Current Approaches For Melasma Treatment and Possible Toxic Effects

Year 2022, Volume: 42 Issue: 2, 105 - 120, 01.06.2022

Hülya Tezel Aylin Balcı , Pınar Erkekoğlu

https://doi.org/10.52794/hujpharm.1005810

Abstract

Melasma is a chronic and localized pigmentation disorder that arises from increased melanin accumulation due to the enhanced number and activity of melanocytes in epidermis and/or dermis. This disorder appears on the parts of face, which are highly exposed to light and seen as hipermelanosis. Even if treated successfully, it can relapse. Most cases of melasma are seen in dark skin-toned (Fitzpatrick skin type IV – VI) and reproductive-aged women who are living in regions with high ultraviolet radiation. However, it is also encountered in different people with every age, race and skin color. Pathogenesis of melasma is complicated and variable and it is thought to occur because of complex interactions between epidermal melanocytes, keratinocytes, dermal fibroblasts, mast cells and vascular endothelial cells. Although some factors like sun exposure, genetic predisposition, pregnancy, oral contraceptive and steroid use, ovary tumors, use of irritant cosmetic products and use of drugs that cause photosensitivity were described for its etiopathogenesis, the accurate cause of malesma is not known. In this review, recent developments in the pathogenesis and treatment of melasma will be summarized, and the efficacy and toxic effects of current and new treatment options will be discussed.

Keywords

hyperpigmentation, melasma, hydroquinone, laser, depigmentation

Melazma Tedavisinde Güncel Yaklaşımlar Ve Olası Toksik Etkileri

Abstract

Melazma epidermiste melanosit sayısının ve aktivitesinin artmasına bağlı olarak epidermis ve/veya dermiste artan melanin birikimiyle çıkan bir kronik ve lokalize pigmentasyon bozukluğudur. Bu bozukluk sıklıkla da yüzün güneşe maruz kalan bölgelerinde görülür ve hipermelanoz şeklinde kendini gösterir. Başarılı bir şekilde tedavi edilse dahi tekrarlayabilir. Melazma vakalarının çoğu, yüksek ultraviyole radyasyonun olduğu bölgelerde yaşayan daha koyu ten rengi tonlarına sahip (Fitzpatrick cilt tipi IV – VI) üreme çağındaki kadınlarda görülür. Ancak, her yaştan, ırktan ve ten renginden insanda da görülebilir. Epidermal melanositler, keratinositler, dermal fibroblastlar, mast hücreleri ve vasküler endotelyal hücreler arasında karmaşık etkileşimler sonucunda oluştuğu düşünüldüğünden, melazmanın patogenezi komplike ve değişkendir. Etiyopatogenezinde güneşe maruz kalma, genetik yatkınlık, gebelik, oral kontraseptif ve steroid kullanımı, yumurtalık tümörleri, irritan kozmetik ürünlerin kullanımı ve fotoduyarlılığa sebep olan ilaçların kullanımı gibi bazı faktörler tanımlanmasına rağmen, melazmanın kesin nedeni tam olarak bilinmemektedir. Bu derlemede melazmanın patogenezindeki ve tedavisindeki en son gelişmeler hakkındaki bilgiler özetlenecek, mevcut ve yeni tedavi seçeneklerinin etkinlikleri ve toksik etkileri tartışılacaktır.

