Treatment of melasma with topical agents, peelings and lasers: an evidence-based review. doi: 10.1111/jdv.15934, 41. In general, no significant difference was found (total P = 0.181) in four out of the 33 P value measures; only two comparisons indicated significant differences. Claire Chang, MD, a board-certified cosmetic dermatologist and skincare expert at Union Square Laser Dermatology in NYC has dealt with acne since she was a teen. Dermatol Ther. And while she still has "small acne breakouts," it's the acne scars (dark marks) mixed with melasma that concerns her now. These therapeutic targets seem to play an important role in the treatment of melasma. I use a small dime-size amount over my whole face and neck nightly and always make sure to moisturize after to prevent excess dryness. The NMA from 59 RCTs in this study compared the clinical efficacy of 14 common interventions for melasma with a mean change in MASI scores and percentage of side effects. Am J Clin Dermatol. This study was restricted by the limited number of RCTs, particularly those related to PICO laser. (2007) 143:4245. Melasma, in particular, is a stubborn and annoying condition that I developed in my late 20s and has been recurrent since.". A single treatment with either fractional CO2 laser or 2,940-nm Er:YAG laser in two sessions with a 1-month interval reduced MASI by 48 and 26%, respectively (23, 30). These data may direct doctors to better treat patients with melasma. Copyright 2021 Liu, Wu, Wu, Liang, Guo and Zhuo. Comparison of the included interventions: mean difference (95% credible intervals). doi: 10.1111/j.1524-4725.2005.31725, 43. Nouri et al. Azelaic Acid Gel and Azelaic Acid Serum STEPS FOR SUCCESS. El-Sinbawy Zenab G, Abdelnabi N M, Sarhan N E, Elgarhy LH. The ROB graph evaluated using the Cochrane Collaboration's tool is shown in Figures 3, 4. Cassiano et al. 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)]. Rosacea vs. Lupus: Whats the Difference? Efficacy and possible mechanisms of topical tranexamic acid in melasma. The graph included placebo and 14 treatments, of which five therapies were energy dependent and nine were nonenergy dependent. doi: 10.1046/j.1524-4725.1999.08248.x, 14. Chan R, Park KC, Lee MH, Lee ES, Chang SE, Leow YH, et al. Moreover, QSND was more effective than HQ and tTA against melasma. Till now, two RCT studies of PLE on melasma have been published. How to use Azelaic Acid 10.PAULAS CHOICE BOOST 10% AZELAIC ACIDhttps://amzn.to/3eRSWm5EltaMD UV Clear Facial Sunscreenhttps://amzn.to/3JLOjrHORThe Ordinary Azelaic Acidhttps://amzn.to/3HwqVN8What is azelaic acid good forAzelaic acid is used for dark spots, melasma, acne, rosacea, and numerous other skincare benefits. Given each treatment with more than 80 participants was considered significant, the ranking of side effects with percentage (n/N%) in ascending order was tretinoin (10.19%), oTA (17.65%), HQ (18.20%), AFL (20%), QSND (21.5%), TCC (25.775), tTA (36.75%), peeling (38.03%), and MN (52.33%). The results from the node-splitting analysis of consistency/inconsistency comparisons are shown in Figure 7. (2010) 130:23335. Detailed information for all these studies presented in the NMA is shown in Supplementary Table 1. The standardized mean difference (SMD) of 95% CI of each result was calculated as the efficacy index. Azelaic acid for melasma TIPS. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). Energy-based devices, MN, peeling, TCC, etc. In addition, AFL and NAFL could remodel the skin tissue to reverse antiphotoaging by creating micro-areas of thermal injury. Saki N, Darayesh M, Heiran A. Nonenergy-dependent therapies, which have few risks of hyperpigmentation, take effect slowly. According to our results, energy-based devices have different effects on melasma. *Correspondence: Fenglin Zhuo, zflsunny@hotmail.com, https://www.frontiersin.org/articles/10.3389/fmed.2021.713554/full#supplementary-material, Creative Commons Attribution License (CC BY). It's a low energy resurfacing laser that helps even out pigmentation, lighten brown spots, and improve post-inflammatory hyperpigmentation. Flow chart showing the screening process of the literature. (2019) 28:7048. TA for melasma targets melanocyte, endothelial cell, mast cell, and keratinocyte to remove pigmentation (Figure 8) (43, 44). first, it encourages cell turnover, and as we know, this can exfoliate the skin and promote new, healthy skin growth. doi: 10.1016/j.cps.2016.03.008, 21. The smaller the P value, the greater the inconsistency. Lasers Med Sci. doi: 10.3109/09546634.2012.735639, 25. 