2010;22(1):215, Fabbrocini G, De Vita V, Fardella N, Pastore F, Annunziata MC, Mauriello MC, et al. Ahmed AM, Lopez I, Perese F, et al. The malar pattern is restricted to the malar cheeks on the face, while mandibular melasma is present on the jawline and chin. Research has identified oral extracts and compounds that can protect against sun damage from the inside out to provide more complete shielding. The treatment of melasma should include a multimodality approach that incorporates photoprotective agents, antioxidant treatments, skin lighteners, exfoliants, and resurfacing procedures, as needed. Another natural compound, azelaic acid (AA), was noted in an open-label study to be effective in improving pigmentation by inhibiting tyrosinase activity [43]. This review will provide an up-to-date overview of the current literature on melasma, including clinical diagnosis, pathogenesis, and treatments including discussion of new topical, oral, and procedural therapies. Picardo M., Carrera M. New and experimental treatments of cloasma and other hypermelanoses. Some studies have reported that 5564% of patients with this condition have a positive family history [12, 32, 33]. Sarkar R., Ailawadi P., Garg S. Melasma in men: A review of clinical, etiological, and management issues. Other studies have found increased levels of Wnt signaling-related genes, which is notable since Wnt has been linked to the proliferation of melanocyte stem cells [28, 29]. Disclaimer. Hou A, Cohen B, Haimovic A, Elbuluk N. Microneedling: a comprehensive review. The UV-only sunscreen contained mexoryl SX, titanium dioxide, octocrylene, TinasorbS, and avobenzone. Moreover, these standardized tools have enhanced the ability to assess therapeutic efficacy of various melasma treatments in clinical trials. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Myriad quality-of-life studies report on the emotional turmoil and psychological devastation that is experienced by affected individuals (Balkrishnan et al., 2003, Ikino et al., 2015, Pawaskar et al., 2007). Chan R, Park KC, Lee MH, Lee ES, Chang SE, Leow YH, et al. However, Kasraee et al. Taylor CR, Anderson RR.
Handel AC, Lima PB, Tonolli VM, Miot LD, Miot HA. One clinical study found that an oral extract of the fern Polypodium leucotomos decreased UV-driven DNA mutations by an astonishing 84% and mitigated photoaging. Vazquez M, Sanchez JL. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (, Hyperpigmentation, Melasma, Pigmentary disorders, Skin of color. No serious adverse events were reported (Del Rosario et al., 2018). Hexsel D, Lacerda DA, Cavalcante AS, Machado Filho CA, Kalil CL, Ayres EL, et al. A randomized, double-blinded, placebo-controlled trial of oral, Choudhry SZ, Bhatia N, Ceilley R, Hougeir F, Lieberman R, Hamzavi I, et al. ), BID, twice daily; FGF, fibroblast growth factor; GSH, glutathione; MASI, Melasma Area Severity Index; MSH, melanocyte-stimulating hormone; SPF, sun protection factor; TSH, thyroid-stimulating hormone; UV, ultraviolet. Cameli N, Abril E, Mariano M, Berardesca E. Combined use of monopolar radiofrequency and transdermal drug delivery in the treatment of melasma. The aqueous extract of the fern Polypodium leucotomos (PLE), Fernblock (IFC, Madrid, Spain), has demonstrated antioxidant and photoprotective activities and has been used for the treatment of several pigmentary disorders. Clinical and histopathologic assessment of facial melasma after low-fluence Q-switched neodymium-doped yttrium aluminium garnet laser. Adalatkhah H., Sadeghi-Bazargani H. The first clinical experience on efficacy of topical flutamide on melasma compared with topical hydroquinone: A randomized clinical trial. Other psychometric scales that can be used in those with melasma are the Dermatology Life Quality Index (DLQI) and the SKINDEX-16 [4246]. The pathogenesis of melasma is complex