It's a low energy resurfacing laser that helps even out pigmentation, lighten brown spots, and improve post-inflammatory hyperpigmentation. (2014) 25:2127. In consequence, QSND and AFL are worthy of being applied as a monotherapy or combination therapy for melasma. McKesey J, Tovar-Garza A, Pandya AG. A total of 297 studies were identified by the literature search (PubMed, Embase, and Cochrane Libraries) (Figure 1). We recommend HQ combined with photoelectric devices for melasma. We'll assume you're ok with this, but you can opt-out if you wish. Res Synth Methods. J Cosmet Dermatol. (2019) 85:63841. doi: 10.1111/j.1365-2230.2011.04150.x, 13. (1975) 111:408. doi: 10.1080/09546634.2021.1914313, Keywords: melasma, efficacy, treatment, comparison, network meta-analysis, Citation: Liu Y, Wu S, Wu H, Liang X, Guo D and Zhuo F (2021) Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials. In general, the efficacy of interventions with multitarget effect in the treatment of melasma is better than those with a single target. Risk of bias summary for individual studies. Not to worry though, because the 10% solutions you find online and over the counter have combination products in addition to the azelaic acid to boost the effects of azelaic acid more effectively than when used alone. Another study further proved that a significantly greater decrease in melanin-induced reflectance in the spinous layer and the basal layer was observed after 755 nm of PICO treatment compared with the QSND treatment for melasma (34). Cutis. randomized, observer-blinded, comparison of combined 1064-nm Q-switched neodymium-doped yttriumaluminumgarnet laser plus 30% glycolic acid peeling vs. laser monotherapy to treat melisma. Network graph. Azelaic acid works to improve melasma in two ways. Kligman AM, Willis I. Systematic Review Registration: identifier: CRD42021239203. The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmed.2021.713554/full#supplementary-material, 1. doi: 10.1111/dth.13629, 28. Clin Cosmet Investig Dermatol. doi: 10.1111/jocd.13182, 12. Rosacea Diet: What Foods to Eat and Avoid. doi: 10.1001/archderm.131.12.1453, PubMed Abstract | CrossRef Full Text | Google Scholar, 2. doi: 10.1111/jocd.13157. This study was restricted by the limited number of RCTs, particularly those related to PICO laser. Cleansing twice, with an oil-based cleanser and then a water-based cleanser, removes acne-causing impurities and leaves my skin feeling much cleaner and smoother. In addition, AFL and NAFL could remodel the skin tissue to reverse antiphotoaging by creating micro-areas of thermal injury. Hence, it is necessary to perform more RCTs and split-face studies that can reduce the ROB to update the current results and help develop more standardized protocols. Antioxidant serumsespecially those containing vitamin Cprotect the skin from sun exposure and environmental pollution all day long. (2007) 143:4245. Neagu et al. Handel AC, Miot LD, Miot HA. SW contributed to statistical methods. JAMA Dermatol. Figure 5. All authors contributed to the article and approved the submitted version. In this study, the first network meta-analysis (NMA) of melasma treatments was conducted using 59 selected RCTs including 14 common interventions: nonenergy-dependent treatments (HQ, topical tranexamic acid (tTA), oral tranexamic acid (oTA), AA, TCC, peeling, topical vitamin C (tVC), tretinoin, and MN) and energy-dependent treatments [IPL, QSND, PICO, ablative fractional laser (AFL), and nonablative fractional laser (NAFL)]. JCAD. There is no need to strip your skin of all its natural lipids and oils because they're actually working to protect your skin's barrier. A P < 0.05 indicated significant inconsistency between direct and indirect evidence in the network. 