10. Treatment of melasma using variable square pulse Er:YAG laser resurfacing. 47. 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. Med. Only 59 studies met the inclusion criteria and were included in the quantitative NMA. J Dermatolog Treat. doi: 10.1111/dth.13629, 28. QSND and AFL were still the best ways to treat melasma among photoelectric devices. I'll use prescription hydroquinone 4% cream for three months and then take a break for three months, alternating every three months. Indian Dermatol Online J. Yi J, Hong T, Zeng H, Li P, Li P, Wang S, et al. The effect of combination therapy with multiple targets among drugs, energy-based devices or MN, and so on would be better than that of single therapy, and it is possible to reduce the recurrence of melasma. Topical treatments help with the surface of the skin, but acne scarring and pigmentation are often in the deeper layers that only laser treatments can reach. Although multiple treatments are available for melasma, no evidence-based ranking exists for it. The second-line treatment indicated combination therapy with the first-line treatment and chemical peelings. Cutis. (1999) 25:1213. 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. (2014) 29:115963. Kim SJ, Park JY, Shibata T, Fujiwara R, Kang HY. doi: 10.1111/ced.12835. ", "During the humid summer months I reach for a lighter lotion or gel that won't feel too heavy, like Neutrogena Hydroboost Gel. The meta-analysis of direct pairwise comparisons (Figure 5A) showed that 14 treatments exhibited greater efficacy than placebo. During the dry winter months when I need extra hydration, I switch to a thicker cream that contains ceramides like CeraVe Moisturizing Cream. I repeat: Do not use retinol on the same nights as the peel pad, as the combination causes too much irritation. J Clin Aesthet Dermatol. We also use third-party cookies that help us analyze and understand how you use this website. IPL ranked second with only three studies, and IPL-based combination therapy was discussed in two studies. J Eur Acad Dermatol Venereol. 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. (2007) 20:10311. The total network graph is provided in Figure 2A. The final assessment endpoint was 440 weeks, with an average of 13 weeks; 26 studies involved single treatment and 33 involved combination therapy. These cookies will be stored in your browser only with your consent. Although azelaic acid is generally well-tolerated, some people may experience side effects nonetheless. (2018) 33:17338. No single treatment that is particularly effective is available. As with all types of melasma treatment, its important to use UV-protective measures such as daily sunscreen use, avoiding the sun at peak hours (10 am 2 pm), and wearing broad-brimmed hats and other sun-protective clothing. In general, the efficacy of interventions with multitarget effect in the treatment of melasma is better than those with a single target. Many people with acne or acne blemishing use harsh physical scrubs with beads or salts but these can actually cause more inflammation and irritation, which can in turn worsen acne breakouts. 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. The included trials had 2,812 randomized participants, of whom 7.1% were men. doi: 10.1111/j.1473-2165.2007.00288.x, 39. (A) Network graph for all selected interventions; (B) network graph for energy-dependent treatments; and (C) network graph for nonenergy-dependent treatments. Women's Health may earn commission from the links on this page, but we only feature products we believe in. (2013) 149:9813. doi: 10.1001/archderm.111.1.40, 36. Erythema and burning were the most common side effects. Thats a good question since, much of the research\" on topical azelaic acid is for prescription-strength formulas of 15- to 20-percent. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. ", "My favorite sunscreen is EltaMD UV Physical, which comes in a tinted formulation, so it doubles as my sunscreen and my foundation. Kaminaka C, Furukawa F, Yamamoto Y. Prevalence of self-diagnosed melasma among premenopausal Latino women in Dallas and Fort Worth, Tex. (1999) 25:4947. MASI measures included evaluation of MASI, modified MASI (mMASI), or hemi-MASI. The P value was used to measure consistency by calculating the probability of observing the results from samples of data, assuming that the null hypothesis was true. (2021) 14:139. A randomized controlled trial of the efficacy and safety of a fixed triple combination (fluocinolone acetonide 001%, hydroquinone 4%, tretinoin 005%) compared with hydroquinone 4% cream in Asian patients with moderate to severe melisma. (2009). Fractional erbium-doped yttrium aluminum garnet laser-assisted drug delivery of hydroquinone in the treatment of melasma. It helps me battle all of my skin problems at once (acne, acne scars, and melasma) while also being one of the most effective anti-aging ingredients. J Cosmet Dermatol. 