RESUMO
PURPOSE: Photobiomodulation therapy (PBM) is a versatile technique for treating skin diseases. Melasma, a chronic hyperpigmentation condition, has recently been associated with vascular features and dermal photoaging and poses significant management challenges. We review the recent literature on melasma etiology and the evidence supporting PBM as a therapeutic modality for melasma treatment. METHODS: We conducted a comprehensive literature search in three different databases from May to August 2023, focusing on studies published in the past 10 years. The inclusion criteria comprised full-text studies investigating low-power lasers and/or light-emitting diodes (LEDs) in in vitro or in vivo models, as well as clinical trials. We excluded studies discussing alternative melasma therapies or lacking experimental data. We identified additional studies by searching the reference lists of the selected articles. RESULTS: We identified nine relevant studies. Clinical studies, in agreement with in vitro experiments and animal models, suggest that PBM effectively reduces melasma-associated hyperpigmentation. Specific wavelengths (red: 630 nm; amber: 585 and 590 nm; infrared: 830 and 850 nm) at radiant exposures between 1 and 20 J/cm2 exert modulatory effects on tyrosinase activity, gene expression, and protein synthesis of melanocytic pathway components, and thus significantly reduce the melanin content. Additionally, PBM is effective in improving the dermal structure and reducing erythema and neovascularization, features recently identified as pathological components of melasma. CONCLUSION: PBM emerges as a promising, contemporary, and non-invasive procedure for treating melasma. Beyond its role in inhibiting melanogenesis, PBM shows potential in reducing erythema and vascularization and improving dermal conditions. However, robust and well-designed clinical trials are needed to determine optimal light parameters and to evaluate the effects of PBM on melasma thoroughly.
Assuntos
Hiperpigmentação , Terapia com Luz de Baixa Intensidade , Melanose , Animais , Terapia com Luz de Baixa Intensidade/efeitos adversos , Melanose/radioterapia , Melanose/complicações , Lasers , Eritema/etiologiaRESUMO
Objective: We conducted a review of topical agents currently used in melasma, discussing their mechanism of action, efficacy, safety, and tolerability, with an update on newer treatments. Methods: A systematic review from PubMed database was performed, using PRISMA guidelines. The search was limited to English and Spanish studies that were double or single blinded, prospective, controlled or randomized clinical trials, reviews of literature, and meta-analysis studies. Results: 348 studies were analyzed; 80 papers met inclusion criteria. Triple combination (TC) therapy and hydroquinone (HQ) are still the most well-studied agents with strong evidence-based recommendation. TC therapy remains the gold standard of care based on efficacy and patient tolerability. Evidence has shown ascorbic acid, azelaic acid, glycolic acid, kojic acid, salicylic acid, and niacinamide to be effective as adjuvant therapies with minimal side effects. Tranexamic acid (TA) and cysteamine have become recent agents of interest due to their good tolerability, however more trials and studies are warranted. Less evidence exists for other topical agents, such as linoleic acid, mulberry extract oil, rucinol, 2% undecylenoyl phenylalanine, and epidermal growth factors agents. Limitations: Some studies discussed represented a low sample size, and there is an overall lack of recent studies with larger populations and long-term follow up. Conclusions: TC therapy continues to be the gold standard of care. Topical cysteamine and TA are newer options that can be incorporated as adjuvant and maintenance treatments into a patient's regimen. Cysteamine and topical TA have no known severe adverse effects. Evidence comparing other topical adjuvant treatments to HQ, maintains HQ as the gold standard of care.