Keywords

hiperpigmentasyon, melazma, hidrokinon, lazer, depigmentasyon

References

• 1. Taraz M, Niknam S, Ehsani AH: Tranexamic acid in treatment of melasma: A comprehensive review of clinical studies. Dermatologic Therapy 2017,30(3):1-8.
• 2. Searle T, Al-Niaimi F, Ali FR: The top 10 cosmeceuticals for facial hyperpigmentation. Dermatologic Therapy 2020,33(6):e14095.
• 3. Dunbar S, Posnick D, Bloom B, Elias C, Zito P, Goldberg DJ Energy-based device treatment of melasma: An update and review of the literature. J Cosmet Laser Therapy 2017 Feb,19(1):2-12. doi: 10.1080/14764172.2016.1229485. PMID: 27594445.
• 4. Sehgal VN, Verma P, Srivastava G, Aggarwal AK, Verma S: Melasma: treatment strategy. Journal of Cosmetic & Laser Therapy 2011,13(6):265-279. doi: 10.3109/14764172.2011.630088. PMID: 21981383.
• 5. Küçük ÖS: Current Treatment Approaches for Melasma. Bezmialem Science 2018,54-62. 6. Rendon M, Berneburg M, Arellano I, Picardo M: Treatment of melasma. Journal of the American Academy of Dermatology 2006,54(5Suppl2):S272-81.
• 7. Ball Arefiev KL, Hantash BM: Advances in the treatment of melasma: a review of the recent literature. Dermatologic Surgery 2012,38(7 Pt 1):971-84.
• 8. Maranduca MA, Branisteanu D, Serban DN, Branisteanu DC, Stoleriu G, Manolache N, Serban IL: Synthesis and physiological implications of melanic pigments. Oncology Letters 2019, 17(5): 4183-4187.
• 9. Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller, AS, Leffell DJ: Disorders of Melanocytes. Fitzpatrick’s Dermatology in General Medicine.7. Baskı. A.B.D:McGraw-Hill Companies Inc. 2008: p.591–608.
• 10. Sarkar R, Devadasan S, Choubey V, Goswami B: Melatonin and oxidative stress in melasma‒an unexplored territory; a prospective study. International Journal of Dermatology 2020,59:572–575.
• 11. Kwon SH, Na JI, Choi JY, Park KC: Melasma: Updates and perspectives. Experimental Dermatology 2019,28(6):704-708.
• 12. Kwon SH, Hwang YJ, Lee SK, Park KC: Heterogeneous Pathology of Melasma and Its Clinical Implications. International Journal of Molecular Sciences 2016,17(6):824.
• 13. Rodrigues M, Pandya AG: Melasma: clinical diagnosis and management options. Australasian Journal of Dermatology 2015, 56(3):151-63.
• 14. Aboul-Einien MH, Kandil SM, Abdou EM, Diab HM, Zaki MSE: Ascorbic acid derivative-loaded modified aspasomes: formulation, in vitro, ex vivo and clinical evaluation for melasma treatment. List of issues Journal of Liposome Research 2020, 30(1):54-67.
• 15. Korać RR, Khambholja KM: Potential of herbs in skin protection from ultraviolet radiation. Pharmacognosy Reviews 2011, 5(10):164-73.
• 16. Westerhof W, Kooyers TJ: Hydroquinone and its analogues in dermatology - a potential health risk. Journal of Cosmetic Dermatology 2005, 4(2):55-9.
• 17. Türkiye Cumhuriyeti Sağlık Bakanlığı. Türkiye İlaç ve Tıbbi Cihaz Kurumu. 23.05.2005 tarihli ve 25823 sayılı Resmî Gazete. Kozmetik Yönetmeliği. İnternet Adresi: https://www.titck.gov.tr/faaliyetalanlari/kozmetik/kozmetik-mevzuati [Web sitesi]
• 18. McKesey J, Tovar-Garza A, Pandya AG: Melasma Treatment: An Evidence-Based Review. American Journal of Clinical Dermatology 2020, 21(2):173-225.
• 19. Rivas S, Pandya AG: Treatment of melasma with topical agents, peels and lasers: an evidence-based review. American Journal of Clinical Dermatology 2013,14(5):359-76.
• 20. Sorg O, Kasraee B, Salomon D, Saurat JH: The potential depigmenting activity of retinaldehyde. Dermatology. 2013, 227(3):231-7.
• 21. Kim DS, Kim HJ, Choi KH, Chung JH, Kim KH, Par KC: UVB-induced GM-CSF production is suppressed by dexamethasone in HaCaT cells. Photodermatology, Photoimmunology and Photomedicine 2001, 17(3):121-5.
• 22. Ogbechie-Godec OA, Elbuluk N: Melasma: an Up-to-Date Comprehensive Review. Dermatology and Therapy. 2017;7(3):305-318.