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. (2011) 65:699714. 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. Handel AC, Miot LD, Miot HA. doi: 10.1038/jid.2010.129, 20. Direct comparisons for all treatments are shown in Figure 5B. Melasma: a clinical, light microscopic, ultrastructural, and immunofluorescence study. Besides that, the action of multiple targets in the therapeutic mechanism is also an important factor. Systematic Review Registration: identifier: CRD42021239203. To help you remember to use azelaic acid, use it at around the same times every day. (2007) 6:369. Azelaic Acid 10 or Azelaic Acid 15Does that matter? Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. Welcome to Derm Diaries, a new series where dermatologists share their skin woesand solutionsso you can steal secrets from their skincare routines. (2017) 43:112033. The time regime with the biggest change in MASI was selected as assessment endpoints. It is usually applied twice a day, in the morning and the evening. We recommend HQ combined with photoelectric devices for melasma. No direct evidence is available to compare TCC with other topical drugs. Etiologic and therapeutic considerations. In addition, 6.7% (4 of 59) and 8.4% (5 of 59) RCTs were unclear in reporting bias and other bias, separately. He is licensed to practice medicine in California, Colorado, Florida, and North Carolina and law in New York and Ontario. Owing to the expected effect, oTA has been recommended as first-line therapy in a recent review (11). J Invest Dermatol. (2011). Salanti G. Indirect and mixed-treatment comparison, network, or multiple treatments meta-analysis: Many names, many benefits, many concerns for the next generation evidence synthesis tool. 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). The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author. 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. 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). This conclusion was inconsistent with a split-face study in which 755-nm PICO was more effective than QSND for melasma in Asians (33). doi: 10.1111/exd.13844, 7. (2019). Figure 5. The role of microneedling in melasma ranked ninth in this study. Women's Health may earn commission from the links on this page, but we only feature products we believe in. Why trust us? ", "Twice a week I switch out my retinol for a glycolic/salicylic acid peel pad. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. How long does azelaic acid for melasma take Now you probably either clicked on this video because you are new to azelaic acid and are just starting or you've given up on the product after it brought no results. (2017) 62:57884. A total of 59 randomized controlled trials (RCTs) met the inclusion criteria and were selected. Wanitphakdeedecha R, Manuskiatti W, Siriphukpong S, Chen TM. Balia LM, Graupe K. The treatment of melasma. I've been using Neocutis Lumiere Eye Cream which contains antioxidants to help protect the skin, peptides to help stimulate collagen, and caffeine to help with swelling. Grimes PE. (2008) 159:697703. (2020) 33:e13629. Dr. Kirsch has experience with therapeutic drug development programs from pre-clinical to Phase 3 studies. Kwon SH, Na JI, Choi JY, Park KC. Treatment of melasma by low-fluence 1064 nm Q-switched Nd:YAG laser. ", "After gentle cleansing, I apply an antioxidant serum to my face every morning. This ingredient is generally applied in a cream formulation at a strength of about 20%. The treatment of melasma has been challenging because of its unclear etiology, stubbornly refractory nature, and frequent relapse. are also considered to remodel the aging microenvironment of melasma (Figure 8). Farris PK. First, it encourages cell turnover to exfoliate the skin and promote new, healthy skin growth. XL participated in the chart making. doi: 10.1111/j.1468-3083.2012.04464.x, 44. J Drugs Dermatol. The most common side effects of azelaic acid include: These side effects are considered normal and