Micro needling vs micro needling combined with autologous topical platelet rich plasma in the treatment of melasma: a prospective randomized comparative study

<p><strong>Background: </strong>Melasma is one of the most common pigmentary disorders worldwide with a still unresolved pathogenesis and treatment continues to be challenging. To assess the effect of micro-needling vs combination of micro-needling followed by application of topical platelet rich plasma (PRP) in the treatment of melasma.</p><p><strong>Methods: </strong>Sixty patients having melasma were randomly grouped into A and B. Group A underwent micro-needling alone and group B was subjected to micro-needling followed by topical application of autologous PRP. The patients were subjected to 3 treatment sessions at monthly intervals. Melasma area and severity index (MASI) and patient satisfaction scores were recorded at each sitting and the final outcome was recorded one month after the last session.</p><p><strong>Results: </strong>Twenty-four patients in group A and 27 patients from group B were selected for final analysis. There was significant improvement of MASI in both groups (Group A: p=0.001, group B: p=0.0001) however, the difference in improvement of MASI between the 2 groups was not significant (p=0.0457) Group B was highly satisfied with the treatment which was statistically significant (p=0.0001)</p><p><strong>Conclusions: </strong>Combining micro-needling with topical PRP appears to be a promising therapeutic modality in the treatment of melasma.</p><p><strong> </strong></p>

A comparative study of oral Ketoconazole versus Itraconazole in the treatment of Tinea versicolor

Tinea (pityriasis) versicolor is a superficial fungal infection and one of the most commonly found pigmentary disorders of the skin caused by the yeast Malassezia. Multiple topical as well as systemic therapies are available for treatment. Systemic therapies are used for extensive disease, frequent relapse or where topical agents have failed. The aim that translates the rationale of the study was to compare the efficacy, safety, tolerability and cost effectiveness of oral ketoconazole dose 200mg daily for 7 days versus a single dose of 400 mg of itraconazole in the treatment of tinea versicolor. A total of 64 patients (aged 18-50 years) were selected for the study from the period of June 2019 to November 2019 in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Bangladesh. Cases having extensive involvement were diagnosed clinically and confirmed by wood's lamp and KOH microscopy was taken. Patients were randomly allocated into equal groups. Group A was given oral ketoconazole dose 200mg daily for 7 days and Group B has given a single dose of 400 mg of itraconazole. 47 (73.4%) male and 17(26.6%) female were included in the study. The mean age of group A was 29.2(SD±8.6) and in group B 28.2(SD±8.5) years. The mean duration of the disease in group A was 3.9(±2.7) months and 3.5(±2.2) months in group B. In group A clinical responders was found cure 25(78.1%), improvement 5(15.6%) and failure in 2(6.2%) and in group B it was found cure 22(68.8%), improvement 7(21.87%) and failure 3(9.4%) at one month. At two months in the group A clinical responder was found to cure 22(68.8%), improvement 5(15.6%), failure in 3(9.4%) and relapse 2(6.2%). In group B it was found cure 18(56.2%), improvement 6(18.75%), failure 4(12.5%) and relapse 4(12.5%). Both oral ketoconazole dose 200mg daily for 7 days versus single dose 400 mg of itraconazole can be effective in the treatment of tinea versicolor with extensive involvement. CBMJ 2020 July: Vol. 09 No. 02 P: 26-33

MISUSE OF TOPICAL CREAMS AIMED AT PREVENTING AND TREATING MELASMA AND FRECKLES AMONG WORKING WOMEN

Topical creams used to treat and prevent melasma and freckles contain corticosteroids, hydroquinone, mercury, and retinoic to lighten skin color. Misuse of these products and the rate of adverse effects have increased greatly in recent years. This study aims to assess the misuse of topical cream to prevent and treat melasma and freckles among working women in northeast Thailand. Our population consisted of 1,143 working women in the region aged 30-59 years old. The respondents were recruited from four provinces eight districts using a structured questionnaire distributed via a multi-stage random sampling method. Descriptive statistics and logistic regression were used to represent and analyze the data. Eight hundred sixty-two (75.42%) of the respondents were users, and 105 (12.18%) had misused the products. The prevalence of misuse of products containing mercury, steroids, hydroquinone, retinoic acid, and mercury plus retinoic acid was 43.8%, 11.43%, 15.24%, 12.38%, and 17.15%, respectively. Factors associated with misuse of this product were age 30-44 years, education level less than a bachelor’s degree, working as a housekeeper or freelancer, presence of melasma and freckles, average monthly income ≤ 15,000 THB and low levels of knowledge and health literacy. Misuse of medication to treat pigmentary disorders is a growing public health concern. Social media and nonprofit campaigns should be implemented to create awareness of these products' misuse and adverse effects.

