Melasma treatment: a systematic review

Neagu, Nicoleta; Conforti, Claudio; Agozzino, Marina; Marangi, Giovanni Francesco; Morariu, Silviu Horia; Pellacani, Giovanni; Persichetti, Paolo; Piccolo, Domenico; Segreto, Francesco; Zalaudek, Iris; Dianzani, Caterina

doi:10.1080/09546634.2021.1914313

Cited by 51 publications

(65 citation statements)

References 99 publications

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“…Additionally, a number of studies reported their efficacy as an adjunctive modality for melasma treatment (Zhuang & Sun, 2012 ; Ibrahim et al., 2015 ; Kwon et al., 2016 ; Jacobus Berlitz et al., 2019 ). Therefore, the use of α-arbutin polymeric systems based on chitosan nanoparticles, augmented with both functional additives; hyaluronic acid and collagen, in treatment of melasma would present a potentially safe and efficacious treatment modality that overcomes side effects associated with the traditional treatment strategies, such as light and laser technologies which may cause a rebound effect after using intense pulsed light through the association to post-inflammatory hyperpigmentation (Neagu et al., 2021 ), chemical peelings which may cause skin inflammation and lead to exacerbation of melasma (Prabha et al., 2014 ) or conventional topical dosage forms which may result in insufficient permeation through skin (Wen et al., 2006 ).…”

Section: Introductionmentioning

confidence: 99%

Functionalized chitosan nanoparticles for cutaneous delivery of a skin whitening agent: an approach to clinically augment the therapeutic efficacy for melasma treatment

et al. 2022

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The increase in the production of melanin level inside the skin prompts a patient-inconvenient skin color disorder namely; melasma. This arouses the need to develop efficacious treatment modalities, among which are topical nano-delivery systems. This study aimed to formulate functionalized chitosan nanoparticles (CSNPs) in gel form for enhanced topical delivery of alpha-arbutin as a skin whitening agent to treat melasma. Ionic gelation method was employed to prepare α-arbutin-CSNPs utilizing a 2 4 full factorial design followed by In vitro, Ex vivo and clinical evaluation of the nano-dispersions and their gel forms. Results revealed that the obtained CSNPs were in the nanometer range with positive zeta potential, high entrapment efficiency, good stability characteristics and exhibited sustained release of α-arbutin over 24 h. Ex vivo deposition of CSNPs proved their superiority in accumulating the drug in deep skin layers with no transdermal delivery. DSC and FTIR studies revealed the successful amorphization of α-arbutin into the nanoparticulate system with no interaction between the drug and the carrier system. The comparative split-face clinical study revealed that α-arbutin loaded CSNPs hydrogels showed better therapeutic efficacy compared to the free drug hydrogel in melasma patients, as displayed by the decrease in: modified melasma area and severity index (mMASI) scores, epidermal melanin particle size surface area (MPSA) and the number of epidermal monoclonal mouse anti–melanoma antigen recognized by T cells-1 (MART-1) positive cells which proved that the aforementioned system is a promising modality for melasma treatment.

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Section: Introductionmentioning

confidence: 99%

Functionalized chitosan nanoparticles for cutaneous delivery of a skin whitening agent: an approach to clinically augment the therapeutic efficacy for melasma treatment

et al. 2022

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“…Management of melasma is challenging owing to its recurrent nature and requirement for longer duration of treatment. No single approach exists to combat melasma; however, triple combination creams (TCC) remains to be the golden standard of treatment, however, with associated side effects on long‐term application 4 …”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of topical metformin 30% cream versus triple combination cream (Kligman's formula) in treating melasma: A randomized controlled study

