The pathogenesis of melasma and implications for treatment

Artzi, Ofir; Horovitz, Tamir; Bar‐Ilan, Efrat; Shehadeh, Waseem; Koren, Amir; Zusmanovitch, Lior; Mehrabi, Joseph N; Salameh, Fares; Nelkenbaum, Gila Isman; Zur, Eyal; Sprecher, Eli; Mashiah, Jacob

doi:10.1111/jocd.14382

Cited by 29 publications

(32 citation statements)

References 153 publications

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“…6,8,9 In addition, the degree of TXA, primarily channelizes its effects against the first four stated pathomechanisms. 16 Therefore, in those patients where basement membrane disruption and melanosome/melanin aggregation predominate, it is but likely to observe a lower efficacy of TXA when compared to those patients in whom other factors are majorly expressed.…”

Section: Discussionmentioning

confidence: 99%

“…A possible explanation regarding this variation could be linked to the heterogeneous patho-mechanisms involved in melasma. Broadly, six principle mechanisms have been proposed; and include inappropriate melanocyte activation, increased mast cell count, solar elastosis, increased dermal vascularization (secondary to increased vascular endothelial growth factor/endothelin 1 expression), epidermal/dermal aggregation of melanosomes/melanin and disruption of skin basement membrane [11][12][13][14][15][16]. Further, the representation of each of the above mechanisms tends to vary from one individual to another.…”

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confidence: 99%

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A comparative evaluation of the efficacy of intralesional tranexamic acid versus platelet rich plasma in the treatment of melasma

Patil¹,

Bubna²

2022

Dermatologic Therapy

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Melasma is a benign, acquired disorder of hyperpigmentation commonly affecting the face. Though easily diagnosable, a tangible treatment for melasma still remains elusive. Our aim was to compare the therapeutic efficacy and safety of tranexamic acid (TXA) and platelet rich plasma (PRP) microinjections in treating patients with melasma. In total, 40 patients with melasma (10 males, 30 females; age range: 21–54 years) were enrolled, and randomly assigned to one of the two groups consisting of 20 patients each. Group A (3 males, 17 females) received intradermal microinjections of TXA (4 mg/ml) and group B (5 males, 15 females) received intradermal microinjections of PRP, once every 4 weeks for a total of five treatment sessions. Clinical images were taken at each visit and improvement in melasma was evaluated using both melasma area severity index (MASI) and modified melasma area severity index (mMASI) scoring systems. Percentage reduction of both MASI and mMASI scores were also assessed at each visit, and the grade of melasma improvement was accordingly outlined for each patient. The study was completed by 18 patients in group A (TXA) and 15 patients in group B (PRP). In group A, both MASI and mMASI scores reduced significantly from 16.6 ± 9.227 at baseline to 10.028 ± 8.07 at end point; and 8.885 ± 5.418 at baseline to 4.639 ± 3.863 at end point, respectively (p value <0.01). Similarly in group B significant reduction in both scores were observed at the end of treatment. MASI declined from 20.42 ± 7.979 to 12.253 ± 7.37; and mMASI plummeted to 5.613 ± 3.98 from 10.673 ± 4.642 (p value <0.01). In group A, the difference in mean reduction of MASI and mMASI from baseline to end point was 6.572 ± 4.528 and 4.211 ± 2.647, respectively. In group B, the difference in mean reduction of both scores at the end of treatment reflected values of 8.167 ± 4.975(MASI) and 5.06 ± 2.977 (mMASI). No significant adverse effects were encountered in both treatment arms during the entire duration of study. Both TXA and PRP microinjections were found to be effective and safe therapeutic options for melasma, providing rapid and substantial improvement even when used as standalone therapies. Although PRP mesotherapy was found to be slightly better than intradermal TXA in our study, the results were not significant statistically.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A comparative evaluation of the efficacy of intralesional tranexamic acid versus platelet rich plasma in the treatment of melasma

Patil¹,

Bubna²

2022

Dermatologic Therapy

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“…Significantly increased superoxide dismutase (SOD) activity and decreased glutathione levels in patients with this disease indicate the presence of elevated oxidative stress in melasma [42].…”

Section: Abnormal Activation Of Melanocytes and Excessive Melanogenesismentioning

confidence: 99%

“…Moreover, VEGF receptors are also found on vascular endothelial cells that stimulate melanogenesis by producing EDN1, thereby stimulating MITF phosphorylation and increasing tyrosinase levels. Researchers have shown a statistically significant relationship between the number of vessels and hyperpigmentation in melasma [42]. Additionally, angiogenetic factor levels increase with the size, density and diameter of vessels in the affected skin [3,4,46].…”

Section: Increased Vascularizationmentioning

confidence: 99%

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

Piętowska

Nowicka

Szepietowski

2022

IJERPH

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Melasma is a chronic skin condition that involves the overproduction of melanin in areas exposed to ultraviolet radiation. Melasma treatment is long-term and complicated with recurrence and resistance to treatment. The pathogenesis of melasma is highly complex with multiple pathologies occurring outside of the skin pigment cells. It includes photoaging, excessive melanogenesis, an increased number of mast cells, increased vascularization, and basement membrane damage. In addition, skin lesions related to melasma and their surrounding skin have nearly 300 genes differentially expressed from healthy skin. Traditionally, melasma was treated with topical agents, including hydroquinone, tretinoin, glucocorticosteroids and various formulations; however, the current approach includes the topical application of a variety of substances, chemical peels, laser and light treatments, mesotherapy, microneedling and/or the use of systemic therapy. The treatment plan for patients with melasma begins with the elimination of risk factors, strict protection against ultraviolet radiation, and the topical use of lightening agents. Hyperpigmentation treatment alone can be ineffective unless combined with regenerative methods and photoprotection. In this review, we show that in-depth knowledge associated with proper communication and the establishment of a relationship with the patient help to achieve good adherence and compliance in this long-term, time-consuming and difficult procedure.

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“…Melasma is a common photoexacerbated hyperpigmentary disorder characterized by the development of asymptomatic hyperpigmented macules and patches symmetrically distributed on the face. It can be classified according to its distribution pattern into centrofacial (the most frequent), malar, and mandibular 1 …”

Section: Introductionmentioning

confidence: 99%