• 23. Bandyopadhyay D: Topical treatment of melasma. Indian Journal of Dermatology 2009,54(4):303-9.
• 24. Telang PS: Vitamin C in dermatology. Indian Dermatology Online Journal 2013,4(2):143-6.
• 25. Ismail ESA, Patsatsi A, Abd El-Maged WM, Nada EEAE: Efficacy of microneedling with topical vitamin C in the treatment of melasma. Journal of Cosmetic Dermatology 2019,18(5):1342-1347
• 26. Lim JT: Treatment of melasma using kojic acid in a gel containing hydroquinone and glycolic acid. Dermatologic Surgery 1999,25(4):282-284.
• 27. Scientific Committee on Consumer Safety (SCCS). Opinion on Kojic Acid. European Commission; 26 – 27 June 2012 Erişim Linki: https://ec.europa.eu/health/scientific_committees/consumer_safety/docs/sccs_o_098.pdf [Web sitesi]
• 28. Burnett CL, Bergfeld WF, Belsito DV, Hill RA, Klaassen CD, Liebler DC, Marks JG Jr, Shank RC, Slaga TJ, Snyder PW, Andersen FA.: Final report of the safety assessment of Kojic acid as used in cosmetics. International Journal of Toxicology 2010, 29(6):244S-73.
• 29. Draelos ZD: Skin lightening preparations and the hydroquinone controversy. Dermatologic Therapy 2007, 20(5):308-13.
• 30. Amer M, Metwalli M: Topical liquiritin improves melasma. International Journal of Dermatology 2000, 39(4):299-301.
• 31. Huh SY, Shin JW, Na JI, Huh CH, Youn SW, Park KC: Efficacy and safety of liposome-encapsulated 4-n-butylresorcinol 0.1% cream for the treatment of melasma: a randomized controlled split-face trial. The Journal of Dermatology 2010,37(4):311-315.
• 32. Kasraee B, Hügin A, Tran C, Sorg O, Saurat JH: Methimazole is an inhibitor of melanin synthesis in cultured B16 melanocytes. Journal of Investigative Dermatology 2004,122(5):1338-41.
• 33. Kasraee B, Handjani F, Parhizgar A, Omrani GR, Fallahi MR, Amini M, Nikbakhsh M, Tran C, Hügin A, Sorg O, Saurat JH: Topical methimazole as a new treatment for postinflammatory hyperpigmentation: report of the first case. Dermatology. 2005, 211(4):360-362.
• 34. Kodali S, Guevara IL, Carrigan CR, Daulat S, Blanco G, Boker A, Hynan LS, Pandya AG: A prospective, randomized, split-face, controlled trial of salicylic acid peels in the treatment of melasma in Latin American women. Journal of the American Academy of Dermatology 2010,63(6):1030-5.
• 35. Sharquie KE, Al-Tikreety MM, Al-Mashhadani SA: Lactic acid as a new therapeutic peeling agent in melasma. Dermatologic Surgery 2005, 31(2):149-154.
• 36. Wang CC, Hui CY, Sue YM, Wong WR, Hong HS: Intense pulsed light for the treatment of refractory melasma in Asian persons. Dermatologic Surgery 2004, 30(9):1196-200.
• 37. Lehraiki A, Abbe P, Cerezo M, Rouaud F, Regazzetti C, Chignon-Sicard B, Passeron T, Bertolotto C, Ballotti R, Rocchi S: Inhibition of melanogenesis by the antidiabetic metformin. Journal of Investigative Dermatology 2014, 134(10):2589-2597.
• 38. Banavase Channakeshavaiah R, Andanooru Chandrappa NK: Topical metformin in the treatment of melasma: A preliminary clinical trial. Journal of Cosmetic Dermatology 2020,19(5):1161-1164.
• 39. Matsui MS, Petris MJ, Niki Y, Karaman-Jurukovska N, Muizzuddin N, Ichihashi M, Yarosh DB: Omeprazole, a gastric proton pump inhibitor, inhibits melanogenesis by blocking ATP7A trafficking. Journal of Investigative Dermatology. 2015,135(3):834-841.
• 40. Yi X, Zhao G, Zhang H, Guan D, Meng R, Zhang Y, Yang Q, Jia H, Dou K, Liu C, Que F, Yin JQ. MITF-siRNA formulation is a safe and effective therapy for human melasma. Molecular Therapy 2011,19(2):362-71.
• 41. Rajanala S, Maymone MBC, Vashi NA: Melasma pathogenesis: a review of the latest research, pathological findings, and investigational therapies. Dermatology Online Journal 2019,25(10).
• 42. Berardesca E, Rigoni C, Cantù A, Cameli N, Tedeschi A, Donne Dermatologhe Italia, Laureti T. Effectiveness of a new cosmetic treatment for melasma. J Cosmet Dermatol. 2020;19(7):1684-1690. doi: 10.1111/jocd.13203.