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      New oral and topical approaches for the treatment of melasma

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          Abstract

          Melasma is a common, therapeutically challenging, and universally relapsing disorder of hyperpigmentation that is most often observed in women and individuals with Fitzpatrick Skin Types III through VI. The pathogenesis of melasma is complex and protean. Contributing factors that are often implicated in the etiopathogenesis of this condition include a genetic predisposition, intense ultraviolet radiation exposure, and hormonal influences. Therapeutic interventions for melasma include a multimodality approach incorporating photoprotection agents, topical and oral skin lighteners, and resurfacing procedures. Given our expanding knowledge of the pathogenesis of melasma, new and effective treatments are expanding our therapeutic armamentarium. This article reviews new and emerging oral and topical treatments for melasma.

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          Impact of long-wavelength UVA and visible light on melanocompetent skin.

          Bassel H Mahmoud, Eduardo Ruvolo, Camile L Hexsel … (2010)
          The purpose of this study was to determine the effect of visible light on the immediate pigmentation and delayed tanning of melanocompetent skin; the results were compared with those induced by long-wavelength UVA (UVA1). Two electromagnetic radiation sources were used to irradiate the lower back of 20 volunteers with skin types IV-VI: UVA1 (340-400 nm) and visible light (400-700 nm). Pigmentation was assessed by visual examination, digital photography with a cross-polarized filter, and diffused reflectance spectroscopy at 7 time points over a 2-week period. Confocal microscopy and skin biopsies for histopathological examination using different stains were carried out. Irradiation was also carried out on skin type II. Results showed that although both UVA1 and visible light can induce pigmentation in skin types IV-VI, pigmentation induced by visible light was darker and more sustained. No pigmentation was observed in skin type II. The quality and quantity of pigment induced by visible light and UVA1 were different. These findings have potential implications on the management of photoaggravated pigmentary disorders, the proper use of sunscreens, and the treatment of depigmented lesions.
          Article 0 comments Cited 81 times – based on 0 reviews     Review now
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            Melasma: histopathological characteristics in 56 Korean patients.

            K. Yoon, W. Kang, T. J. Kim … (2002)
            Melasma is a common acquired symmetrical hypermelanosis characterized by irregular light to dark brown macules and patches on sun-exposed areas of the skin. Its histopathological characteristics are not fully understood. To characterize the histopathological features of facial melasma skin in comparison with adjacent normal skin. Biopsies were taken from both melasma lesional skin and adjacent perilesional normal skin in 56 Korean women with melasma. The sections were stained using haematoxylin and eosin, Fontana-Masson, diastase-resistant periodic acid-Schiff, Masson trichrome and Verhoeff-van Gieson stains, and immunostaining for melanocytes. Data on the changes in number of melanocytes and melanin contents of the epidermis were analysed by a computer-assisted image analysis program. The ultrastructure of the skin was also examined. The amount of melanin was significantly increased in all epidermal layers in melasma skin. The staining intensity and number of epidermal melanocytes increased in melasma lesions. Lesional skin showed more prominent solar elastosis compared with normal skin. Melanosomes increased in number and were more widely dispersed in the keratinocytes of the lesional skin. Lesional melanocytes had many more mitochondria, Golgi apparatus, rough endoplasmic reticulum and ribosomes in their cytoplasm. A dihydroxyphenylalanine reaction was apparent in the cisternae and vesicles of the trans-Golgi network in melanocytes from lesional skin. Melasma is characterized by epidermal hyperpigmentation, possibly caused both by an increased number of melanocytes and by an increased activity of melanogenic enzymes overlying dermal changes caused by solar radiation.
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              Melasma. Etiologic and therapeutic considerations.

              P Grimes (1995)
              Melasma is a common acquired symmetric hypermelanosis characterized by irregular light- to gray-brown macules and patches involving sun-exposed areas of skin. Etiologic factors in the pathogenesis of melasma include genetic influences, exposure to UV radiation, pregnancy, hormonal therapies, cosmetics, phototoxic drugs, and antiseizure medications. Melasma is often a therapeutically challenging disease, and current treatments include hypopigmenting agents, chemical peels, and lasers. Hypopigmenting agents include phenolic and nonphenolic derivatives. Phenolic agents include hydroquinone and hydroquinone combination preparations. Despite controversies regarding the issue of hydroquinone-induced ochronosis, hydroquinone remains the most effective topically applied bleaching agent approved by the Food and Drug Administration for the treatment of melasma. Nonphenolic bleaching agents include tretinoin and azelaic acid. Superficial, medium, and deep chemical peels are more often used in lighter-complexioned patients. Such peels should be used with caution in blacks. Although lasers have demonstrated significant efficacy in the treatment of a variety of hyperpigmentary disorders, their precise efficacy and place in the therapy of melasma have yet to be established. In the hierarchy of therapies for melasma, the treating physician must consider the devastating psychosocial impact of pigmentary imperfections within the realm of the benefits and risks associated with each treatment.
              Article 0 comments Cited 62 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                P.E. Grimes
                Journal
                Journal ID (nlm-ta): Int J Womens Dermatol
                Journal ID (iso-abbrev): Int J Womens Dermatol
                Title: International Journal of Women's Dermatology
                Publisher: Elsevier
                ISSN (Electronic): 2352-6475
                Publication date PMC-release: 20 November 2018
                Publication date Collection: February 2019
                Publication date (Electronic): 20 November 2018
                Volume: 5
                Issue: 1
                Pages: 30-36
                Affiliations
                [a ]Vitiligo & Pigmentation Institute of Southern California, Los Angeles, California
                [b ]Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, California
                Author notes
                [* ]Corresponding Author. pegrimesmd@ 123456aol.com
                Article
                Publisher ID: S2352-6475(18)30043-1
                DOI: 10.1016/j.ijwd.2018.09.004
                PMC ID: 6374710
                PubMed ID: 30809577
                SO-VID: 2cf4a1bc-c1bf-415b-b96c-5ec57b7b3d56
                Copyright © © 2018 Published by Elsevier Inc. on behalf of Women's Dermatologic Society.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 11 August 2018
                Date revision received : 30 September 2018
                Date accepted : 30 September 2018
                Categories
                Subject: Article

                Keywords: melasma,photoprotection,lightening agents,oral treatments,topical treatments,new and emerging
                Data availability:
                Keywords: melasma, photoprotection, lightening agents, oral treatments, topical treatments, new and emerging

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