47. Low-fluence Q-switched Nd:YAG laser for the treatment of melasma in Asian patients. You may be able to find more information about this and similar content at piano.io, A Dermatologists Eczema-Approved Skincare Routine, How A Latinx Dermatologist Treats Her Melasma, How A Dermatologist Treats Her Dark Spots, How A Dermatologist Treats Her Own Sensitive Skin, How A Dermatologist Treats Her Melasma And Acne, How A Dermatologist Treats Her Own Oily Skin, How A Dermatologist Treats Her Combination Skin, How A Dermatologist Treats Her Hyperpigmentation, How A Dermatologist Treats Her Acne-Prone Skin. Chan R, Park KC, Lee MH, Lee ES, Chang SE, Leow YH, et al. (1999) 25:4947. J Cosmet Dermatol. However, the risk of melanocyte irritation and postinflammatory hyperpigmentation (PIH) cannot be ignored, especially the high risk of PIH after NAFL and AFL treatment, but this also increases the risk of side effects (22, 23). STATA version 15.0 software (StataCorp LLC, 4905 Lakeway Drive, college station, TX 77845, USA) was used for data analysis, namely, pairwise meta-analysis, estimation of inconsistency, and forest plot. Except for three studies that treated only one session, the average duration of treatment in the remaining studies was 12 weeks, ranging from 5 to 30 weeks. You may be able to find the same content in another format, or you may be able to find more information, at their web site. The final assessment endpoint was 440 weeks, with an average of 13 weeks; 26 studies involved single treatment and 33 involved combination therapy. The following details were extracted: trial information (author, publication year, sample size, trial duration, and types of intervention), population characteristics (age and skin types), outcomes of efficacy (change in MASI), and adverse effects (events and numbers). doi: 10.1097/DSS.0000000000001120, 26. The second-line treatment indicated combination therapy with the first-line treatment and chemical peelings. YL contributed to data collection and article writing. doi: 10.1111/j.1468-3083.2012.04464.x, 44. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. Erythema and burning were the most common side effects. Kim SJ, Park JY, Shibata T, Fujiwara R, Kang HY. Is Azelaic Acid Effective For Melasma Treatment? J Clin Aesthet Dermatol. J Cosmet Dermatol. 15. Based on the literature review of the evidence, the first-line therapy was topical therapy, such as HQ cream and TCC, for at least 3 months. Relative effects table. Figure 6. And while she still has "small acne breakouts," it's the acne scars (dark marks) mixed with melasma that concerns her now. (2013) 149:9813. Aesthetic Plast Surg. Topical vitamin C (VC) and tTA rankings were inferior to HQ in this study, which might be relevant to the delivery mode with VC iontophoresis or intradermal TA (41). Figure 3. Longo C, Pellacani G, Tourlaki A, Galimberti M, Bencini PL. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. This content is imported from {embed-name}. The ROB graph evaluated using the Cochrane Collaboration's tool is shown in Figures 3, 4. A treatment may rank favorably, but the low quality of evidence with the risks of bias, inconsistency, and/or imprecision may cast doubt on confidence in such a favorable ranking (18). Clin Plast Surg. (2017) 6:79. doi: 10.1186/s13643-017-0473-z, 19. The random-effects NMA was performed within the Bayesian framework (16). confirmed the effectiveness of QSND for melasma by observing the changes in dermatoscopy and in vivo confocal microscopy (27, 28). While Dr. Chang admits that she switches up her skincare routine depending on the season or whether her acne or pigmentation is worse, these are the products she turns to over and over again. In the SUCRA ranking, peeling held the middle position (7/14), also ranking higher than tretinoin and HQ. Am J Clin Dermatol. J Cosmet Dermatol. The former contains topical medicine such as hydroquinone (HQ), triple combined cream (TCC), azelaic acid (AA), tranexamic acid (TA), visible and UV light protection cream, chemical peelings, microneedles (MNs), platelet-rich plasma (PRP), ultrasound therapy, and so forth (8, 9). doi: 10.1111/exd.13844, 7. (2003) 72:6772. Higgins JP, Jackson D, Barrett JK, Lu G, Ades AE, White IR. Subcellular selective photothermolysis of melanosomes in adult zebrafish skin following 1064-nm Q-switched Nd:YAG laser irradiation. Clinical & ultrastructural evaluation of the effect of fractional CO2 laser on facial melisma. Taylor SC, Torok H, Jones T, Lowe N, Rich P, Tschen E, et al. One study found that azelaic acid was effective at least as hydroquinone, the gold standard ingredient in topical creams, without the side effects of hydroquinone (Balia). Farshi S. Comparative study of therapeutic effects of 20% azelaic acid and hydroquinone 4% cream in the treatment of melasma. Rivas S, Pandya AG. I take breaks between using hydroquinone because long-term use has been associated with a rare skin condition called ochronosis, that causes a blue-grey pigmentation