and protean. Using a Woods lamp, the hyperpigmentation can be accentuated when the pigment is epidermal [8]. Bagherani N, Smoller BR. RCM is a non-invasive technique that detects pigmentary changes in melasma at a cellular level resolution [10]. Fewer studies have been carried out on men with melasma, but they clinically tend to exhibit similar clinical features and exacerbating factors [21]. Differences in visible light-induced pigmentation according to wavelengths: a clinical and histological study in comparison with UVB exposure. Melasma: systematic review of the systemic treatments. Martin L.K., Caperton C., Woolery-Lloyd H., Avashia N. A randomized double-blind placebo controlled study evaluating the effectiveness and tolerability of oral. Park JM, Tsao H, Tsao S. Combined use of intense pulsed light and Q-switched ruby laser for complex dyspigmentation among Asian patients. Effect of tranexamic acid on melasma: A clinical trial with histological evaluation. The results of these studies suggest the need to test oral and topical GSH for melasma. Major side effects in melasma clinical trials are rarely reported. CO2 lasers have been used in clinical trials with Q-switched alexandrite lasers, but have been repeatedly found to be associated with PIH, especially at the periphery of lesions [97, 98]. The hormone melatonin, which is secreted by the pineal gland, is a potent antioxidant and free-radical scavenger that stimulates several antioxidant enzymes, including superoxide dismutase, glutathione reductase, and glutathione peroxidase. Angsuwarangsee S, Polnikorn N. Combined ultrapulse CO, Nouri K, Bowes L, Chartier T, Romagosa R, Spencer J. Gene and protein expression of oestrogen-beta and progesterone receptors in facial melasma and adjacent healthy skin in women. Nonetheless, physicians have enormous variability in prescribing practices for hydroquinone, so there is no universal standard of treatment. These pathways include melanocyte activation, melanosome development, melanin synthesis, melanosome transfer, and keratinocyte differentiation and desquamation. Combination of fractional QSRL and IPL for melasma treatment in chinese population. Rathore SP, Gupta S, Gupta V. Pattern and prevalence of physiological cutaneous changes in pregnancy: a study of 2000 antenatal women. 11,12 Com relao produo d e eritema, percebemos comportamento semelhante, ainda que . Sanchez NP, Pathak MA, Sato S, Fitzpatrick TB, Sanchez JL, Mihm MC., Jr Melasma: a clinical, light microscopic, ultrastructural, and immunofluorescence study. Melasma and aspects of pigmentary disorders in Asians. government site. There has been much interest recently in the use of Polypodium leucotomos (PL) as an adjunct photoprotective agent in melasma. Patients were randomized to receive either oral PL 240 mg twice daily or placebo for 12 weeks. Melasma: a clinico-epidemiological study of 312 cases. Kameyama K, Sakai C, Kondoh S, Yonemoto K, Nishiyama S, Tagawa M, et al. Recent studies suggest that patients with melasma express markers, which suggests increased oxidative stress (Sekin et al., 2014). Hydroquinone has been banned in some countries due to concerns of ochronosis and possible cases of depigmentation. A study of 3298 people in Saudi Arabia revealed a 2.9% prevalence, compared to a prevalence of 13.415.5% seen in an Arab-American population in Michigan [17, 18]. Ochronosis is characterized by hyperpigmented lichenoid, which are cavier-like papules that appear in cutaneous areas treated with hydroquinone. In addition, most studies show no quantitative increase in melanocytes; however, the cells are enlarged with prominent and elongated dendrites and more abundant melanosomes. Prevalence of pigmentary disorders and their impact on quality of life: a prospective cohort study. Mansouri P., Farshi S., Hashemi Z., Kasraee B. and transmitted securely.
