Efficacy and safety of microneedling and oral tranexamic acid in the treatment of facial melasma in women: An open, evaluator-blinded, randomized clinical trial

Cassiano, Daniel; Espósito, Ana Cláudia Cavalcante; Hassun, Karime Marques; Bagatin, Ediléia; Lima, Mariana; Lima, Emerson; Miot, Luciane Donida Bartoli; Miot, Hélio Amante

doi:10.1016/j.jaad.2020.02.002

Cited by 14 publications

(34 citation statements)

References 5 publications

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“…Melasma exhibits alterations in different skin compartments (e.g. epidermis, basement membrane and upper dermis), and Thiamidol should be further explored in combination with other treatments, such as oral tranexamic acid, antioxidants, lasers and microneedling, to maximize its benefits 30–34 …”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of topical isobutylamido thiazolyl resorcinol (Thiamidol) vs. 4% hydroquinone cream for facial melasma: an evaluator‐blinded, randomized controlled trial

Lima

Dias

Cassiano

et al. 2021

Acad Dermatol Venereol

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Background Melasma can be refractory to treatment, and relapses are frequent. Thiamidol is a new potent tyrosinase inhibitor that has been found effective as a cosmeceutical for the depigmenting of melasma.Objective This study compared the efficacy and tolerability of topical 0.2% Thiamidol vs. 4% hydroquinone for facial melasma.Methods Fifty women with facial melasma participated in a randomized, evaluator-blinded, controlled study from September through November 2020. Patients were randomly assigned to apply a double layer of 0.2% Thiamidol twice a day or 4% hydroquinone cream at bedtime, for 90 days. Both groups received tinted sunscreen (sun protection factor 60, PPD 20). The primary outcome was the change from the baseline Modified Melasma Area Seve:rity Index (mMASI) score. Secondary outcomes were improvements in the patients' quality of life [Melasma Quality of Life Index (MELAS-QoL)], colourimetry, and Global Aesthetic Improvement Scale (GAIS) evaluation.Results One participant, from the hydroquinone group, did not complete the study (unrelated to adverse effects). The mean (SD) age of the participants was 43 (6) years, and 86% were phototypes III-IV. Both groups exhibited a reduction in mMASI, MELASQoL, and colour contrast scores (P < 0.01). The mean [95% confidence interval (CI 95%)] reductions of the mMASI scores were 43% (35-50%) for Thiamidol and 33% (23-42%) for hydroquinone. There was no difference between the groups in the reductions in mMASI, MELASQoL, colourimetric contrast and GAIS scores (P ≥ 0.09). The GAIS analysis resulted in an improvement of 84% (CI: 95% 67-97%) for participants in the Thiamidol group and 74% (CI: 95% 61-93%) for those in the hydroquinone group. There were only mild adverse effects in the Thiamidol group, but allergic contact dermatitis was evidenced in two (8%) participants. ConclusionThe melasma improvement achieved using 0.2% Thiamidol did not differ from that of 4% hydroquinone cream. Thiamidol can be considered a suitable option for melasma patients with poor tolerability or treatment failure with hydroquinone.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of topical isobutylamido thiazolyl resorcinol (Thiamidol) vs. 4% hydroquinone cream for facial melasma: an evaluator‐blinded, randomized controlled trial

Lima

Dias

Cassiano

et al. 2021

Acad Dermatol Venereol

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“…Melasma has a complex pathogenesis that surpasses melanocyte hypertrophy, and a combination of strategies can lead to more effective results 24–27 . Specific designs for assessing the long‐term efficacy of cysteamine as well as its use as a maintenance treatment after other potent depigmenting agents (e.g., triple combination), laser or oral tranexamic acid are needed in order to position it among the existing strategies for the management of melasma 15,28 …”

Section: Discussionmentioning

confidence: 99%

“…[24][25][26][27] Specific designs for assessing the long-term efficacy of cysteamine as well as its use as a maintenance treatment after other potent depigmenting agents (e.g., triple combination), laser or oral tranexamic acid are needed in order to position it among the existing strategies for the management of melasma. 15,28…”

