A pilot study of oral tranexamic acid and Glycyrrhizin compound in the treatment of recalcitrant Riehl's melanosis.

BACKGROUND: Up till now, there is no standardized and satisfactory treatment strategy for Riehl's melanosis. OBJECTIVE: In this pilot study, we evaluated the efficacy and safety of a novel combination therapy with oral administration of tranexamic acid (TA) and Glycyrrhizin compound for recalcitrant Riehl's melanosis. METHODS: Ten patients with Riehl's melanosis were recruited in this study. After elimination of potential contraindication, all patients were treated with 500 mg TA together with 150 mg Glycyrrhizin compound per day orally for 3 months, followed by 500 mg TA per day orally alone for another 3 months. Lesions were imaged by reflectance confocal microscopy (RCM), dermatoscopy, and VISIA® Complexion Analysis System monthly. Mexameter was adopted to evaluate Melanin Index (MI) and Erythema Index (EI). Clinical outcome scores were given by both physicians and patients. RESULTS: Seven out of ten patients received "marked improvement", while two received "moderate improvement" and one "minimal improvement" at the final visit. Both mean MI and EI were significantly decreased compared with baselines. Furthermore, RCM and dermatoscopy analyses confirmed the improvement of pigmentation and erythema with decreased pigment granules and telangiectatic vessels. CONCLUSION: Oral administration of TA in combination with Glycyrrhizin compound may be an effective therapy for Asian patients with recalcitrant Riehl's melanosis.

Validation of a physician global assessment tool for vitiligo extent: Results of an international vitiligo expert meeting.

Currently, vitiligo lacks a validated Physician Global Assessment (PGA) for disease extent. This PGA can be used to stratify and interpret the numeric scores obtained by the Vitiligo Extent Score (VES). We investigated the interrater reliability of a 5-point PGA scale during an international vitiligo workshop. Vitiligo experts from five different continents rated photographs of non-segmental vitiligo patients with varying degrees of extent with the PGA score. Good interrater agreements (intraclass correlation coefficient >0.6) were observed between the raters overall and within each continent. All hypotheses to evaluate construct validity were confirmed. Median VES values per category were for limited 1.10 [IQR: 0.21-1.67], moderate 3.17 [IQR: 1.75-6.21], extensive 9.58 [IQR: 6.21-13.03] and very extensive 42.67 [IQR: 21.20-42.67]. Defined categories for vitiligo extent can be valuable for inclusion criteria and may impact future reimbursement criteria.