A comparison of serum zinc levels in melasma and non-melasma patients: a preliminary study of thyroid dysfunction.

INTRODUCTION: Melasma is an acquired hyperpigmentation disorder, clinically identified by symmetrical blackish-brown macules, especially on the facial area. Several factors are thought to play a role, including thyroid dysfunction and zinc deficiency. The aim of this study was to determine serum zinc levels in melasma and non-melasma patients with and without thyroid dysfunction. METHODS: A cross-sectional study was conducted in Jakarta in September 2019. There were 60 melasma patients and 60 non-melasma patients. The two groups were matched for age and sex. Atomic absorption spectrophotometry was used to measure serum zinc levels. Blood laboratory tests were used to check thyroid function by measuring thyroid stimulating hormone and free T4. Statistical analysis was performed using SPSS software. RESULTS: The mean serum zinc level in the melasma group was 10.25 ± 1.89 µmol/l and in the non-melasma group 10.29 ± 1.46 µmol/l (< 0.901). The mean serum zinc level in melasma patients with thyroid dysfunction was 8.77 ± 0.69 µmol/l, in melasma patients without thyroid dysfunction 10.33 ± 1.89 µmol/l, in non-melasma patients with thyroid dysfunction 10.48 ± 2.4 µmol/l, and in non-melasma patients without thyroid dysfunction 10.27 ± 1.4 µmol/l (< 0.184). CONCLUSIONS: There was no significant difference between serum zinc levels in the melasma and non-melasma groups with and without thyroid dysfunction.

Randomised, controlled, double-blind study of combination therapy of oral tranexamic acid and topical hydroquinone in the treatment of melasma.

BACKGROUND/OBJECTIVES: Melasma is a common pigmentary disorder for which oral tranexamic acid has shown some efficacy in previous studies. The aim of this study was to assess the effectiveness of oral tranexamic acid in combination with hydroquinone cream in the treatment of melasma. METHODS: Subjects with moderate-to-severe melasma were enrolled. Group A received hydroquinone 4% cream, sunscreen and oral tranexamic acid, while Group B received hydroquinone 4% cream, sunscreen and placebo capsules for 3 months. All subjects had an additional 3-month follow-up visit on sunscreen alone. The primary outcome measure was change in modified Melasma Area and Severity Index (mMASI) score. In addition, the melanin index was measured using a mexameter. RESULTS: Fifty subjects were enrolled, and all completed the study. There was a 55% reduction in mMASI after 3 months from mean 8.96 (SD 2.45) to 4.0 (SD 1.6) in Group A compared to 10.9% from mean 8.53 (SD 2.04) to 7.6 (SD 2.0) in Group B. Three months after oral and topical therapy was discontinued, there was a 42% decrease in mMASI compared to baseline in Group A (mean 5.1 SD 1.7) vs. 4.7% in Group B (mean 8.1 SD 2.0). No serious adverse events were observed. CONCLUSIONS: A combination of oral tranexamic acid and topical hydroquinone is more effective than hydroquinone alone in the treatment of melasma.

Purpuric nail striae as the initial manifestation in multisystem Langerhans cell histiocytosis.

Nail involvement in Langerhans cell histiocytosis (LCH) is very uncommon. We describe a 9-month-old boy with longitudinal purpuric bands, onychodystrophy, and paronychias on his fingernails and toenails, which antedated manifestations of recurrent bilateral spontaneous pneumothorax and elevated transaminases. The diagnosis of nail LCH was then confirmed by immunohistochemistry demonstrating positive S100 and CD1a staining in the epithelium of nail bed tissue. This case report affirms that nail involvement may be the initial manifestation of multisystem LCH and could portend an unfavorable prognosis.

Applicability of Trichoscopy in Scalp Seborrheic Dermatitis.

INTRODUCTION: Seborrheic dermatitis (SD) is a chronic-recidive inflammatory skin disorder with predilection in areas rich of sebaceous gland. The most common clinical manifestations are pruritus and scales. Although SD can be diagnosed without special tools, other examinations may be needed to determine additional specific therapy. Trichoscopy is one of the noninvasive tools which can help to diagnose SD as it can provide the microstructure view of the scalp. MATERIALS AND METHODS: This descriptive study was conducted to explore the trichoscopic features of SD and its characteristics. There were 96 SD patients enrolled in this study. The scalp was divided into four areas, and each area was scored based on Seborrheic Area Severity Index, comprising erythema, desquamation, number of papules, and percentage of lesion area. The most severe area was examined with a trichoscopy to observe the characteristics of hair and scalp. The association between trichoscopic findings and SD severity was analyzed with Fisher's exact test. RESULTS: Overall, the participants were 36% males and 64% females with the mean age of 30 (13-70) years old. Based on the trichoscopic examination, the most common findings were thick hair shafts (72%), white scales (69%), arborizing thin vessels (38%), yellowish area (36%), and structureless red area (19%). These findings were not significantly different between mild and moderate SD (P > 0.05). CONCLUSION: Considering the merits and demerits of trichoscopic examination, it can be helpful to aid the diagnosis of SD. Further studies in Asian population with greater sample size are needed to demonstrate more significant result.