Hydroquinone 4% cream Cream applied once daily at night on affected areas for 3 months.

Silymarin 0.7% cream Cream applied twice daily on affecectec areas for 3 months.

Melasma

Hydroquinone is tyrosinase inhibitor and thus inhibits melanogenesis.

Hydroquinone 4% Cream

Silymarin is a plant derived flavonoid, extracted from fruits and seeds of milk thistle.

silymarin 0.7% cream

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

Islamabad medical and Dental College

Comparison of Topical Silymarin With Hydroquinone in the Treatment of Melasma

>75% improvement as excellent
50-75% improvement as good
25-50% improvement as medium
< 25% improvement as poor

0 - 10 very unsatisfied.
11 - 18 unsatisfied.
19 - 26 satisfied.
27 - 28 very satisfied.

Sumaira Abdullah

Senior Registrar

Islamabad Medical and Dental College

The patients received three sessions of PRP application, at intervals of 15 days between each of them. It was applied by means of a 32G needle to introduce the PRP by means of superficial micro-injections via the mesotherapy technique (approximately 1.5-2.0 mm deep) and it was deposited in the papillary dermis of the rosotro.

1 ml of PRP was distributed in the papillary dermis of the face, repeating the dose at 15 and 30 days.

Platelet-Rich Plasma

Western Medical Center, Mexican Institute of Social Security

Efficacy of Platelet-rich Plasma in Treatment of Melasma

First divide the face into four regions: front (F), right malar (MR), left malar (ML), and chin (CH), which corresponds to 30%, 30%, 30% and 10% , respectively, of the total area(A) of the face. Subsequently, the area involved in each region is evaluated, assigning values from 1 to 6, depending on whether it affects: less than 10%; 10 to 29%; 30 to 49%; 50 to 69%; 70 to 89%; or 90 to 100%. A score is also assigned according to the darkening of the pigmentation (D): absent (0); mild (1); moderate (2); marked (3) or maximum (4). Finally, following this same scale, a value is assigned according to the homogeneity of the pigmentation (H).
The following equation is used to calculate this index:
The Melasma Area and Severity Index= 0.3 (DF + HF) AF+ 0.3 (DMR + HMR) AMR + 0.3 (DML + HML) AML + 0.1 (DCH + HCH) ACH
The range is 0-48, although it is strictly an aesthetic problem, the higher the score, the greater the affectation. This scale was applied before and after the treatment.

For this analysis, the obtained samples were fixed by 10% formalin and cuts of 6 μm were made. Hematoxylin-eosin staining was used for the visualization of melanophages in the dermis, cutaneous atrophy, solar elastosis and inflammatory infiltrate. Fontana-Masson stain to evaluate the pigmentation, focality of the pigmentation, distribution and absence of pigment in the papillary dermis.
Biopsy was taken at the beginning of the study and at the end.

It was performed using a dermatoscope (DermLite DL3N brand) with polarized light. Pictures were taken, (with Canon Powershot G12 camera) of the most characteristic part of the lesion, either in front, cheekbones or jaw. The photograph was taken before and after starting the treatment of the same anatomical site on both occasions. The melasma was classified according to the depth in: epidermal (regular and brown pigment is appreciated), dermal (regularity is lost and a color between blue and gray is seen) and mixed (combinations of these two). Two researchers were in charge of performing the dermatoscopy and the qualitative measurement of it.

Photographs were compared by dermatoscopy of the most characteristic part of the lesion before and after treatment. Categorizing these photographs in: 0 (without appreciable lesions), 1 (discolorations and slight presence of pigment), 2 (scattered pigment points) and 3 (pigment points together).

Photographs were compared by dermatoscopy of the most characteristic part of the lesion before and after treatment. Categorizing these photographs in: 1 (brown pigment), 2 (gray-blue) or 3 (dark brown / black).

Photographs were compared by dermatoscopy of the most characteristic part of the lesion before and after treatment. In search of telangiectasias. Two researchers were in charge of performing the dermatoscopy and the qualitative measurement of it.

Melasma Quality of Life scale (MELASQOL) is a useful and objective tool to assess the quality of life of patients. In this protocol, the Sp-MELASQOL will be used, since it is the version in Spanish validated by Domínguez and cols, for the Latin American population. Which consists of 10 questions, with a score for each question from 1 to 7 points, where 1 = never and 7 = always.
The results range from 7-70 points, the higher the score indicated, the lower the quality of life presented by the patients.
We compare the results obtained before and after the intervention.