AboAlsoud

Eldahshan

Mohammed

et al. 2022

J of Cosmetic Dermatology

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Background Melasma is an acquired common pigmentary condition that mostly presents as pigmented macules on the face. Triple combination creams (TCC), commonly known as kligman's formula, had been regarded as the mainstay of treatment for years. Topical metformin was recently studied for its melanopenic effects and potential use in melasma. Aim of the work This study aimed to evaluate the efficacy and safety of using 30% metformin cream to that of triple combination creams (Kligman's formula) in treating melasma. Patients and Methods About 40 patients complaining of melasma were recruited for this controlled randomized trial and were divided into 2 groups. Group 1 (n = 20) subjects received 30% metformin cream whereas group 2 (n = 20) were treated with TCC for eight consecutive weeks. Pigmentation severity and improvements were assessed using the melasma area severity index (MASI) at baseline and after 8 weeks of using treatment. Results MASI score decreased dramatically from 12.18 ± 9.33 before treatment to 5.59 ± 4.61 at Week 8 with a mean decrease percentage of 55.97 ± 16.77 for group 1 (p = 0.001) and from 16.05 ± 8.73 to 7.54 ± 5.77 with a mean decrease percentage of 56.50 ± 19.44 for group 2 (p = 0.001). No significant difference was reported between the two treatment modalities regarding the reduction in melasma throughout the study period (p = 0.968). Conclusion Metformin cream is a safe, potential effective treatment for melasma, which needs to be verified by long‐term large scale studies in diffident populations.

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Section: Discussionmentioning

confidence: 99%

“…Neagu et al (52) suggested that no single treatment for melasma is generally effective. Compared with a single treatment, both double and triple treatments show good curative effects (52). Among 56 included studies in the study, 31 studies compared the efficacy of combination therapy with a single therapy, of which 27 considered that the efficacy of combination therapy was better than that of single therapy, and four considered that there was no significant difference between the two.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials

Liu

et al. 2021

Front. Med.

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Background: Melasma is an acquired pigmentation disorder with challenges in treatment because of its refractory nature and high risk of recurrence.Objectives: This study aimed to compare the efficacy and side effects of 14 common therapies for melasma using a systematic review and network meta-analysis (NMA).Methods: The PubMed, Embase, and Cochrane Library databases were searched till December 2020 using the melasma area and severity index as a therapeutic index. A total of 59 randomized controlled trials (RCTs) met the inclusion criteria and were selected.Results: The ranking of relative efficacy compared with placebo in descending order was Q-switched Nd:Yag 1,064-nm laser (QSND), intense pulsed light, ablative fractional laser (AFL), triple combined cream (TCC), topical vitamin C, oral tranexamic acid (oTA), peeling, azelaic acid, microneedles (MNs), topical tranexamic acid (tTA), tretinoin, picosecond laser, hydroquinone (HQ), and non-AFL. Moreover, QSND was more effective than HQ and tTA against melasma. The ranking of percentage (%) of side effects in ascending order for each of 14 therapies with more than 80 participants was tretinoin (10.1%), oTA (17.6%), HQ (18.2%), AFL (20.0%), QSND (21.5%), TCC (25.7%), tTA (36.75%), peeling (38.0%), and MN (52.3%). Taking both efficacy and safety into consideration, TCC was found to be the most favorable selection among the topical drugs for melasma. QSND and AFL were still the best ways to treat melasma among photoelectric devices. oTA as system administration was a promising way recommended for melasma. Among 31 studies, 87% (27/31) studies showed that the efficacy of combination therapies is superior to that of single therapy. The quality of evidence in this study was generally high because of nearly 50% of split-face RCTs.Conclusions: Based on the published studies, this NMA indicated that QSND, AFL, TCC, and oTA would be the preferred ways to treat melasma for dermatologists. However, more attention should be paid to the efficacy and safety simultaneously during the clinical application. Most of the results were in line with those of the previous studies, but a large number of RCTs should be included for validation or update.Systematic Review Registration: identifier: CRD42021239203.

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Melasma treatment: a systematic review

Cited by 51 publications

References 99 publications

Functionalized chitosan nanoparticles for cutaneous delivery of a skin whitening agent: an approach to clinically augment the therapeutic efficacy for melasma treatment

Functionalized chitosan nanoparticles for cutaneous delivery of a skin whitening agent: an approach to clinically augment the therapeutic efficacy for melasma treatment

Safety and efficacy of topical metformin 30% cream versus triple combination cream (Kligman's formula) in treating melasma: A randomized controlled study

Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials

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