Estudo piloto sobre a eficácia e segurança do uso da cisteamina 5% como terapia de contato por toda noite no tratamento do melasma facial / Efficacy and safety of the 5% cysteamine cream left in overnight for facial melasma: a pilot study

Não se aplica, trata-se de uma carta

Not applicable, this is a letter.

Hipomelanosis macular progresiva: respuesta al tratamiento con minociclina / Progressive macular hypomelanosis: response to treatment with minocycline

La hipomelanosis macular progresiva (HMP) es una dermatosis caracterizada por máculas hipopigmentadas, que se observa con mayor frecuencia en las mujeres y en los fototipos III y IV. Se ha asociado a Cutibacterium acnes (C. acnes) de tipo III como factor etiológico. Se presenta el caso de una paciente de 30 años, con máculas hipopigmentadas redondeadas en el tronco y la raíz de los miembros inferiores, de 10 años de evolución. El estudio histológico informó disminución del número de melanocitos y de pigmento melánico en la capa basal e infiltrado inflamatorio mononuclear perivascular superficial. Se indicó minociclina 100 mg/día por vía oral durante 8 meses, tras lo cual se observó la resolución total de las lesiones.

Progressive macular hypomelanosis (PMH) is a dermatosis characterized by hypopigmented macules, most frequently found in females and in phototypes III and IV. Cutibacterium acnes (C. acnes) type III has been associated as an etiological factor. We present the case of a thirty-year-old female patient with a 10-year history of nummular hypopigmented macules located on the top of the lower limbs and on the trunk. The histological study reported a decrease in the number of melanocytes and melanotic pigment in the basal layer and the presence of superficial perivascular mononuclear inflammatory infiltrate. After an 8-month regimen of oral minocycline 100 mg/day, there was a complete resolution of the lesions.

Corneal melanosis successfully treated using topical mitomycin-C and alcohol corneal epitheliectomy: a 3-year follow-up case report / Tratamento com êxito da melanose de córnea utilizando mitomicina-C tópica e epiteliectomia auxiliada por álcool: relato de caso com três anos de seguimento

ABSTRACTWe report a case of primary acquired corneal melanosis without atypia associated with corneal haze in a patient with a history of limbal malignant melanoma and the effect of mitomycin-C. A 75-year-old woman with a history of limbal malignant melanoma presented with loss of vision in right eye. Corneal examination showed a patchy melanotic pigmentation with a central haze. Topical mitomycin-C improved visual acuity and corneal haze. However, the pigmented lesions persisted, and they were removed with alcohol corneal epitheliectomy. Histopathological examination demonstrated primary acquired melanosis without atypia. The lesions were successfully removed, and there were no recurrences during the follow-up period of 36 months. The association of conjunctival and corneal melanosis without atypia is a rare condition. In addition, co-existence of central corneal haze and melanosis may decrease visual acuity. Topical mitomycin-C and alcohol corneal epitheliectomy can be useful treatments in this condition.

RESUMORelatar um caso de melanose adquirida primária de córnea sem atipia, associado a haze corneano em um paciente com história de melanoma maligno de limbo e o efeito da mitomicina-C. Uma mulher de 75 anos de idade, com história de melanoma maligno do limbo apresentado com diminuição de visão no olho direito. O exame de córnea mostrou uma pigmentação melânica irregular com um haze central. O uso de mitomicina-C tópica levou à melhora da acuidade visual e da opacidade corneana. No entanto, as lesões pigmentadas persistiram e foram removidas com epiteliectomia associada ao álcool. O exame histopatológico demonstrou melanose adquirida primária sem atipia. As lesões foram removidas com êxito, e não houve recidiva durante o período de acompanhamento de 36 meses. A associação melanose sem atipia da conjuntiva e da córnea é uma condição rara. Além disso, a coexistência de haze corneano central e melanose pode diminuir a acuidade visual. O uso de mitomicina-C tópica e epiteliectomia corneana auxiliada pelo álcool podem ser tratamentos úteis nessa situação.

