Systematic review of clinical studies assessing the needling for treatment of melasma: Focusing on efficacy, safety, and recurrence rate

Abstract

Background and objective Melasma is common, chronic and treatment‐challenging cosmetic concern and the aim of this study was to systematically evaluate clinical studies assessing the treatment of melasma through needling while focusing on efficiency, safety, and recurrence. Method After e‐search a total of 54 articles were reviewed and 12 published articles (February 2011‐September 2020) in terms of content, topic, and purpose, were finalized. Articles were open pilot trials, case reports, case series, retrospective studies, quasi‐experimental trials, randomized clinical trials, and split face comparative studies. Results The highest decrease in MASI score was 85.71% and allocated to microneedling method following only 3 sessions with an interval of 30 days. On the other hand, the lowest decrease in this score was 3.7% and allocated to microneedling treatment and its use for vitamin C delivery at the end of the fourth week of treatment. No side effects were reported in included studies, and the various needling methods used were safe. Recurrence after treatment was reported in none of these articles, and only one of them reported a 4% recurrence in the second phase of treatment, but no recurrence was reported in the last phase of that study. Conclusion Non‐aggressive microneedling with topical depigmenting agents was more effective than topical depigmenting agents alone, so that the mean MASI score was significantly higher than those who used lightening serum alone. So needling can be suggested as an effective and safe method with low recurrence rate for the treatment of melasma.

Comparison of the efficacy of Hydroquinone cream versus Hydroquinone cream plus Danggui Shaoyao powder in the treatment of melasma

“…In spite of a powerful therapeutic demand, melasma treatment is facing recurrent relapse which is a big problem in managing these patients [ 28 , 29 ]. Non systemic treatments are classically the usual approach for treating melasma, among which hydroquinone (H) is one of the effective depigmenting agent and is known as the gold standard for melasma treatment [ 30 , 31 ]. However, numerous researches reported a wide range of side effects after treating by H. H has been related with repeatedly irritant dermatitis.…”

Medical therapies for melasma

“…Although hydroquinone, alone or in triple combination, remains the gold standard of topical treatment despite concerns for its adverse effects, several new agents with a potential to inhibit melanogenesis have been developed and can be opted in sequential therapy in the management of melasma despite poor evidence for their efficacy for lack of controlled clinical trials. The evidence for observed efficacy of platelet‐rich plasma (PRP) therapy alone or in combination with topical TA or IPL in small studies or that of needling (microneedling, mesoneedling, radiofrequency microneedling) to increase the delivery of topical medications or to induce epidermal thickness for protection against UV radiation remains limited for lack of controlled clinical trials 179,180 …”

“…plasma (PRP) therapy alone or in combination with topical TA or IPL in small studies or that of needling (microneedling, mesoneedling, radiofrequency microneedling) to increase the delivery of topical medications or to induce epidermal thickness for protection against UV radiation remains limited for lack of controlled clinical trials. 179,180 Pregnancy remains the most common trigger for melasma (mask of pregnancy) and it is mostly treatment-resistant.…”

Understanding Melasma-How Can Pharmacology and Cosmetology Procedures and Prevention Help to Achieve Optimal Treatment Results? A Narrative Review

“…It is also worth emphasizing the role of microneedling, which when combined with active substances, e.g., tyrosinase inhibitors, TA, vitamin C, PRP seems to be an effective and safe additional and complementary treatment method, with a relatively low relapse rate, and can be used in daily medical practice [240][241][242].…”