aRTicle | dermatology |
Figure 5 A patient treated with tretinoin 10% peel mask, before (a) and after (b) the treatment
area, and percentage reduction in lesions50
. the
majority of patients showed moderate to excellent response rates, with a 35–63% improvement (P < 0.05), and significant side-effects were not observed. treatment with tretinoin 10% peeling mask is a further
available option. Priming 1 week before the peel with a 0.025% tretinoin cream on a daily basis (at night), then four tretinoin peels (one every 3 weeks) with the use of total sunblock throughout the treatment duration. the skin will become reddish on the first and second days of treatment, while the exfoliation begins on the third and fourth days and lasts for approximately 1 week. the authors have achieved good results with this technique56
.
In this study, the authors evaluated the efficacy and the tolerability of a 10% tretinoin peel on 20 patients, 10 of whom had a skin phototype higher then IV51
all melasma
patients should be aware that UV exposure is a significant
triggering or aggravating factor in the
development of melasma.
26 ❚ . the patients
were analysed both before and after treatment with standardised digital photos, maSI evaluation and with the more objective method of using the mexameter scale. the results showed a significant difference in the clinical melasma area and severity index (maSI) from baseline to week 10. at 10 weeks, the difference in the average maSI calculated at baseline and after 10 weeks was 2.9. the mexameter results demonstrated a significant decrease in the degree of pigmentation using the tretinoin 10% peeling mask. the average difference from baseline to week 10 was 12 (Figure 3). regular exfoliation for 1 week post-treatment was
subject to a complete absence of side-effects and thereby facilitated an optimal patient compliance. to summarise, superficial peeling (with salicylic acid and
July 2011 |
prime-journal.com
tretinoin mask peels) represents the best treatment method in the authors’ opinion, because the risk of postinflamamtory hyperpigmentation is much too high for stronger chemical substances57
.
New injection treatments a recent study by lee et al58
revealed that topical trans-4-
aminomethylcyclohexanecarboxylic acid (tranexamic acid), a plasmin inhibitor, prevents UV-induced pigmentation. tranexamic acid, as a lysine analogue, prevents the binding of plasminogen to the lysine-binding site by interfering with the kringle structure of the plasminogen molecules. this technique comprises intradermal or subcutaneous microinjection of 0.05– 0.1 ml of a highly diluted tranexamic acid, or of a single product at the sites of the body having medical or aesthetic problems. By injecting tranexamic acid intradermally, it may be possible to treat the dermal-type melasma in addition to the mixed type. a gradual reduction in the maSI score was noted at week 4, and the maSI score significantly decreased at both 8 and 12 weeks. No patients developed any significant complications58
.
Conclusions treatment options for melasma continue to be a challenge for physicians. all melasma patients should be aware that UV exposure is a significant triggering or aggravating factor in the development of melasma. Prolonged sun exposure could stimulate certain specific clones of keratinocytes, fibroblasts, or endothelial cells to produce melanogenic factors. these combined
IMAGES GHERSETICH
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