Estudio clínico comparativo de productos despigmentantes en melasma facial en mujeres latinas / Clinical comparative study of skin lightening products in facial melasma in hispanic women

Las lesiones hiperpigmentadas son unas de las consultas más frecuentes en dermatología, siendo más susceptibles de tratamiento efectivo las adquiridas. De ellas la más frecuente corresponde al melasma, siendo actualmente la hidroquinona la terapia de elección en este tipo de lesiones. Nuestro objetivo fue comparar la eficacia de un tratamiento a base de Diacetylboldine-DAB, Alfa Arbutiny Licorice con la hidroquinona al 4 por ciento. Realizamos un estudio piloto en 30 pacientes latinas (piel tipo III y IV según clasificación de Fitzpatrick) en el cual se aplicaba el producto en estudio en un lado de la cara y la hidroquinona en el otro, durante 60 días. En nuestro estudio se demostró que el uso combinado de sustancias activas es similar y comparable a la hidroquinona en un período de tiempo de 60 días.

Hyperpigmented lesions are some of the most frequent dermatological consultations, being more effectively treated the acquired ones. Out of them, the most common is melasma, which is currently treated with hydroquinone. Our objective was to compare the efficacy of a treatment based on Diacetylboldine-DAB, Alfa Arbutin and Licorice with hydroquinone 4 percent. We carried out a pilot study on 30latin patients (skin type III and IV after Fitzpatrick’s classification). The product under study was applied on one side of the face and hydroquinone on the other, during 60 days. We demonstrated that the combined use of active substances is similar and comparable to hydroquinone in a 60 day period.

Exogenous ochronosis: case report and literature review / Ocronose exógena: relato de caso e revisão de literatura

Exogenous ochronosis is a rare, cosmetically disfiguring condition, resulting from the longterm use of topical hydroquinone in treatment of melasma. It manifests as gray-brown or blue-black macules in hydroquinone-exposed regions. The exact incidence of ochronosis is unknown. High rates have been reported in the South African population, and it is rare in the United States. We report the case of a patient who developed exogenous ochronosis while using topical hydroquinone. It is necessary to recognize this disorder at the earliest stage and discontinue hydroquinone immediately, as its treatment is difficult. Sun exposure facilitates the formation of exogenous ochronosis and must be strictly avoided, although it is a practical problem in the tropical climate of Brazil, particularly for those who work outdoors.

Ocronose exógena é uma condição rara, cosmeticamente desfigurante, devido ao uso tópico indiscriminado de hidroquinona para tratamento do melasma. Manifesta-se como máculas marrom-acinzentadas ou preto-azuladas em áreas cutâneas do uso de hidroquinona. A exata incidência de ocronose Exógena é desconhecida. Altos índices têm sido relatados em populações sul-africanas, sendo rara nos Estados Unidos. Relatamos um caso de uma paciente que desenvolveu ocronose Exógena durante uso de hidroquinona para tratamento do melasma. É necessário o reconhecimento dessa patologia no seu estágio precoce e imediata descontinuação da droga, pois seu tratamento é difícil. A exposição solar é um fator precipitante e deve ser estritamente evitada, embora isso seja difícil no clima tropical do Brasil, especialmente para aqueles que trabalham ao ar livre.

Associação de emblica, licorice e belides como alternativa à hidroquinona no tratamento clínico do melasma / Association of emblica, licorice and belides as an alternative to hydroquinone in the clinical treatment of melasma

FUNDAMENTOS: Melasma é uma melanodermia comum, cuja terapêutica representa um desafio clínico. OBJETIVOS: Avaliar a eficácia e segurança clínicas do complexo despigmentante emblica, licorice e belides, em comparação à hidroquinona 2 por cento, na abordagem do melasma. MÉTODOS: Após 60 dias de uso exclusivo de fotoprotetor FPS35, 56 mulheres com idades entre 18 e 60 anos, fotótipos I a IV, com melasma epidérmico ou misto, foram divididas em dois grupos de um estudo clínico monocego: A) creme contendo complexo despigmentante emblica, licorice e belides 7 por cento, usado duas vezes ao dia; B)creme de hidroquinona 2 por cento, usado à noite. O estudo durou 60 dias consecutivos e avaliações médica, das voluntárias (auto-avaliação) e fotográfica (Visia®) foram realizadas quinzenalmente. RESULTADOS: 89 por cento das voluntárias (50/56), 23 do Grupo A e 27 do Grupo B, concluíram o estudo. Duas voluntárias do Grupo A contra sete do Grupo B apresentaram eventos adversos leves transitórios. Houve despigmentação do melasma pelas avaliações médica (Grupo A: 78,3 por cento; Grupo B: 88,9 por cento) e auto-avaliação (Grupo A: 91,3 por cento; Grupo B: 92,6 por cento), todos estatisticamente significantes (p<0,001), sem diferenças entre os grupos (p>0,05). O mesmo padrão foi observado pelo Visia®, tanto no número (p = 0,001) quanto no tamanho e no tom (p<0,001), para ambos os grupos, e sem diferenças entre eles (p>0,05) nas manchas UV. CONCLUSÕES: Não houve diferença estatística na melhora do melasma nos dois grupos; o Grupo A apresentou menor incidência de eventos adversos. Logo, o complexo despigmentante emblica, licorice e belides é uma alternativa segura e eficaz na abordagem do melasma.