Computer-Aided Detection (CADe) System with Optical Coherent Tomography for Melanin Morphology Quantification in Melasma Patients

Dark skin-type individuals have a greater tendency to have pigmentary disorders, among which melasma is especially refractory to treat and often recurs. Objective measurement of melanin amount helps evaluate the treatment response of pigmentary disorders. However, naked-eye evaluation is subjective to weariness and bias. We used a cellular resolution full-field optical coherence tomography (FF-OCT) to assess melanin features of melasma lesions and perilesional skin on the cheeks of eight Asian patients. A computer-aided detection (CADe) system is proposed to mark and quantify melanin. This system combines spatial compounding-based denoising convolutional neural networks (SC-DnCNN), and through image processing techniques, various types of melanin features, including area, distribution, intensity, and shape, can be extracted. Through evaluations of the image differences between the lesion and perilesional skin, a distribution-based feature of confetti melanin without layering, two distribution-based features of confetti melanin in stratum spinosum, and a distribution-based feature of grain melanin at the dermal–epidermal junction, statistically significant findings were achieved (p-values = 0.0402, 0.0032, 0.0312, and 0.0426, respectively). FF-OCT enables the real-time observation of melanin features, and the CADe system with SC-DnCNN was a precise and objective tool with which to interpret the area, distribution, intensity, and shape of melanin on FF-OCT images.

Herb Sanqi-Derived Compound K Alleviates Oxidative Stress in Cultured Human Melanocytes and Improves Oxidative-Stress-Related Leukoderma in Guinea Pigs

Sanqi, a traditional Chinese herb, is widely used for cardiovascular diseases, and its neuroprotective effects against oxidative stress were recently discovered. The purpose of this study was to investigate whether Sanqi-derived compound K (Sanqi-CK), an active metabolite of Sanqi, could protect melanocytes from oxidative stress. Cultured human primary skin epidermal melanocytes (HEMn-MPs) were treated with hydrogen peroxide (H2O2) in the presence or absence of Sanqi-CK. Sanqi-CK exhibited protective effects against H2O2-induced cell death by reducing oxidative stress. In addition, treatment with Sanqi-CK reversed the decreased glutathione reductase activity and decreased ratio of reduced glutathione (GSH)/oxidized glutathione (GSSG) seen in H2O2-treated melanocytes. Furthermore, topical application of Sanqi-CK alleviated leukoderma in guinea pigs, a disorder characterized by melanocyte cell death resulting from rhododendrol-induced oxidative stress. Taken together, these data suggest that Sanqi-CK protects melanocytes against oxidative stress, and its protective effects are associated with modulating the redox balance between GSH and GSSG and activating glutathione reductase. Thus, Sanqi-CK may be a good candidate for preventing melanocyte loss in oxidative-stress-associated pigmentary disorders.

Elucidation of Melanogenesis-Associated Signaling Pathways Regulated by Argan Press Cake in B16 Melanoma Cells

The beneficial effect on health of argan oil is recognized worldwide. We have previously reported that the cake that remains after argan oil extraction (argan press-cake or APC) inhibits melanogenesis in B16 melanoma cells in a time-dependent manner without cytotoxicity. In this study, the global gene expression profile of B16 melanoma cells treated with APC extract was determined in order to gain an understanding of the possible mechanisms of action of APC. The results suggest that APC extract inhibits melanin biosynthesis by down-regulating microphthalmia-associated transcription factor (Mitf) and its downstream signaling pathway through JNK signaling activation, and the inhibition of Wnt/β-catenin and cAMP/PKA signaling pathways. APC extract also prevented the transport of melanosomes by down-regulating Rab27a expression. These results suggest that APC may be an important natural skin whitening product and pharmacological agent used for clinical treatment of pigmentary disorders.