PDF Polypodium Leucotomos Extract in the Treatment of Melasma - Heliocare Hormonal influences play a significant role in the pathogenesis of melasma as seen by the increased prevalence with pregnancy, oral contraceptive use and other hormonal therapies [2, 3, 33, 34]. Recently, several studies have documented the efficacy of cysteamine in patients with melasma. Ochronosis was first reported in Africa and is usually caused by the long-term use of high concentrations of hydroquinone with inadequate sun protection (Bhattar et al., 2015, Grimes, 2009). Light microscopic, immunohistochemical, and ultrastructural alterations in patients with melasma. Many studies have attempted to calculate the prevalence and incidence of melasma from data available in dermatology clinics. (2018) assessed the efficacy of TA 250 mg twice daily versus placebo in a 3-month study, followed by 3 months of sunscreen only.
Treatment of melasma: a review of less commonly used antioxidants Therefore, photoprotection that incorporates visible light, such as iron oxide sunscreens, is essential. Adalatkhah H., Pourfarzi F., Sadeghi-Bazargani H. Flutamide versus a cyproterone acetate-ethinyl estradiol combination in moderate acne: a pilot randomized clinical trial.
Oral Polypodium Leucotomos for Melasma - Full Text View Melasma, formerly known as chloasma, is an acquired pigmentary condition, occurring most commonly on the face. In a separate split-face study, a TA 3% suspension was applied to one side of the face and a suspension with hydroquinone 2%, dexamethasone 0.01%, and vitamin C to the opposite side. Kang H.Y. and transmitted securely. 8600 Rockville Pike Int J Environ Res Public Health. With a poorly understood pathogenesis, and no universal cure, melasma is a challenge for many dermatologists. Kodali S, Guevara IL, Carrigan CR, Daulat S, Blanco G, Boker A, et al. Visible blue light has been shown recently to stimulate opsin-3, which activates the melanogenesis-associated transcription factor and other melanogenic enzymes such as tyrosinase and dopachrome tautomersae (Regazzetti et al., 2018). Menter A. Historically, melasma has been classified as having three histologic variants: epidermal, dermal, and mixed [1]. This compound works by inhibiting tyrosinase, which prevents the conversion of DOPA to melanin [50]. Handog E.B., Datuin M.S., Singzon I.A. Lee A.Y. Besouw M., Masereeuw R., van den Heuvel L., Levtchenko E. Cysteamine: An old drug with new potential. Another split-face study showed no difference in a regimen with salicylic acid (SA) 2030% peel and HQ 4% compared to HQ monotherapy [86]. Mixed melasma often displays combined histologic features of the epidermal and dermal subtype. Chemical peels have been studied as an adjunctive treatment modality for melasma due to their ability to increase epidermal remodeling and to increase keratinocyte turnover. Phytother Res. Wu S, Shi H, Wu H, Yan S, Guo J, Sun Y, et al. Yadav A, Garg T, Mandal AK, et al. Multiple articles have been published in the lay press on the use of GSH for a variety of diseases including melasma. Studies have demonstrated occasional negative findings when used as a monotherapy, but increased efficacy when used in combination with other pigmentation-based therapies [5761]. Evidence-based studies suggest that first line therapies for melasma encompass intense photoprotection and topical lightening agents (Jutley et al., 2014, Rivas and Pandya, 2013; Sarkar et al., 2013; Sarma et al., 2017). Melasma continues to be a frustrating condition to treat and one with significant psychosocial implications. Multiple etiologies, including light exposure, hormonal influences, and family history, have been implicated in the pathogenesis of this disorder. MeSH Bagherani N, Gianfaldoni S, Smoller BR. Treatment of melasma using variable square pulse Er:YAG laser resurfacing. Inclusion in an NLM database does not imply endorsement of, or agreement with, Some authors postulate that repeated IPL treatments may promote the upward shedding of the melanosomes destroyed by QSRL [80, 96]. Second-line treatments, such as chemical peels and lasers, are efficacious in some patients, but these approaches can be associated with acute and long-term complications, particularly in individuals with darker skin types. Navarrete-Sols J., Castanedo-Czares J.P., Torres-lvarez B., Oros-Ovalle C., Fuentes-Ahumada C., Gonzalez F.J. A double-blind, randomized clinical trial of niacinamide 4% versus hydroquinone 4% in the treatment of melasma. government site. Holme SA, Beattie PE, Fleming CJ. Mahmoud BH, Ruvolo E, Hexsel CL, Liu Y, Owen MR, Kollias N, et al.
