Search Results (98)

Background: Melasma is a chronic, relapsing pigmented skin disease with challenging and unsatisfactory treatment outcomes. This study aims to compare the efficacy and safety of different treatments for melasma. Methods: We conducted a comprehensive search of PubMed and EMBASE databases to identify randomized controlled clinical trials (RCTs) for melasma treatment modalities between January 2022 and January 2025. Relative efficacy refers to the comparison of the improvement in melasma severity before and after treatment for all modalities of interest at a specific time point. The Melasma Area Severity Index (MASI) (also known as modified MASI (mMASI) or half-MASI score) was defined as the efficacy index. Safety refers to the incidence of the most common adverse events. The quality of the included trials was assessed using the GRADE method. Results: The analysis included 14 clinical trials with 15 treatment modalities involving 738 women who met the inclusion criteria. The mean difference in efficacy index showed that intradermal PRP (platelet-rich plasma) and intradermal PRP + oTXA (oral tranexamic acid) were the best treatment options compared with HQ4%, intradermal TXA, intradermal PRGF (plasma rich in growth factor) + HQ4 (hydroquinone 4%), followed by intradermal TXALaser (intradermal TXA + Q-switched fractional 1064-nmNd:YAG lasers). The efficacy indices of other modalities were comparable. Most treatment-related adverse events were mild, were well tolerated, or resolved with treatment. The quality of evidence was generally high. Conclusions: This NMA showed that intradermal PRP in combination or alone is an effective and safe treatment option for melasma. PRP may be a direction for the development of new melasma treatment options in the future, but well-designed, comprehensive, large-scale randomized controlled trials are needed to verify it. Full article

Background: Hormonal fluctuations significantly influence skin physiology, affecting collagen production, sebum regulation, pigmentation, and tissue repair. Hormonal therapies are increasingly used in cosmetic dermatology to address age-related and hormone-dependent skin changes. Methods: This narrative review synthesizes the current literature on the mechanisms, clinical applications, and future directions of hormonal therapies in dermatologic aesthetics. Studies were selected through a comprehensive search on PubMed, Scopus, and Web of Science. Results: Estrogens, androgens, progesterone, and other hormones act on skin through specific receptors, modulating fibroblast, sebocyte, and melanocyte activity. Clinical applications include hormone-based strategies for anti-aging, acne, melasma, alopecia, and postmenopausal atrophy. Both systemic (e.g., HRT) and topical (e.g., clascoterone, phytoestrogens) approaches are discussed. Safety concerns, including systemic absorption and off-label use, require careful evaluation. Emerging technologies such as SERMs, nanocarriers, and regenerative combinations suggest promising future avenues. Conclusions: Hormonal therapies offer a biologically rational and increasingly evidence-based tool in cosmetic dermatology. Responsible integration into clinical practice depends on personalized approaches, ethical prescribing, and further research on long-term safety and efficacy. Full article

Achieving even skin tone and controlling pigmentation are key goals in dermocosmetics, given the impact of disorders like melasma, post-inflammatory hyperpigmentation, and age spots. The process of pigmentation begins with melanin synthesis within melanosomes, specialized organelles in melanocytes. Once produced, melanin is transferred to neighboring keratinocytes, where it forms protective caps over cell nuclei before undergoing eventual degradation. Disruptions at any stage of this complex process, whether in melanin production, melanosome transport, or post-transfer processing, can lead to visible pigmentation irregularities. While traditional treatments primarily focus on inhibiting melanin production (e.g., through tyrosinase inhibitors), emerging research highlights the important role of melanosome transport and keratinocyte-mediated processing in determining visible pigmentation. This review focuses on the underexplored stages of melanosome transport, transfer, and keratinocyte-mediated processing as promising targets for therapeutic and cosmetic strategies in managing pigmentation disorders. Full article