CLOTILDE FUENTES OROZCO

Instituto Mexicano del Seguro Social

A prospective cohort study with therapeutic intervention for one year. We included patients older than 18 years with a diagnosis of melanoma and a history of pregnancy with a time greater than 6 months, who were not in the period of lactation, with no history of skin cancer, with a history of liver, thyroid or injury, of acne and traumatic injuries on the face, in addition, with no work history of PRP. The patients received three sessions of PRP application, at intervals of 15 days between each of them.

include 20 patients will be treated with TCA25% +microneedle 8 sessions for TCA 25 peel and 4 sessions for microneedle (derma pen).

include 20 patient will be treated with TCA 25% only ( 8 sessions)

TCA peeling session: Facial skin will be cleansed with tap water and degreased by rubbing with an alcohol sponge .
Then TCA 25% will be applied to the whole face by cotton tipped applicator or gauze pad. The entire face will be treated until complete frosting occur.
The patients will be instructed to wash their faces to decrease the burning sensation.
Combined session: starts with microneedle using microneedle device (Derma pen) The skin of each patient is cleaned with anti septic solution and anesthetic cream may be applied to lessen discomfort.
(Dermapen) will be applied on the lesional skin in four direction, vertical, horizontal and in the two diagonal until pin point bleeding occur which will be gently massaged .
After 10 minutes TCA peeling will be applied TCA peeling will be done for 8 session with 2 weeks interval between each session.
Microneedle will be done for 4session with 4 weeks interval between each session.

Microneedle

Microneedle and Trichloroaceticacid in Treatment of Melasma

Combined Trichlotoaceticacid and Microneedle Versus Trichlroacetic Acid Alone in the Treatment of Melasma

Efficacy of the treatment =(mMASIscorebefor -mMASIscoreafter)/mMASIscore before x100.
Clinical efficacy was categorized into :
Excellent response: if morethan 75%fall in [mMASI] score. Very good response:if 50-75%fall in ]mMASI[score . Good respone: if 25-50%fall in ]mMASI[score. Poor response: if less25%fall in mMASIscore. No response: when there was no change in [mMASI] score at the end of the therapy.
Efficacy of the treatment =(mMASIscorebefor -mMASIscoreafter)/mMASIscore before x100.
Clinical efficacy was categorized into :
Excellent response: if morethan 75%fall in [mMASI] score. Very goodresponse:if 50-75%fall in ]mMASI[score . Good respone: if 25-50%fall in ]mMASI[score. Poor response: if less25%fall in mMASIscore. No response: when there was no change in [mMASI] score at the end of the therapy.

before x100.
Clinical efficacy was categorized into :
Excellent response: if morethan 75%fall in [mMASI] score. Very good response:if 50-75%fall in ]mMASI[score . Good respone: if 25-50%fall in ]mMASI[score. Poor response: if less25%fall in mMASIscore. No response: when there was no change in [mMASI] score at the end of the therapy.
Efficacy of the treatment =(mMASIscorebefor -mMASIscoreafter)/mMASIscore before x100.
Clinical efficacy was categorized into :
Excellent response: if morethan 75%fall in [mMASI] score. Very goodresponse:if 50-75%fall in ]mMASI[score . Good respone: if 25-50%fall in ]mMASI[score. Poor response: if less25%fall in mMASIscore. No response: when there was no c

Safaa Hamed

Principal investigator

Assiut University

TCA peeling session: Facial skin will be cleansed with tap water and degreased by rubbing with an alcohol sponge .
Then TCA 25% will be applied to the whole face by cotton tipped applicator or gauze pad. The entire face will be treated until complete frosting occur.
The patients will be instructed to wash their faces to decrease the burning sensation.
Combined session: starts with microneedling using microneedling device (Dermapen) The skin of each patient is cleaned with anti septic solution and anesthetic cream may be applied to lessen discomfort.
(Dermapen) will be applied on the lesional skin in four direction, vertical, horizontal and in the two diagonal until pin point bleeding occur which will be gently massaged .
After 10 minutes TCA peeling will be applied TCA peeling will be done for 8 session with 2 weeks interval between each session.
Microneedling will be done for 4session with 4 weeks interval between each session.

intradermal injection of 5 ml of autologous platelet rich plasma in the lesional skin of the face of 20 melasma patients every 4 weeks for 3 times

Platelet Rich Plasma

10 ml of blood will be drawn from the patients on an anticoagulant then it will be centrifuged to get platelet rich plasma that will be injected in the melasma lesions of the patients after its activation with calcium chloride.

Platelet rich plasma

Assiut university hospitals

Platelet Rich Plasma in Treatment of Melasma

Evaluation of the Therapeutic Effect of Platelet Rich Plasma in Melasma

evaluation of the degree of clinical improvement of melasma by using platelet rich plasma

compare the intensity of immunohistochemical expression of transforming growth factor beta in skin biopsies taken from the the lesional melasma skin ( of participants who accept only) before and after treatment with platelet rich plasma The results will be scored as follows: 0 for negative staining, 1+ for weak staining, 2+ for moderate staining intensity, and 3+ for strong positive staining.

melasma/antimykotikum

Comparison of Topical Silymarin With Hydroquinone in the Treatment of Melasma

Efficacy of Platelet-rich Plasma in Treatment of Melasma

Microneedle and Trichloroaceticacid in Treatment of Melasma

Platelet Rich Plasma in Treatment of Melasma

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