Current knowledge in Polypodium leucotomos effect on skin protection For decades, there has been investigation into the role of oxidative stress in melasma. Both ascorbic acid and kojic acid can inhibit tyrosinase activity and have been shown in small studies to lead to decreased pigmentation [46, 6365]. Gokalp H, Akkaya AD, Oram Y. Other lightening agents are often essential to maintain the results achieved with hydroquinone use. Flutamide is a nonsteroidal antiandrogen that blocks the action of endogenous and exogenous testosterone by binding to the androgen receptor. Del Rosario et al. The largest retrospective study of TA treatment was conducted in Singapore. There are few readily available iron oxide formulations, and such formulations optimally block UV light in the visible spectrum. Mazurek K, Pierzchala E. Comparison of efficacy of products containing azelaic acid in melasma treatment. Exogenous ochronosis. Recent progress in melasma pathogenesis. Pawaskar M.D., Parikh P., Markowski T., McMichael A.J., Feldman S.R., Balkrishnan R. Melasma and its impact on health-related quality of life in Hispanic women. An Indian study of 312 patients with melasma found a 4:1 female to male ratio [8]. Would you like email updates of new search results? After eliminating homogeneity from the calculation due to the decreased interrater reliability of that metric, the modified MASI (mMASI) was created [39]. Prevalence of self-diagnosed melasma among premenopausal Latino women in Dallas and Fort Worth, Tex. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility of the integrity of the work as a whole, and have given final approval for the version to be published. Globally, the prevalence of melasma has also varied. Birk Y. Griffiths CE, Finkel LJ, Ditre CM, Hamilton TA, Ellis CN, Voorhees JJ. Monteiro R.C., Kishore B.N., Bhat R.M., Sukumar D., Martis J., Ganesh H.K. Another adjunctive treatment is microneedling or mesotherapy, which creates small channels in the skin to deliver small amounts of topical drugs intradermally [56, 58, 88]. Ikino J.K., Nunes D.H., Da Silva V.P.M., Frde T.S., Sens M.M. Na J.I., Choi S.Y., Yang S.H., Choi H.R., Kang H.Y., Park K.C.
Polypodium leucotomos: Uses, Benefits, and Side Effects Taylor SC. Studies have shown that melasma has a female predominance [6, 8, 20]. Promising oral therapies for melasma include tranexamic acid, Polypodium leucotomos, and glutathione. Taylor A, Pawaskar M, Taylor SL, et al. Methimazole is a potent peroxidase inhibitor that blocks melanin synthesis. Subjects will be randomized to either Group 1, which will receive oral Polypodium leucotomos extract plus topical sunscreen, or Group 2, which will receive oral . Werlinger K.D., Guevara I.L., Gonzlez C.M., Rincn E.T., Caetano R., Haley R.W. Received 2018 Aug 11; Revised 2018 Sep 30; Accepted 2018 Sep 30. Melasma: a clinical and epidemiological review. 8. This review serves as a comprehensive update on the current understanding of the epidemiology, pathogenesis, clinical and histologic features of melasma, as well as treatments for this common, yet therapeutically challenging, condition. An Bras Dermatol 2014; 89: 771-782. This is a numeric score calculated as an area-weighted score of pigmentation and homogeneity located on the forehead, chin, right and left malar cheek [39]. PMC Although the general accepted female to male ratio is 9:1, a more recent large, multicenter study of 953 melasma patients in Brazil found a 39:1 ratio [6, 20]. An immunohistochemical study of the epidermis and dermis of affected and unaffected neighboring skin found significantly increased expression of the progesterone receptor in the epidermis of affected skin [35]. A clinical and histologic study. A Narrative Review. Promising oral therapies for melasma include tranexamic acid, Polypodium leucotomos, and glutathione. Melanocytes sense blue light and regulate pigmentation through the Opsin3. Topical flutamide, an antiandrogenic agent, has also been studied in comparison to HQ 4%, and was found to have statistically significant MASI scores and patient satisfaction; however, no difference in the mexameter melanin assay was observed between the two groups [62]. Association of emblica, licorice and belides as an alternative to hydroquinone in the clinical treatment of melasma. Oral TA should be prescribed with care and caution. | August 26, 2022 A review from an international team of researchers summarizes the available medical therapies for melasma and offers suggestions and recommendations for the use of these therapies in clinical practice. Costa A, Moises TA, Cordero T, Alves CR, Marmirori J. Additionally, a lymphohistiocytic infiltrate may be seen in the dermis in areas with increased melanin deposition.