Section: Discussionmentioning

confidence: 99%

“…Subjects were also assessed at the inclusion and after 60 and 120 days of treatment for modified Melasma Area and Severity Index (mMASI) (main outcome), Melasma Quality of Life Scale (MELASQoL), and the difference in colorimetric luminosity (Dif*L) between skin affected by melasma and the adjacent unaffected skin (<2 cm distance), assessed by CR-400 Chroma Meter (Konica Minolta). 14,15 The Global Aesthetic Improvement Scale (GAIS) was used to assess the difference in the appearance of the skin through standardized photographs (T0 vs. T120). 16 The compliance of participants was assessed at 60 and 120 days by inquiring about the duration of cysteamine tolerability Brazil, and has a suitable psychometric performance.…”

Section: Methodsmentioning

confidence: 99%

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A comparative study of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women

Lima¹,

Dias²,

Cassiano

et al. 2020

Int J Dermatology

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Objective To assess the efficacy and safety of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women. Topical 5% cysteamine is an antioxidant and tyrosinase inhibitor that has been shown to be effective in the treatment of melasma. However, to date, no study has compared the performance of topical cysteamine to hydroquinone for facial melasma. Methods A quasi-randomized, multicenter, evaluator-blinded clinical trial was conducted on 40 women with facial melasma who were submitted to the nightly application of 5% cysteamine (CYS) or 4% hydroquinone (HQ) on hyperpigmented areas for 120 days. Both groups were required to use tinted sunscreen (SPF 50; PPD 19). Subjects were assessed at the inclusion and after 60 and 120 days of treatment for mMASI, MELASQoL, and the difference in colorimetric luminosity between melasma and the adjacent unaffected skin. The Global Aesthetic Improvement Scale was used to assess the difference in the appearance of the skin through standardized photographs. Results The mean reduction of the mMASI scores was 24% for CYS and 41% for HQ (P = 0.015) at 60 days, and 38% for CYS and 53% for HQ (P = 0.017) at 120 days. The photographic evaluation revealed up to 74% improvement for both groups, without statistically significant difference between them (P = 0.087). The MELASQoL score showed a progressive decrease for both groups over time, despite the greater reduction for HQ after 120 days (P = 0.018). Colorimetric assessment disclosed progressive depigmenting in both groups, without statistically significant difference between them (P > 0.160). No severe adverse effects were identified in either group. Erythema and burning were the most important local adverse effects with cysteamine, although their frequency did not differ between groups (P > 0.170). Conclusion Cysteamine proved to be safe, well-tolerated, and effective, despite its inferior performance to hydroquinone in decreasing mMASI and MELASQoL in the treatment of melasma.

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“…8 Recently, microneedling has been also suggested to be safe and efficient alternative to treat melasma. 12 Although the combination treatment modalities are recommended, publications are few in number. 8 In this study, we aimed to investigate the efficacy of the combination therapy of QsNd-YAG laser and microneedling with mesotherapy containing biomimetic peptides.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the combination of Q‐switched Nd:YAG laser and microneedling for melasma

Köse

Borlu

2020

J of Cosmetic Dermatology

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Melasma is a frequently acquired pigmentary disorder, affecting up to thirty percent of child-bearing woman with darker skin. 1 It is characterized by asymptomatic hyperpigmented patches with symmetrical distribution mostly on the face. 1 The etiology of melasma is multifactorial, and the pathogenesis is complicated. 1,2 Melanogenesis is affected by multiple factors such as hormonal changes, inflammation, age, UV light, and visible light. 2,3 Eumelanin and pheomelanin are catalyzed by specific melanogenic enzymes. 4

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Efficacy and safety of microneedling and oral tranexamic acid in the treatment of facial melasma in women: An open, evaluator-blinded, randomized clinical trial

Cited by 14 publications

References 5 publications

Efficacy and safety of topical isobutylamido thiazolyl resorcinol (Thiamidol) vs. 4% hydroquinone cream for facial melasma: an evaluator‐blinded, randomized controlled trial

Efficacy and safety of topical isobutylamido thiazolyl resorcinol (Thiamidol) vs. 4% hydroquinone cream for facial melasma: an evaluator‐blinded, randomized controlled trial

A comparative study of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women

Efficacy of the combination of Q‐switched Nd:YAG laser and microneedling for melasma

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