Melasma is an acquired hyperpigmentation that is more common in women and mainly affects the face. It can significantly reduce quality of life due to its chronic nature and resistance to treatment. Objectives: This study aimed to compare the clinical efficacy of azelaic acid peeling and combined tranexamic acid microneedling in patients with melasma, evaluating the impact of these therapies on skin depigmentation. Methods: This was a prospective clinical trial with a split-face design, using a convenience sample. Patients were recruited and divided into two groups for comparative treatment. Microneedling with 4 mg/mL tranexamic acid was applied to the right hemiface and 30% azelaic acid peeling to the left hemiface. The protocol included five sessions with a 15-day interval. Photographic records were taken before treatment, in the fifth session, and 15 days after the last session. The Melasma Area and Severity Index (MASI) and non-parametric tests were used to analyze the results. Results: The study included 10 patients, of whom 9 completed the treatment. The average age was 42 years. The most common skin phototype was type III (50%) and the predominant locations were the central facial area, forehead, and cheeks (55.6%). The photographic evaluation and MASI showed a significant improvement on both sides of the face, with the final values better than the initial ones. It was possible to observe that the azelaic acid peeling showed a significant whitening after the fourth session when compared to the other method. Conclusions: The clinical study of hemifaces concluded that both the azelaic acid peeling and microneedling with tranexamic acid are effective in the treatment of melasma, with the azelaic acid peeling showing results after the fourth session. Further studies with larger, randomized samples are recommended. Full article

Azelaic acid (AzA), a saturated dicarboxylic acid, is indicated for the treatment of acne vulgaris, rosacea, melasma, and post-inflammatory hyperpigmentation. Its antimicrobial, anti-inflammatory, and antimelanogenic properties support its use; however, its poor aqueous solubility and limited skin permeability constrain its optimal topical delivery. This review summarizes clinical evidence and advances in formulations—including conventional vehicles, polymeric/lipid nanocarriers, and deep eutectic solvent (DES) systems—to promote more effective and well-tolerated use. Across indications, 15–20% azelaic acid (AzA) formulations produced clinically meaningful improvements with mild, transient local irritation. For acne vulgaris, reductions in inflammatory and noninflammatory lesions were comparable to those of topical retinoids/adapalene, and tolerability was superior in some studies. For rosacea, the 15% gel formulation was comparable to metronidazole in reducing papules, pustules, and erythema while maintaining negligible systemic exposure. In melasma and other dyschromias, 20% cream demonstrated efficacy similar to hydroquinone, exhibiting a favorable safety profile. Advanced delivery systems, including liposomes, niosomes/ethosomes, nanostructured lipid carriers, microemulsions, nanosponges, and DES platforms, increased AzA solubilization, cutaneous deposition, and stability. This enabled dose-sparing strategies and improved adherence. Data on AzA cocrystals and ionic salts suggest additional control over release and irritation. AzA remains a versatile and well-tolerated dermatologic agent whose performance is strongly vehicle-dependent. Rational selection and engineering of carriers, particularly DES-integrated polymeric and lipid systems, can mitigate solubility and permeability limitations, enhance skin targeting, and reduce irritation in the treatment of acne and rosacea. Full article

Cannabidiol (CBD), a non-psychoactive phytocannabinoid derived from Cannabis sativa L., has emerged as a promising multifunctional agent in dermatology and cosmetic science. The review provides an updated synthesis of CBD’s topical therapeutic potential, challenges, and evolving regulatory frameworks. CBD exhibits diverse biological effects, including anti-inflammatory, antioxidant, antibacterial, analgesic, lipostatic, antiproliferative, moisturising, and anti-ageing properties through interactions with the skin’s endocannabinoid system (ECS), modulating CB1, CB2, TRPV channels, and PPARs. Preclinical and clinical evidence support its efficacy in managing acne, psoriasis (including scalp psoriasis), atopic and seborrheic dermatitis, and allergic contact dermatitis. CBD also relieves pruritus through neuroimmune modulation and promotes wound healing in conditions such as pyoderma gangrenosum and epidermolysis bullosa. In hair disorders such as androgenetic alopecia, it aids follicular regeneration. CBD shows promise in managing skin cancers (melanoma, squamous cell carcinoma, Kaposi sarcoma) and pigmentation disorders such as melasma and vitiligo. It enhances skin rejuvenation by reducing oxidative stress and boosting collagen and hydration. However, there are challenges regarding CBD’s physicochemical stability, skin penetration, and regulatory standardisation. As consumer demand for natural, multifunctional skincare grows, further research is essential to validate its long-term safety, efficacy, and optimal formulation strategies. Full article