on the skin. The results from the node-splitting analysis of consistency/inconsistency comparisons are shown in Figure 7. (2020) 19:28129. Arch Dermatol. Very few studies are available on MN monotherapy. Studies showed that the efficacy of TCC in treating melasma was far better than that of HQ (38, 39) and was equivalent to a 755-nm PICO laser (40). ", "After cleansing in the evening, I apply a lightening cream to help improve the surface pigment of my dark spots and melasma. Indian Dermatol Online J. doi: 10.1111/j.1524-4725.2009.01066.x, 31. doi: 10.1016/j.cps.2016.03.008, 21. Currently, combination therapies are preferable. Rankings need to consider the quality of evidence and the context of the main results of an NMA, which is the relative treatment effect. The risk of bias among the included studies was assessed according to the Cochrane risk-of-bias (ROB) tool (15). Azelaic acid for melasma TIPS. (2011). doi: 10.1111/j.1524-4725.2005.31725, 43. Topical vitamin C: A useful agent for treating photoaging and other dermatologic conditions. ", "I admit that my skincare regimen only gets me so far in helping to treat my acne scarring, brown spots, and melasma. Direct comparisons for all treatments are shown in Figure 5B. 5. Early clinical and histological changes induced by microneedling in facial melasma: A pilot study. Chemical Peels in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group. (2014) 89:77182. First, it encourages cell turnover to exfoliate the skin and promote new, healthy skin growth. DG participated in the article revision, and the article topic selection and final revision were in the charge of FZ. Wait at least 15 minutes before lying down in bed and sleeping on your back so you absorb it more effectively.DISCLAIMER: This video is for information only and should not be used for the diagnosis or treatment of medical conditions. The databases PubMed, Embase, and Cochrane Library were searched for original studies, and the search ended on December 2020. He is licensed to practice medicine in California, Colorado, Florida, and North Carolina and law in New York and Ontario. Med. HW participated in the article screening. You may feel insecure about your skin if you live with melasma since it can be difficult to feel confident about a condition that compromises your natural skin glow. These help exfoliate my skin, clear out my pores, prevent acne, improve acne marks, and lighten my melasma. Na JI, Choi SY, Yang SH, Choi HR, Kang HY, Park KC. Results: The ranking of relative efficacy compared with placebo in descending order was Q-switched Nd:Yag 1,064-nm laser (QSND), intense pulsed light, ablative fractional laser (AFL), triple combined cream (TCC), topical vitamin C, oral tranexamic acid (oTA), peeling, azelaic acid, microneedles (MNs), topical tranexamic acid (tTA), tretinoin, picosecond laser, hydroquinone (HQ), and non-AFL. Melanocytes and removal of dermal melanophages could be destroyed through subcellular selective photothermolysis (Figure 8) (1921). It uses multiple active ingredients, including niacinamide, tranexamic acid, and resorcinol that can help with brightening the skin and pigmentation. On my off months, I use another powerful lightening cream called SkinMedica Lytera 2.0. Flow chart showing the screening process of the literature. Detailed information for all these studies presented in the NMA is shown in Supplementary Table 1. (2019) 12:E734. The Clear and Brilliant is one of my favorites. Kaminaka C, Furukawa F, Yamamoto Y. Chee-Leok G, Sai Yee C, Thng Guan TS, Alejandra VM, Arancha DR. Polypodium leucotomos double-blind, placebo-controlled trial to evaluate the effectiveness of extract in the treatment of melasma in asian skin: a pilot study. The average age of the participants was 39.25 6.69 years, and the score of MASI at baseline was 11.34 4.51. Available online at: http://handbook.cochrane.org/ (accessed April 27, 2016). ", "My favorite sunscreen is EltaMD UV Physical, which comes in a tinted formulation, so it doubles as my sunscreen and my foundation. ", "After gentle cleansing, I apply an antioxidant serum to my face every morning. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. No single treatment that is particularly effective is available. 