Melasma | SpringerLink Nordlund J.J., Grimes P.E., Ortonne J.P. 2023 Apr;22(4):1157-1162. doi: 10.1111/jocd.15561. The effects of the melatonin on ultraviolet-B irradiation cultured dermal fibroblasts. Topical retinoids have also been effective in treating melasma, with a postulated mechanism of promoting keratinocyte turnover [53]. Histologically, melasma can display increased epidermal and/or dermal pigmentation, enlarged melanocytes, increased melanosomes, solar elastosis, dermal blood vessels, and, occasionally, perivascular lymphohistiocytic infiltrates. Melasma in men. Javaheri SM, Handa S, Kaur I, Kumar B. It's available as an. Mandibular melasma. However, more studies are needed to determine its long-term safety and efficacy. Passeron T., Picardo M. Melasma, a photoaging disorder. The authors reported a statistically significant effect of PL compared with placebo. One study showed that TA may also decrease VEGF and entothelin-1, both of which may be responsible for increasing vascularity in affected lesions [44]. The dermal subtype has melanophages in the superficial and deep dermis. Jiang J, Akinseye O, Tovar-Garza A, et al. 2022 Dec 24;15(1):56. doi: 10.3390/pharmaceutics15010056. No adverse events have been associated with the use of Polypodium leucotomos. A detailed history should be taken for each patient to exclude individuals at risk for untoward complications. The vascular characteristics of melasma. It is now used in clinical trials [40]. (2016) treated 30 healthy Filipino women with a 500 mg buccal glutathione lozenge. Lutfi RJ, Fridmanis M, Misiunas AL, Pafume O, Gonzalez EA, Villemur JA, et al. Diagnostic utility of dermatoscopy in hydroquinone-induced exogenous ochronosis. Hydroquinone should not be used in pregnant or breastfeeding women due to its Category C characterization. Safety and efficacy of glycolic acid facial peel in Indian women with melasma. J Cosmet Dermatol. Federal government websites often end in .gov or .mil. Their effect in melasma is, however, poorly documented. Although very effective and dosed at different strengths, it can cause an irritant dermatitis in some individuals and chronic use can lead to exogenous ochronosis [7]. The authors reviewed data from 561 patients with melasma who were treated with TA, and improvement was noted in 90% of patients. Plastic Surg Int. Topical treatments, including photoprotection, are typically the first-line therapies for melasma. Historically, hydroquinone has been the gold standard. The melanin index was significantly reduced in the GSH-treated side (Watanabe et al., 2014). The majority of clinical trials that have assessed the efficacy and safety of hydroquinone have not extended beyond 6 months. The Therapeutic Use of Antioxidants for Melasma. Hence, TA is contraindicated in patients with clotting disorders or a history of thromboembolism (Kim et al., 2017). Pichardo R, Vallejos Q, Feldman SR, Schulz MR, Verma A, Quandt SA, et al. Morphologically, melasma presents as symmetric reticulated hyperpigmented patches with irregular borders on the centrofacial region, malar cheeks, mandible, and rarely upper chest and extremities. 1 Medical Therapies for Melasma It is a fern extract from Central and South America that is believed to activate p53, inhibit COX-2, and, thus, produce an antioxidant effect when taken orally. Therefore, they suggest that combined IPL and QSRL therapy may decrease the risk of post-inflammatory hyperpigmentation (PIH) and therefore may also require more treatment sessions. The melanin index showed a significant reduction, and global assessments reported moderate lightening in 90% of subjects (Handog et al., 2016). 