Although epidermal growth factor (EGF) has potential wide applications in the cosmetic industry, it still has limitations, such as a costly purification process and low stability in the surrounding environment. To overcome these limitations, we developed genetically modified Pediococcus pentosaceus CBT SL4, which can secrete EGF protein in growth media, thereby producing probiotic-derived PP-EGF culture medium supernatant (PP-EGF-SUP). Even at low EGF concentrations, PP-EGF-SUP exhibited EGF activities, such as cell scratch wound healing, tyrosinase inhibition, and improvements in anti-wrinkle factors, similar to or stronger than those of recombinant human EGF (rhEGF), which was used as a positive control. PP-EGF-SUP exhibited strong additional biological activities, such as antioxidant, anti-inflammatory, and anti-microbial activities, even though rhEGF did not have such properties. PP-EGF-SUP could be easily transformed to PP-EGF-SUP dried powder (PP-EGF-DP) using the freeze-drying method, and it could also be well resolved in water up to 20 mg/mL; furthermore, it still maintained its bioactivity after the manufacturing process. To determine melasma improvement efficacy, a human application test was performed using melasma ampoules containing 1% or 5% PP-EGF-DP formulations for four weeks. When comparing the melasma values before and after treatment, it was found that the light melasma value statistically decreased by 3.38% and 3.79% and that the dark melasma value statistically decreased by 1.74% and 2.93% in the test groups applying the 1% and 5% PP-EGF-DP melasma ampoules, respectively. In addition, the melasma area also decreased by 21.21% and 29.1%, while the control group showed no statistical difference. During the study period, no significant adverse skin reactions were observed due to the application of the PP-EGF-DP melasma ampoule. In conclusion, PP-EGF-DP may offer unique advantages in the cosmetic ingredient market, such as safety (as a probiotic derivative), stability (postbiotics protect EGF activity), and diverse bioactivities (activity potentiation and postbiotic-derived biological activities). Full article

Melanin overproduction contributes to hyperpigmentation disorders such as melasma and solar lentigines, leading to increasing demand for safe and effective skin-lightening agents. D-cycloserine (DCS), a known antimicrobial agent, has not been previously evaluated for dermatological applications. This study aimed to explore the potential of DCS as a novel anti-melanogenic compound and to elucidate its underlying molecular mechanisms in melanogenesis inhibition. The cytotoxicity and anti-melanogenic effects of DCS were assessed in B16F10 melanoma cells stimulated with α-MSH. Cell viability was determined via MTT assays, while melanin content, tyrosinase activity, and the expression levels of MITF, TYR, TRP-1, TRP-2, and major signaling proteins (e.g., CREB, MAPKs, GSK-3β/β-catenin) were evaluated using colorimetric assays and Western blotting. A 3D human skin model was also used to confirm in vitro findings, and a primary skin irritation test was conducted to assess dermal safety. DCS significantly reduced α-MSH-induced melanin content and tyrosinase activity without cytotoxicity at concentrations ≤100 µM. It downregulated MITF and melanogenic enzyme expression and modulated signaling pathways by enhancing ERK activation while inhibiting CREB, JNK, and p38 phosphorylation. Additionally, DCS suppressed β-catenin stabilization via GSK-3β activation. These effects were confirmed in a 3D human skin model, and a clinical skin irritation study revealed no adverse reactions in human volunteers. DCS exerts its anti-melanogenic effect by targeting multiple pathways, including CREB/MITF, MAPK, and GSK-3β/β-catenin signaling. Its efficacy and safety profiles support its potential as a novel cosmeceutical agent for the treatment of hyperpigmentation. Further clinical studies are warranted to confirm its therapeutic utility in human skin pigmentation disorders. Full article

