the quality of life . Pregnant women and those who use oral contraceptives (OCP) are reported as particularly susceptible to develop melasma .…”

Section: Introductionmentioning

confidence: 99%

“…In literature, countries with stronger sun radiation such as India, Pakistan, and Middle East and Mediterranean countries are linked to an increased prevalence of this pigmentary disorder . Furthermore, the reported prevalence of melasma ranged from 1% to 50% …”

Section: Introductionmentioning

confidence: 99%

Melasma and thyroid disorders: a systematic review and meta‐analysis

et al. 2019

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AbstractsBackground Thyroid hormones may play a key role in melasma; however, melasma link with thyroid disorders remains controversial.Objectives To compare the serum levels of thyroid-stimulating hormone (TSH), T4, T3, anti-thyroid peroxidase (anti-TPO), and antithyroglobulin between patients with melasma and control group using meta-analysis.Methods We screened 10 databanks and search engines, searched mesh and nonmesh terms. The identified evidences were reviewed and quality assessed using the Newcastle-Ottawa Scale (NOS). The heterogeneity between the primary results was investigated using Cochrane and I-square indices. Random effect model was applied to combine the standardized mean differences of thyroid function indicators between patients with and without melasma. P values meta-analysis was used to investigate the association between anti-TPO and melasma. ResultsWe included seven studies, 473 cases, and 379 controls that had been investigated. The total standardized mean differences (95% confidence intervals) of TSH, T3, T4, and antithyroglobulin antibody between cases and controls were estimated to be 0.33 (0.18, 0.47), À0.01 (À0.20, 0.19), À1.50 (À2.96, À0.04), and 0.62 (0.14, 1.11), respectively. The corresponding figures among women were 0.35 (0.17, 0.52), 0.10 (À0.17, 0.38), À2.75 (À6.30, 0.81), and 0.99 (0.14, 1.83), respectively. P value of metaanalysis showed a significant relationship between anti-TPO serum level and melasma (Fisher = 26.80, P = 0.020).Conclusion Serum levels of TSH, anti-TPO, and antithyroglobulin antibody were significantly higher in patients with melasma than those without melasma. Moreover, these differences were more severe among women with melasma. What is new?• Melasma is an acquired type of hyperpigmentation and might be associated with thyroid disorders.• Results of the present study showed that serum levels of TSH, anti-thyroid peroxidase (anti-TPO), and antithyroglobulin antibody were significantly higher in patients with melasma than those without melasma. Moreover, these differences were more severe among women with melasma.• Serum levels of TSH, anti-TPO, and antithyroglobulin antibodies are associated with melasma, especially among women. Risk of biasThe Newcastle-Ottawa Scale (NOS) checklist was applied to determine the risk of bias in primary studies. This checklist evaluates the studies in three section including selection (four scores), comparability (two scores), and exposure (three scores). Each study was achieved between 0 and 9 scores, and studies with less than five scores were removed from the metaanalysis. The quality assessment was performed by two independent methodologists. 20

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“…Melasma is an extensively seen and chronic hyperpigmentation of the integumentary system . It most often involves the face and therefore is a source of major distress for the affected individuals.…”

Section: Introductionmentioning

confidence: 99%

“…Although treatment is frequently a multifaceted approach, topical applications are the anchor of therapy for melasma and can be used as single, dual, or triple combinations. Other interventions are often second‐ or third‐line approaches, and mostly, they are the supplements of topical therapy . Hydroquinone (HQ), frequently the main component of pharmaceutical combinations, is utilized with agents like azelaic acid (AA), retinoic acid, and topical corticosteroids (TCs).…”

Section: Introductionmentioning

confidence: 99%

A novel triple combination in treatment of melasma: Significant outcome with far less actives

Pekmezci

2019

J of Cosmetic Dermatology

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Summary Background Melasma is an acquired hyperpigmentation, often involving the face, and a source of distress for the affected individuals. Although treatment is challenging and frequently a multimodality approach, topical applications are the mainstay of therapy. Objective Due to the frequent relapses, a therapy both acting rapidly and suitable for long‐term use, with fewer adverse effects should be administered. In our outpatient clinic, we treated the melasma patients with a previously unreported triple combination which was empirically formulated with lesser amount of active components, regarding the balance between long‐term use and safety. Methods Sixty‐eight female patients with melasma who referred to our hospital dermatology clinic in the years 2016‐2017 were retrospectively recruited. They all had completed 6‐month treatment with a prescribed cream mixture comprised of azelaic acid (4%), hydroquinone (1.6%), methylprednisolone aceponate (0.04%), and salicylic acid (2%). The outcomes were evaluated both instrumentally (Melanin Index/MI) and by patients (Patient Self‐Assessment Scale/PSAS). Results Adverse effects declared by the patients were transient irritation in three and mild hypertrichosis in two. Both the MI and PSAS values were found extremely significant at the end of 6th month, compared with initial values. Approximately 62% of total decrease in MI was realized in the first 3 months. Conclusion The triple combination containing active ingredients with lesser concentrations than proposed, and with the addition of 2% salicylic acid, may be promising as a quite effective and safe protocol in treatment of melasma for longer durations.

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Chemical peels in melasma: A review with consensus recommendations by Indian pigmentary expert group

Cited by 18 publications

References 19 publications

Melasma: Updates and perspectives

Melasma: Updates and perspectives

Melasma and thyroid disorders: a systematic review and meta‐analysis

A novel triple combination in treatment of melasma: Significant outcome with far less actives

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