Topical silymarin versus hydroquinone in the treatment of melasma: A comparative study

Abstract

Silymarin cream might serve as an effective and safe treatment modality for melasma.

Efficacy and safety of intralesional steroid injection in the treatment of melasma

“…Although there are different topical treatment agents of melasma, its treatment is still challenging. 9,12 This study showed significant reduction in the severity of melasma after four treatment sessions with intralesional triamcinolone injection, with no statistically significant difference in the therapeutic response between triamcinolone injection and kligman' formula.…”

“…The main targets in the treatment of melasma are suppression of the activity of melanocytes, decrease synthesis of melanosomes, and increase their degradation. [7][8][9] Certain inflammatory cytokines such as interleukin (IL)1a, IL 1b, IL6, MMP2, MMP9, Vascular endothelial growth factor (VEGF), prostaglandin (PG)F2, PGE2, and PGD2 are involved in the pathogenesis of melasma through their stimulatory impact on melanocyte proliferation, dendricity, and melanogenesis. These cytokines had been suggested to enhance the activity of melanogenic molecules, such as melanocyte-stimulating hormone (MSH), tyrosinase-related protein −1 (TRP-1) and by increasing the activity of tyrosinase enzyme.…”

Treatment of melasma: a review of less commonly used antioxidants

“…In a study by Altaei, 98 melasma patients used silymarin cream and were 100% satisfied with significant pigment improvement and lesion size reduction. Likewise, in a study by Nofal et al, 99 melasma patients received 0.7 or 1.4% silymarin cream versus 4% hydroquinone cream. MASI scores were significantly reduced in all groups with no significant difference between groups.…”

Current evidence to support the therapeutic potential of flavonoids in oxidative stress-related dermatoses

“…Results from the in vitro experiment revealed that the balance of antioxidant/oxidant was disrupted and the OS markers significant elevated in melasma with an abnormal increase in MDA, NO, Cu/Zn-SOD and GSH-Px and a decrease in protein carbonyl [126]. Besides, UV-produced free radicals could directly excite PI3K/Akt signaling pathway to activate NF-κB signal, which would promote the transcription of iNOS in keratinocyte to produce NO, further enhancing tyrosinase activity in melanocytes and ultimately increasing melanin formation [55,127]; more importantly, it was discovered that OS indicators (like MDA, NO, ROS) positively correlated with melasma area severity index (MASI) in chloasma [55], further confirming the catalytic role of OS in chloasma pathogenesis.…”

“…Similarly, a clinical trial in female chloasma patients proved that three-time daily administration of pycnogenol from a Pinus pinaster bark extract containing flavonoids evidently decreased the average melasma area and pigmentary intensity possibly attributed to its role of photoprotection from UV and resistance to UVinduced OS [130]. Apart from that, silymarin, extracted from the seed of the milk thistle plant, has strong antioxidant and photoprotective effects to suppress UV-induced OS and inflammation; it could remarkably reduce the production of melanin through inhibiting the L-dopa oxidation activity of tyrosinase, preventing OS damage, and blocking UVinduced NF-κB pathway activation [127,131]. In a randomized, double-blind controlled trial of 96 patients with chloasma, Altaei et al showed that silymarin at a different dose was topically administrated to patients ′ affected areas twice daily for 4 weeks; it turned out that silymarin eliminated skin pigmentation of chloasma patients in a dose-dependent manner, possibly being associated with antioxidant activity of silymarin via mitigating OS [132].…”