Skin pigmentation results from complex cellular interactions and is influenced by genetic, environmental, and metabolic factors. Emerging evidence highlights the multiple pathways by which lipids regulate melanogenesis and points to lipid metabolism and signaling as key players in this process. Lipidomics is a high-throughput omics approach that enables detailed characterization of lipid profiles, thus representing a valid tool for evaluating skin lipid functional role in both physiological melanogenesis and pigmentary disorders. The use of lipidomics to gain a deeper comprehension of the role of lipids in skin pigmentation is still an evolving field, but it has allowed the identification of significant lipid dysregulation in several pigmentary pathologies. This review summarizes the current knowledge on the involvement of lipids in skin pigmentation, focusing on lipid profile alterations described in hyper- and hypopigmentary disorders such as post-inflammatory hyperpigmentation, melasma, solar lentigo, and vitiligo. Lipidomic profiling reveals disease-specific alterations supporting the pivotal role of lipid signaling in the physiopathological mechanisms of melanogenesis. These findings provide insights into disease pathogenesis and show promise for the discovery of biomarkers and innovative therapeutic strategies for pigmentary disorders. Full article

Background: Melasma is an acquired hyperpigmentation disorder with multifactorial etiologies and limited response to conventional therapies. Recent evidence suggests that Botulinum Toxin A (BoNT-A) may modulate ultraviolet (UV)-induced pigmentation and offer therapeutic benefits. Objective: We sought to evaluate the efficacy and safety of two intradermal dilutions of Letibotulinum toxin A (LetiBoNT-A) in Thai patients with melasma. Methods: In this randomized, double-blind, split-face study, 30 participants aged 32–62 years received a single intradermal injection of LetiBoNT-A, with 20 units administered per cheek. A 1:5 dilution was injected on one side of the face, and a 1:10 dilution was injected on the contralateral side. Outcomes were evaluated over a 6-month period using the Hemi-modified Melasma Area and Severity Index (Hemi-mMASI), VISIA^® brown spot analysis, and quantitative assessments of skin texture. Results: Both dilutions significantly improved Hemi-mMASI scores (1:5, p = 0.043; 1:10, p = 0.002) and brown spots (1:5, p = 0.002; 1:10, p < 0.001). The 1:10 dilution showed earlier and more sustained improvements. Subgroup analysis revealed greater reductions in Hemi-mMASI scores among patients with telangiectatic melasma, particularly with the 1:10 dilution, though they were not statistically significant. Additionally, the 1:10 dilution significantly reduced pore volume, pore area, and sebum levels. One case of transient facial asymmetry was reported with the 1:5 dilution. Conclusions: LetiBoNT-A is a safe and effective adjunct in melasma treatment. The 1:10 dilution offered superior clinical outcomes. Full article

The sebaceous gland (SG) is an integral part of the pilosebaceous unit and is a very active and dynamic organ that contributes significantly to the maintenance of skin homeostasis. In addition to its primary role in sebum production, the SG is involved in the maintenance of skin barrier function, local endocrine/neuroendocrine function, the innate immune response, and the regulation of skin bacterial colonization. Structural and functional alterations of SGs leading to the dysregulation of sebum production/composition and immune response may contribute to the pathogenesis of inflammatory dermatoses. This review summarises the current knowledge on the contribution of SGs to the pathogenesis of common inflammatory skin diseases. These findings are crucial for the development of more effective therapeutic strategies for the treatment of inflammatory dermatoses. Full article