RESUMO
Introdução: O melasma é uma hipermelanose crônica, adquirida, que afeta áreas fotoexpostas da pele. Sua etiopatogenia ainda não está bem esclarecida. A exposição solar é fator importante, mas também tem sido descrita a relação com fatores hormonais, vasculares, predisposição genética e proteínas relacionadas à tirosinase. Devido à sua natureza recorrente e refratária, o tratamento do melasma é difícil e tem como objetivo a prevenção ou a redução da área afetada, com o menor número possível de efeitos adversos. Os princípios da terapia incluem a proteção contra a radiação ultravioleta (UV) e a inibição da atividade dos melanócitos e da síntese da melanina. Objetivo: Realizar revisão sistemática da literatura para identifi car os tratamentos mais efi cazes e seguros para o melasma, incluindo os tópicos, os orais e os procedimentos. Método: A pesquisa foi realizada no período de 5 de fevereiro a 15 de março de 2009, utilizando três bases de dados: MEDLINE (1966-2009), Biblioteca Cochrane e LILACS. Após estabelecer os critérios de seleção, os melhores estudos controlados e comparativos foram descritos individualmente. Resultados: Foram detectados 703 artigos no MEDLINE, 89 no LILACS e 100 na Biblioteca Cochrane e revisados 143, dos quais 10 descritivos (6,99%), 30 de revisão (20,97%) e 103 de intervenção (72,03%). Os estudos de intervenção não controlados, os descritivos e os de revisão foram analisados em conjunto. Dos demais, foram selecionados 42 artigos com melhor delineamento para descrição individual. Doze de 42 compreendiam estudos controlados (28,57%) e 30 de 42, comparativos (71,43%). Dezoito dos 42 compreendiam o tipo split face (42,86%) e 24, grupos paralelos (57,14%), sendo 34 (80,95%) randomizados. Oito (19,05%) apresentavam o delineamento ideal, ou seja, foram controlados com placebo e cegos. Limitações: Heterogeneidade dos estudos, poucos com delineamento adequado. Conclusões: A utilização de protetor solar de largo espectro é importante no tratamento do melasma e a hidroquinona tópica é o tratamento mais utilizado. Demais agentes clareadores mais usados incluem ácido retinoico, ácido azelaico e ácido kójico. Combinações terapêuticas aumentam a efi cácia em comparação à monoterapia. Peelings químicos e físicos e tratamentos com laser e luz intensa pulsada constituem modalidades complementares utilizadas para tratar o melasma.
Introduction: melasma is an acquired hypermelanosis of sun-exposed areas. The pathophysiology of melasma is uncertain. The most important factor in the development of melasma is exposure to sunlight, but also it has been described in relation to hormonal factors, vascular, genetic predisposition, proteins related to tyrosinase. Due to its refractory and recurrent nature, the treatment of melasma is often diffi cult. The goals of treatment often include prevention or reduction of the affected area with the fewest possible adverse effects. The principles of therapy include protection against UV radiation, the inhibition of activity of the melanocytes and melanin synthesis. Objectives: to conduct a systematic review to identify the most effective and safe treatment, including topical treatments, oral treatments and surgical procedures, for the melasma. Method: the study was conducted in the period from February, 05 to March, 15 2009, using 3 databases: MEDLINE (1966- 2009), Cochrane Library and LILACS. After establishing criteria for the selection of studies, the best controlled and comparative studies were described individually. Results: We found 703 articles in MEDLINE, 89 and 100 in LILACS and Cochrane Library, reviewed 143 articles of which 10 were descriptive studies (6,99%), 30 review (20,97%), 103 randomized controlled trials (72,03%). Descriptive studies and reviews were analyzed together. Forty two articles with the best design were chosen for individual description. 12/42 included controlled studies (28,57%) or 30/42 comparative (71,43%), like split face (18) or parallel groups (24), and 34 (80,95%) randomized. 8 (19,05%) had the ideal design, i.e. blind placebocontrolled. Limitations: heterogeneity of the studies, few with good methodological quality. Conclusions: The use of broad-spectrum sunscreen is important, as is topical hydroquinone, the most common treatment for melasma. Other lightening agents include retinoic acid, azelaic acid, kojic acid and others. Combination therapies increases effi cacy as compared with monotherapy. Chemical and physical peels, laser treatments, and intense pulsed light therapy are additional modalities that have been used to treat melasma.