BACKGROUND: Melasma is a common skin pigment disorder with a difficult clinical response to treatment. OBJECTIVES: To evaluate the clinical efficacy and safety of the association of Belides, Emblica and Licorice 7 percent, compared to Hydroquinone 2 percent, in the treatment of melasma. METHODS: After 60 days of exclusive use of an SPF35 sunscreen, 56 women, 18 to 60 years of age, phototypes I to IV, with epidermal or mixed melasma, were divided into two different groups in a mono-blind clinical study: A) cream with Belides, Emblica and Licorice, applied twice a day; B) cream with Hydroquinone 2 percent, used at night. They were observed in a 60-day study; every 15 days, they were submitted to medical evaluation, self-evaluation, and photographic registration (Visia®). RESULTS: 50 volunteers (89 percent), 23 in Group A and 27 in Group B, concluded the study. Two volunteers in Group A and 7 in Group B had mild skin adverse events. Depigmentation was observed through medical evaluation (Group A: 78.3 percent; Group B: 88.9 percent) and volunteers' self-evaluation (Group A: 91.3 percent; Group B: 92.6 percent); these results were statistically significant (p<0.001), with no differences between groups (p>0.05). This pattern of results was observed by Visia® in the number (p = 0.001) and size and tone (p<0.001) of the uv stains, for both groups, with no differences between them (p>0.05). CONCLUSION: There were no statistic differences between groups in the improvement of melasma. Group A showed less skin adverse events. Therefore, the association of Emblica, Licorice and Belides is a safe and efficient alternative for the treatment of melasma.

Ocronose exógena induzida por hidroquinona: relato de quatro casos / Exogenous ochronosis hydroquinone induced: a report of four cases

A ocronose exógena é uma dermatose, aparentemente pouco frequente, caracterizada por hiperpigmentação negro-azulada fuliginosa, localizada na região onde foi aplicado o agente causador. Pode ser causada por uso de medicamentos sistêmicos, os antimaláricos e de uso tópico, como fenol, resorcinol, benzeno, ácido pícrico e a hidroquinona - que é um composto fenólico, com propriedade despigmentante, muito utilizado em formulações dermatológicas para o tratamento de melasma e outras hiperpigmentações. A fisiopatogenia deste processo ainda não está esclarecida e as abordagens terapêuticas são insatisfatórias. Relatam-se quatro casos de pacientes do sexo feminino que, após uso de preparados contendo hidroquinona, desenvolveram hiperpigmentação acentuada na face, caracterizadas no exame dermatológico e histopatológico como ocronose. Enfatiza-se a possibilidade de casos de ocronose exógena estarem sendo diagnosticados erroneamente, como falha de tratamento de melasma, e também para os riscos do uso indiscriminado de formulações, contendo hidroquinona, muitas vezes, sem acompanhamento médico.

Exogenous ochronosis is an infrequent dermatosis characterized as a dark blue hyperpigmentation localized where the causing agent was applied. It may be caused by the use of systemic medication such as antimalarials and by the use of topic substances such as phenol, resorcinol, benzene, or hydroquinone, which is a fenolic compound with depigmentation action, largely used in the treatment of melasma and other hyperpigmentation. The physiopathology of this process is not well clear up to this moment, and the therapeutic measures are not satisfactory either. Here we present four cases of female patients that developed hyperpigmentation on their faces after the use of hydroquinone containing compounds, characterized clinically and histological as ochronosi. We emphasize the possibility of exogenous ochronosis cases being misdiagnosed as a melasma treatment failure. We also emphasize the risks of the indiscriminated use of hydroquinone containing compounds, used, in many instances, without medical prescription.