2017 Sep;56(9):902-908. doi: 10.1111/ijd.13578. There is a growing interest in oral antioxidant supplements like extract of Polypodium leucotomos, green tea extract and vitamin C. 13 - 15 These ingredients improve photoprotection by decreasing the production or limiting the effect of the oxidative stress. Paine C., Sharlow E., Liebel F., Eisinger M., Shapiro S., Seiberg M. An alternative approach to depigmentation by soybean extracts via inhibition of the PAR-2 pathway. The active and placebo groups were also treated with a broad spectrum sunscreen and hydroquinone 4% daily. A significantly greater reduction in Melasma Area Severity Index (MASI) score occurred in patients treated with the combination UV-visible light formula. Hydroquinone is used globally for melasma (De Caprio, 1999, Grimes, 2009, Nordlund et al., 2006, Tse, 2010), and although used for more than 60 years, it remains our most efficacious topical agent. Cysteamine induced significant reductions in MASI scores at 16 weeks compared with placebo. It reduces the number of sunburn cells. An official website of the United States government. Oxidative stress status in patients with melasma.
Polypodium leucotomos Extract as Sunscreen Adjunct Kim S.J., Park J.Y., Shibata T., Fujiwara R., Kang H.Y. The site is secure. In a casecontrol study, melasma was shown to be associated with an increased number of lentigines and nevi [32]. Boukari F, Jourdan E, Fontas E, Montaudie H, Castela E, Lacour JP, et al. Another study showed that visible light at a wavelength of 415nm can cause increased pigmentation that could last for 3months [26]. Shankar K, Godse K, Aurangabadkar S, Lahiri K, Mysore V, Ganjoo A, et al. Lajis A.F., Hamid M., Ariff A.B. The group treated with PL achieved a significantly greater reduction in MASI score at 56 and 84 days of treatment (Goh et al., 2018). No genome-wide study has been performed to examine associated genes, but current findings would suggest that the genes responsible involve pigmentary, inflammatory, hormonal, and possibly vascular responses. Development and clinical assessment of a comprehensive product for pigmentation control in multiple ethnic populations. An overview on melasma. The dermal stem cell factor and c-kit are overexpressed in melasma. She recommends patients ingest polypodium leucotomos orally twice daily to improve melasma. Clipboard, Search History, and several other advanced features are temporarily unavailable. Ineffective treatment of refractory melasma and postinflammatory hyperpigmentation by Q-switched ruby laser. More recent studies have found improvement in pigmentation with low fluence QNd:YAG, although the patients also applied sunscreen, HQ, tretinoin, or ascorbic acid after laser treatment [93, 94]. Kim EJ, Park HY, Yaar M, Gilchrest BA. New research continues to increase our understanding of melasma and how it can be best treated. Interpretability of the modified melasma area and severity index (mMASI).
Lasers, lights, and compounds for melasma in aesthetics Lee HC, Thng TG, Goh CL. Caregivers of patients with melasma often report the common occurrence of rapid and frequent relapses after intense UV exposure. Procedures, including chemical peels, microneedling, radiofrequency, and lasers, are also often used as primary or adjunctive treatments for melasma. http://creativecommons.org/licenses/by-nc/4.0/, http://www.medengine.com/Redeem/C1E8F0602EB3D30A, Irritation, exogenous ochronosis (with HQ), Anti-inflammatory with non-selective inhibition of melanogenesis, Telangiectasias, epidermal atrophy, steroid-induced acne, striae, hypopigmentation, Abdominal bloating, menstrual irregularities, headache, deep venous thrombosis, Burn, post inflammatory pigment alteration (PIPA), Fractional photothermolysis leading to melanin extrusion.
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