indicate that your medication is working. The SUCRA is a percentage interpreted as the probability of the most effective treatment. "In the morning, I use a gentle cleanser to wash my face of any oil, sweat, and bacteria that may have accumulated in my pores overnight. A total of 297 studies were identified by the literature search (PubMed, Embase, and Cochrane Libraries) (Figure 1). (2012) 3:8097. The efficacy of 14 therapies was directly and indirectly compared with placebo using the mean change of melasma area and severity index (MASI) before and after treatment as the outcome measure. doi: 10.1111/jocd.13157. Rankings need to consider the quality of evidence and the context of the main results of an NMA, which is the relative treatment effect. doi: 10.4103/ijd.IJD_490_17, 49. 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. Taking both efficacy and safety into consideration, TCC was found to be the most favorable selection among the topical drugs for melasma. During the dry winter months, I use an over-the-counter retinol (SkinBetter AlphaRet Overnight Cream) which tends to be gentler and less drying. Chemical peeling is the recommended second-line treatment for melasma, and it can accelerate epidermal renewal and collagen regeneration to remove epidermal melanin and suspend the transfer of melanosomes (48). This study aimed to provide an evidence-based comparison for treating melasma. (2012) 3:98110. Among 31 studies, 87% (27/31) studies showed that the efficacy of combination therapies is superior to that of single therapy. In a meta-analysis-based assessment, IPL-based combination therapies had a significantly lower MASI compared with the single-treatment group (SMD = 0.61, CI [0.42, 0.80] P < 0.0001) (29). doi: 10.1111/jocd.13182, 12. (2005) 31:8147. But opting out of some of these cookies may have an effect on your browsing experience. doi: 10.1007/s40257-013-0038-4, 11. Graupe K, Cunliffe WJ, Gollnick HP, Zaumseil RP. A P < 0.05 indicated significant inconsistency between direct and indirect evidence in the network. At present, the therapies of melasma can generally be divided into two categories: nonenergy-dependent and energy-dependent therapies. 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. 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. https://www.ncbi.nlm.nih.gov/pubmed/1816137/, https://www.ncbi.nlm.nih.gov/pubmed/8654128, New Study Finds Combination Melasma Treatment Is Safe & Effective, Redness or dryness at the application site. Chemical Peels in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group. Evidence-based review, grade of recommendation, and suggested treatment recommendations for melasma. Melasma: Updates and perspectives. (1975) 111:408. A meta-analysis based assessment of intense pulsed light for treatment of melasma. J Cosmet Dermatol. Rivas S, Pandya AG. 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. oTA as system administration was a promising way recommended for melasma. Overall, the ROB was low. Comparing the efficacy of topical hydroquinone 2% versus intradermal tranexamic acid microinjections in treating melasma: a split-face controlled trial. Antioxidant serumsespecially those containing vitamin Cprotect the skin from sun exposure and environmental pollution all day long. doi: 10.1080/01913123.2019.1673861, 24. AFL combined with tTA or TCC also demonstrated higher efficacy on melasma (31, 32). The top six of SUCRA scores demonstrated QSND with the highest SUCRA (85.0%), followed by IPL (79.6%), AFL (78.6%), TCC (75.8%), tVC (68.5%), and oTA (63.3%). Besides, hyperpigmentation after treatment and long-term treatment makes it more difficult (6, 7). doi: 10.1002/jrsm.1044, 18. (2018). Generally, the quality of evidence graded mostly moderate to high. Energy-dependent therapies include intense pulsed light (IPL), Q-switched (QS) laser, picosecond laser (PICO), fractional laser, and so forth (10). I get these monthly on my face. So if its not been time yet, I would keep applying it and not stop just yet.Azelaic acid gel or Azelaic acid serumAzelaic acid comes as a gel, foam, or a cream to apply to the skin. doi: 10.1111/ajd.12290. Manaloto RM, Alster T. Erbium: YAG laser resurfacing for refractory melasma. Kligman AM, Willis I. 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. Am J Clin Dermatol. The top three treatments of the SUCRA ranking in descending order were QSND, IPL, and AFL, which were all energy-dependent therapies.
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