Tratamiento de melasna con ácido Kójico / Treatment of melasna with Kójico acid

El melasma es una hipermelanosis adquirida caracterizada por máculas pigmentarias en zonas expuestas a la luz solar, más frecuentemente observada en mujeres y en fototipos IV a VI. La causa exacta se desconoce, aunque múltiples factores han sido implicados en la etiopatogénesis de esta enfermedad.Objetivo: evaluar la eficacia de una crema despigmentante con ácido kójico 1 % en melasma, en mujeres, durante cuatro meses de tratamiento. Diseño: estudio observacional, prospectivo, longitudinal y descriptivo. Método: se realizó un interrogatorio sobre el tiempo de evolución y circunstancias de aparición del melasma, tratamientos realizados y resultados, durante diciembre 2004 a mayo 2005. Se entregó una crema despigmentada a base de ácido kójico 1% más lipohidroxiácido, y un protector solar FPS 60 Mexoryl. La evaluación del resultado fue realizado por el paciente( por su apreciación subjetiva.), un observador independiente a través de fotografías y el médico investigador por criterio clínico( ficha). Se evalúo cada 30 días por cuatro meses la localización, intensidad, nivel del pigmento, mejoría y reacciones adversas. Resultados: se incluyeron diez pacientes; una fue excluida; de las nueve restantes, ocho pacientes relataron buena mejoría y una de ellas moderada, ninguna paciente relató no mejorar. El médico investigador y el observador ciego encontraron mejoría en todas las pacientes; en 6 las calificaron como moderada y en tres como buena, ninguna sin mejoría . Conclusiones: los resultados y la satisfacción de los pacientes fueron buenos, los efectos colaterales mínimos y pasajeros. Un estudio más grande comparando el producto contra placebo o contra el protector solar solo sería necesario para objetivar más claramente los resultados.

Melasma. Revisión clínico-terapéutica / Melasma. Clinical and therapeutic review

Se procederá a la revisión de los mecanismos conducentes a la melanogénesis y los distintos factores que inciden en la pigmentación cutánea, para luego realizar una descripción de los diferentes productos utilizados en el tratamiento del melasma.

Cutaneous pseudolymphoma due to topical application of 4% hydroquinone cream for melasma

Cutaneous pseudolymphoma is an aggregate of mature or abnormal looking lymphocytes in the dermis, which clinically and /or histologically simulates lymphoma but has a benign course and outcome. Systemic drugs, especially anti-epileptics, are an important cause of cutaneous pseudolymphomas. Pseudolymphoma of the skin, secondary to topical drug application, is very rare. We report a case of cutaneous pseudolymphoma induced by local application of 4% hydroquinone cream to melasma over the cheeks

Therapeutic Effect of Topical Application of Linoleic Acid and Lincomycin in Combination with Betamethasone Valerate in Melasma Patients

Melasma is an acquired symmetric hypermelanosis characterized by irregular lightto gray-brown macules and patches on sun-exposed areas. Many therapeutic agents are available but are unsatisfactory. Recently, it has been demonstrated that lincomycin (LM) and linoleic acid (LA) can inhibit melanogenesis in vitro. Our purpose was to investigate the clinical efficacy of topical application of LM and LA in combination with betamethasone valerate (BV) in melasma patients. Fortyseven Korean female adults with clinically diagnosed melasma were enrolled in a 6-week, double-blind, randomized clinical trial. Patients were treated with one application of the vehicle (group A), 2% LM mixed with 0.05% BV (group B), or 2% LM mixed with 0.05% BV and 2% LA (group C) on the face every night. Determination of efficacy was based on the Melasma Area and Severity Index (MASI) score and objective assessment (no effect, mild, moderate, or excellent) at intervals of 2 weeks until the end of the study at 6 weeks. After 6 weeks, in comparison with the pre-treatment MASI score, the average MASI score of group C decreased to 68.9%, compared with 98% in group A (p<0.05) and 85.4% in group B. There was no statistically significant difference between group A and group B. Seven patients (43.7%) in group C revealed more than moderate improvement in objective assessment, compared with none in group A and two patients (12.5%) in group B. There were no significant side effects. Topical application of linoleic acid is considered to be effective in the treatment of melasma patients.

Topical isotretinoin for melasma in Thai patients: a vehicle-controlled clinical trial.