Background/Objectives: Facial melasma is a common, chronic, and relapsing hyperpigmentation disorder, affecting up to 40% of adult women in Southeast Asia. Although most cases are mild, the condition may have a considerable psychological impact. Ocular photoaging diseases are also common and have been increasingly recognized in aging populations exposed to chronic sunlight. Ultraviolet (UV) radiation is implicated in both melasma and ocular photoaging; however, their relationship remains unclear. Methods: This cross-sectional study investigated the association between facial melasma and UV-induced ocular conditions among 315 participants aged 30–80 years at Walailak University Hospital, Thailand. Facial melasma was diagnosed clinically and dermoscopically, with severity assessed using the modified Melasma Area Severity Index. Ophthalmological examinations evaluated UV-related ocular conditions, including pinguecula, pterygium, climatic droplet keratopathy, cataracts, and age-related macular degeneration. Logistic regression analyses were performed, adjusting for age, sex, and sun exposure. Results: Facial melasma was identified in 66.0% of participants (n = 208), and nuclear cataracts were significantly associated with melasma (adjusted odds ratio, 2.590; 95% confidence interval, 1.410–4.770; p = 0.002). Additionally, melasma severity correlated with nuclear cataract severity (ρ = 0.186, p = 0.001). Other ocular conditions were not significantly associated with melasma. Conclusions: These findings suggest a shared UV-related pathogenesis between facial melasma and nuclear cataracts. Sun protection measures, including regular sunscreen use, UV-blocking eyewear, and wide-brimmed hats, may help mitigate the risk of both conditions. Further multicenter studies are warranted to confirm these findings and explore the underlying mechanisms. Full article

Skin hyperpigmentation disorders, such as melasma, are linked to excessive melanin production, primarily regulated by the enzyme tyrosinase (TYR). While current inhibitors like kojic acid (KA) are effective, they often cause adverse side effects, driving the search for safer andnatural alternatives. This study evaluated the TYR inhibitory potential of bioactive-rich extracts from acorn, cocoa, cork, and eucalyptus, extracted using hydroethanolic (HE) and natural deep eutectic solvents (NADES), and explored the enhancement of their bioactivity through laccase-assisted polymerization. NADES significantly improved extraction yields and preserved bioactive compounds, with cocoa extracts showing the highest TYR inhibition. Laccase-mediated polymerization further enhanced TYR inhibitory activity, particularly of NADES extracts, suggesting a more effective and sustainable approach for skincare applications. The results highlight the potential of combining green chemistry principles with enzymatic catalysis to develop eco-friendly and efficient treatments for hyperpigmentation disorders, offering a promising alternative to conventional methods. Full article

Melasma is an incredibly common dyschromic disorder, mostly impacting women with skin of color. There are three variants of melasma based on the depth of pathologic involvement: epidermal, mixed, and dermal. While there are many treatments for melasma, there is a paucity of research on melasma treatments and their dermatopathological correlates. A scoping review was conducted of all human trials on melasma with histopathologic analysis, including 37 trials in the final analysis. Most studies were conducted on women with a Fitzpatrick skin type of III or greater. Strong histologic evidence supports the utilization of retinols/retinoids for epidermal melasma and microneedling for dermal melasma. There is a paucity of trials conducted on melasma utilizing histologic correlates, and fewer still that are comprehensive to include analyses on quality of life. Full article

Melasma is a chronic skin disorder characterized by hyperpigmentation, predominantly affecting women with darker skin types, including those of African descent. This study investigates the association between genetic variants in SLC45A2, TYR, HERC2, and SLC24A5 genes and the severity of melasma in women of reproductive age. Forty participants were divided into two groups: twenty with facial melasma and twenty without. Deoxyribonucleic acid (DNA) was extracted from blood samples and genotyped using TaqMan assays to identify allele frequencies and genotype distributions. Significant associations were observed for the TYR gene (rs1042602), HERC2 gene (rs1129038), and SLC24A5 gene (rs1426654) polymorphisms, highlighting their potential roles in melasma susceptibility. For example, the rs1042602 Single Nucleotide Polymorphisms (SNP) in the TYR gene showed a strong association with melasma, with the AA genotype conferring a markedly increased risk. Similarly, the rs1129038 SNP in the HERC2 gene and the rs1426654 SNP in the SLC24A5 gene revealed significant genetic variations between groups in women of African descent. These findings underscore the influence of genetic polymorphisms on melasma’s pathogenesis, emphasizing the need for personalized approaches to its treatment, particularly for women with darker skin types. Full article