4. Proposal of a quantitative method to describe melasma distribution in women. Prevalence of self-diagnosed melasma among premenopausal Latino women in Dallas and Fort Worth, Tex. DerSimonian and Laird random-effects model was used for standard paired meta-analysis. Grimes PE. Effect of tranexamic acid on melasma: a clinical trial with histological evaluation. Securities and Financial Regulation). Fractional erbium-doped yttrium aluminum garnet laser-assisted drug delivery of hydroquinone in the treatment of melasma. J Dermatolog Treat. This website uses cookies to improve your experience. Most studies assessed the use of MN in combination with other topical agents for the facilitation of drug delivery. Direct comparisons. The network graph shows the evidence network for all selected interventions. Efficacy and safety of a new triplecombination agent for the treatment of facial melasma. Since everyones melasma responds to treatment differently, the best way to achieve clear skin is a prescription-strength cream tailored to your unique needs. Treatment of melasma with topical agents, peelings and lasers: an evidence-based review. AFL combined with tTA or TCC also demonstrated higher efficacy on melasma (31, 32). doi: 10.1001/jamadermatol.2013.4294, 48. The meta-analysis of direct pairwise comparisons (Figure 5A) showed that 14 treatments exhibited greater efficacy than placebo. Photoelectric devices, such as QSND and AFL, ranked first and third in efficacy, show similar side effects (21.5 and 20%) but a little higher than those of oTA (17.65%). In a large, multicenter RCT, TCC was found to be more effective than any dual combination of the three active ingredients (37). Comparison of the included interventions: mean difference (95% credible intervals). J Cosmet Dermatol. Lee MC, Lin YF, Hu S, Huang YL, Chang SL, Cheng CY, et al. The adverse effects involved burning or stinging, erythema, scaling, swelling, hyperpigmentation, edema, and so forth. Always consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions.As an Amazon Associate I earn from qualifying purchases.#azelaicacid #melasma Melasma, in particular, is a stubborn and annoying condition that I developed in my late 20s and has been recurrent since.". Only 59 studies met the inclusion criteria and were included in the quantitative NMA. 11:1320. Yi J, Hong T, Zeng H, Li P, Li P, Wang S, et al. 11:1419. ", "Twice a week I switch out my retinol for a glycolic/salicylic acid peel pad. MN creates minor skin damage, and in the process of skin self-repairment, it may reverse some structural patterns of melasma (50). ", Why Marvel's Karen Gillan Embraces Her Anxiety, Your New Must-Try: Sauted Dandelion Toast, The Only Marathon Training Plan You'll Ever Need, Your June Horoscope: Communication Clarity. The PRISMA extension statement for reporting of systematic reviews incorporating network meta -analyses of health care interventions: checklist and explanations. This ingredient is generally applied in a cream formulation at a strength of about 20%. During the dry winter months when I need extra hydration, I switch to a thicker cream that contains ceramides like CeraVe Moisturizing Cream. (2021) 14:139. Necessary cookies are absolutely essential for the website to function properly. This conclusion should attribute to the single target to UV radiation protectant as an adjunct to topical sunscreen. Arch Dermatol. Ponzio HA, Favaretto AL, Rivitti EA. Dermatol Surg. Secondly, azelaic acid also has antioxidant properties that help remove free radicals that can contribute to dull skin for a naturally brighter complexion. (2017) 62:57884. Dermatol Surg. IPL ranked second with only three studies, and IPL-based combination therapy was discussed in two studies. Table 1. Although azelaic acid is generally well-tolerated, some people may experience side effects nonetheless. (A) Direct comparisons with placebo for each treatment; (B) direct comparisons for all treatments. Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. This result was consistent with the current ranking. The results showed that compared with placebo, local therapies (TCC, tTA, peeling, and HQ), systemic medication (oTA), and device-based treatments (QSND, IPL, AFL, and NAFL) demonstrated significantly greater odds ratios of MASI change. The random sequence generation (selection bias) in all studies (59/59, 100%) was properly described; 94.9% (56 of 59) RCTs had a low risk of allocation concealment (selection bias), and 83.0% (49 of 59) had a low risk of detection bias. Methods: The PubMed, Embase, and Cochrane Library databases were searched till December 2020 using the melasma area and severity index as a therapeutic index. Dr. Kirsch started his career as a lawyer and holds law degrees from the University of Western Ontario (LL.B.) You also have the option to opt-out of these cookies. (2015) 162:77784. In recent years, energy-based devices are becoming popular treatments for melasma. doi: 10.1007/s40257-013-0038-4, 11. However, more studies are needed to determine its long-term safety and efficacy. Clin Exp Dermatol. 20% azelaic acid versus 4% hydroquinone cream. Rosacea vs. Lupus: Whats the Difference? J Clin Aesthet Dermatol. Objectives: This study aimed to compare the efficacy and side effects of 14 common therapies for melasma using a systematic review and network meta-analysis (NMA). doi: 10.1038/jid.2010.129, 20. Among 31 studies, 87% (27/31) studies showed that the efficacy of combination therapies is superior to that of single therapy. Kim JH, Kim H, Park HC, Kim IH. 16. Spierings NMK. RCTs could be placebo control studies or comparison trials of different therapies including single or combination therapy. The most effective treatment was TCC (MD [95% CI]: 130.19 [8.85, 1,914.41]), followed by tVC (MD [95% CI]: 102.57 [7.76, 1,355.08]), AFL (MD [95% CI]: 89.24 [12.32, 646.34]), and QSND (MD [95% CI]: 86.32 [13.54, 550.40]); tretinoin (MD [95% CI]: 6.20 [0.62, 62.17]) was the worst. (2007) 20:10311. The keywords used were melasma or chloasma in the title/abstract, and filters for randomized controlled trial and controlled clinical trial were applied to the search. Treatment of melasma by low-fluence 1064 nm Q-switched Nd:YAG laser. The clinical and histological effect of a low-fluence Q-switched 1,064-nm neodymium: yttrium-aluminum-garnet laser for the treatment of melasma and solar lentigenes in asians: prospective, randomized, and split-face comparative study. (2012) 3:8097. Etiologic and therapeutic considerations. (2020) 34:62432. (A) Network graph for all selected interventions; (B) network graph for energy-dependent treatments; and (C) network graph for nonenergy-dependent treatments. Dermatol Surg. Energy-dependent therapies include intense pulsed light (IPL), Q-switched (QS) laser, picosecond laser (PICO), fractional laser, and so forth (10). The higher the SUCRA score, the higher the probability of effectiveness. Prescription strength requires a minimum of 2 month commitment before results are seen, and for over the counter products, youll see results after three to four month commitment. doi: 10.1046/j.1524-4725.1999.08248.x, 14. (2020) 44:94752. doi: 10.1002/lsm.23025, 35. It indicates that 64.3% of treatments (9 of 14) in the relative effects were superior to placebo. and Georgetown (LL.M. Abdel et al. Am J Clin Dermatol. (2011) 0:2827. To be more specific. Figure 7. TA for melasma targets melanocyte, endothelial cell, mast cell, and keratinocyte to remove pigmentation (Figure 8) (43, 44). No direct evidence is available to compare TCC with other topical drugs. The target and mechanism of 14 common interventions for melasma are involved in this study. J Eur Acad Dermatol Venereol. Wang YJ, Lin ET, Chen YT, Chiu PC, Lin BS, Chiang HM, et al. (2007) 6:369. doi: 10.4103/ijdvl.IJDVL_44_19, 51. Melasma: a clinical, light microscopic, ultrastructural, and immunofluorescence study. doi: 10.1046/j.1524-4725.1999.08103.x, 23. doi: 10.1001/archderm.111.1.40, 36. The third-line therapy was the addition of laser and light-based devices to the aforementioned treatments (11). Thats a good question since, much of the research\" on topical azelaic acid is for prescription-strength formulas of 15- to 20-percent. Above all, the advantage of MN includes the very low risk of PIH. A meta-analysis based assessment of intense pulsed light for treatment of melasma. Dermatol Ther. Indian J Dermatol Venereol Leprol. UV Physical Broad-Spectrum SPF 41 Sunscreen, This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. The results of the NMA comprising monotherapies and combination treatments are shown in Figure 6. Park et al. If you experience other side effects, such as fever or difficulty breathing, its important to stop using the medication and contact your dermatologist immediately, as these may be signs of an allergic reaction.
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