BACKGROUND: Melasma is an acquired hyperpigmentary disorder commonly seen in Orientals. Recently it has been demonstrated that tretinoin (all-trans-retinoic acid) can produce significant clinical improvement of melasma. However, moderate cutaneous side effects (retinoid dermatitis) occurred in a number of patients. OBJECTIVE: To investigate the efficacy of topical 0.05 per cent isotretinoin gel (Isotrex) in the treatment of melasma in Thai patients. METHOD: Thirty patients with moderate to severe melasma entered a 40-week, randomized, vehicle-controlled clinical trial in which they applied either 0.05 per cent isotretinoin gel, or its vehicle base together with a broad spectrum sunscreen (SPF 28) daily to the entire face. They were evaluated clinically (using Melasma Area and Severity Index), and colorimetrically (using our Melasma Area and Melanin Index). RESULTS: After 40 weeks, the average MASI and MAMI scores of the isotretinoin-treated group decreased by 68.2 per cent and 47 per cent respectively, while the corresponding control scores declined 60 per cent and 34 per cent. There was no statistically significant difference between the isotretinoin and vehicle groups. When the MASI and MAMI scores of each visit were compared to their baseline data, a statistically significant reduction of the score was first noted at weeks 4 and 12 respectively. Lightening of melasma, as determined clinically (MASI score), correlated well with pigmentation measurements (MAMI score). Side effects were limited to a mild transient "retinoid dermatitis" occurring in 27 per cent of isotretinoin-treated patients. CONCLUSION: Daily use of broad spectrum sunscreen has a significant lightening effect on melasma in Thai patients. However, there was no statistically significant difference between the isotretinoin and vehicle-treated group.

Arbutin: un nuevo depigmentante: estudio terapéutico en pacientes portadoras de melasma / Arbutin: a new depigmentant: therapeutic study in melasma carrier patients

En este trabajo se presentan los resultados de un estudio clínico terapéutico abierto, en el cual se incluyeron 10 pacientes portadoras de melasma que fueron tratadas con un nuevo preparado depigmentante: el producto fue utilizado en dos concentraciones (2 por ciento y 5 por ciento), asociado con ácido glicólico al 10 por ciento, por un período de 60 días. La respuesta fue muy buena y no se observaron efectos secundarios

Acido Kójico: un nuevo despigmentante / Kojico acid: a new despigmentation agent

El melasma es considerado como una de las patologías dermatológicas de más difícil tratamiento, consecuencia de una compleja etiología que involucro factores genéticos, hormonales y ambientales. La farmacoterapia con medicamentos en formulaciones tópicas, tales como la hidroquinona y, actualmente, el ácido kójico, apunta a inhibir el complejo tirosinasa, responsable de la síntesis de la melanina a partir de tirosina, entre otros sustratosfenólicos. Aún cuando ambos medicamentos son efectivos en el tratamientos del melasma y pueden desarrollar reacciones adversas similares, el ácido kójico presenta ventajas en cuanto a la estabilidad de laformulación, al no oxidarse ni adquirir la coloración parda característica de las formulaciones con hidroquinona

Evaluation of different bleaching agents in the treatment of some hypermelanotic disorders

The study comprised 47 patients, 32 patients having melasma and 15 having Berloque dermatitis. The three bleaching agents were: Kilgman Willis formula, hydrocortisone butyrate 0.1% oint. and hydroquinone 5% +retinoic acid 0.1% oint. applied twice daily except hydrocortisone butyrate 0.1% which was used once daily. These bleaching agents were applied for about 6 weeks. The response to these agents was detected by comparing the intensity of hypopigmentation after treatment and the presence of any side effect Zinc oxide oint. was applied in the morning as a sun screen. Hydrocortisone butyrate 0.1% was found more effective in the treatment of Berloque dermatitis than melasma [rhoc 0.05]. Kligman Willis formula and the combination of hydroquinone 5% +Retinoic acid 0.1% were more effective than hydrocortisone butyrate in the treatment of melasma. Erythema and peeling were marked with hydroquinon 5% +retinoic acid 0.1%

Eficacia del ácido azelaico vs. hidroquinona en melasma: resultados de un estudio doble ciego multicéntrico / Efficacy of azelaic acid vs. hidroquinone for melasma: results of double-blind multicentric study

Fue realizado un ensayo clínico doble ciego para el tratamiento del melasma en base a una preparación tópica del ácido azelaico (AA) al 20%vs. otra a base de hidroquinona (Hq) al 4%. Se estudiaron 50 pacientes con melasma epidérmico de localización malar o centrofacial. Las cremas fueron aplicadas dos veces al día durante el invierno. Los controles para determinar el área blanqueada fueron realizados en las semanas 4a., 9a., 14a., 19a. y 24a. Los resultados muestran que la Hq es mejor que el AA con una diferencia significativa (p<0,05) observada en las semanas 19a. y 24a. Consideramos que el tratamiento mínimo para esta afección es de 14 semanas dado que allí se logra el 50%del blanqueamiento. Además pensamos que el AA debe usarse cuando exista intolerancia a la Hq