590 nm LED Irradiation Improved Erythema through Inhibiting Angiogenesis of Human Microvascular Endothelial Cells and Ameliorated Pigmentation in Melasma.

Melasma is a common refractory acquired pigmentary skin disease that mainly affects middle-aged women. The pathogenesis of melasma is still uncertain, while abnormal vascular endothelial cells may play a role. We previously demonstrated the yellow light of light-emitting diodes (LED) could inhibit melanogenesis through the photobiomodulation (PBM) of melanocytes and keratinocytes. In the current study, we investigated the effect of 590 nm LED on the function of human microvascular endothelial cells (HMEC-1). We revealed 0-40 J/cm2 590 nm LED had no toxic effect on HMEC-1 in vitro. 590 nm LED irradiation significantly reduced cell migration, tube formation, as well as the expression of vascular endothelial growth factor (VEGF) and stem cell factor (SCF), a pro-melanogenic factor. Moreover, we illustrated that 590 nm LED inhibited the phosphorylation of the AKT/PI3K/mTOR signaling pathway, and the inhibitory effect on HMEC-1 could be partially reversed by insulin-like growth factor 1 (IGF-1), an AKT/PI3K/mTOR pathway agonist. Besides, we conducted a pilot clinical study and observed a marked improvement on facial erythema and pigmentation in melasma patients after amber LED phototherapy. Taken together, 590 nm LED inhibited HMEC-1 migration, tube formation and the secretion of VEGF and SCF, predominantly through the inhibition of the AKT/PI3K/mTOR pathway, which may serve as a novel therapeutic option for melasma.

Heterogeneous Pathology of Melasma and Its Clinical Implications.

Melasma is a commonly acquired hypermelanosis that affects sun-exposed areas of the skin, with frequent facial involvement. Its histologic manifestations are evident in the epidermis, extracellular matrix, and dermis. In addition to epidermal pigmentation, pathologic findings of melasma include extracellular matrix abnormality, especially solar elastosis. The disrupted basement membrane has been described in melasma with variable incidences. In the dermis, an increase in vascularity and an increase in the number of mast cells were observed, indicating that dermal factors have critical roles in the pathogenesis of melasma, despite the fact that melasma is characterized by epidermal hyperpigmentation. This review discusses such histologic characteristics of melasma, with consideration to their implications for melasma treatment.

A double-blind, placebo-controlled randomized trial of Serratulae quinquefoliae folium, a new source of ß-arbutin, in selected skin hyperpigmentations.

BACKGROUND: Arbutin is one of the most effective lightening substances. Serratula quinquefolia is a new source of its ß-anomer. The HPLC method showed that the solid content of this compound in the dried plant raw material accounts for 6.86%. The leaves of Serratula quinquefolia do not contain hydroquinone. AIMS: To assess the efficacy of the aqueous extract from' leaf of five-leaf serratula as a skin-lightening agent. PATIENTS/METHODS: We did a randomized, placebo-controlled, double-blind trial. The study involved 102 women aged 26-55, with two kinds of hyperpigmentary diseases: melasma and lentigo solaris. Patients were randomly assigned to one of the treatment groups: a study group (N = 54) or a control group (N = 48). The study group applied the cream with the aqueous extract from leaf of five-leaf serratula containing 2.51% of arbutin. The cream was applied twice a day on the discolored side for 8 weeks. RESULTS: The experimental data showed that the cream with the extract causes decreased level of melanin in the skin pigmentation spot. Clinical effect in the form of lightening and evening skin tone on the discolored side was observed in 75.86% of the female patients with melasma and 56.00 % of the female patients with lentigo solaris. CONCLUSIONS: The cream with the aqueous extract from leaf of five-leaf serratula proved to be an effective and safe preparation for lightening skin discolorations (66.67 % of the female patients in the study group).

Better clinical results with long term benefits in melasma patients.

BACKGROUND: Low fluence Q-switched Nd:YAG laser has become popular in the treatment of melasma in Asian patients. However, it needs a lot of treatment sessions for substantial results and repetitive laser exposures may end up with unwanted depigmentation. OBJECTIVE: We evaluated clinical effects and safety of combinational treatment using intense pulsed light and low fluence Q-switched Nd:YAG laser over laser treatment alone. METHODS: Retrospective case series of 35 female patients with mixed type melasma were analyzed. Group A were treated with combination methods and group B with laser alone. At each visit, digital photographs were taken. Erythema index (EI) and melanin index (MI) were measured on the highest point on cheekbones. Modified melasma area and severity index (MASI) scores were marked using photographs by two blinded investigators. RESULTS: The mean values of MI and EI decreased significantly in both groups. Modified MASI score reduction were 59.35% and 45.66% in groups A and B, respectively. In group A, 12 out of 20 patients were followed up (mean 5.9 months) without any further treatments and no clinical aggravations were observed. All patients in group B required at least five more treatment sessions for satisfactory results. CONCLUSION: Combination treatment may provide more rapid clinical resolution in mixed type melasma with possible long term clinical benefits.

[Clinical research of chloasma treated with the meridian cosmetology and the impacts on estrogen and progestin].

OBJECTIVE: To observe the efficacy difference between meridian cosmetology and western medicine in the treatment of chloasma and explore the impacts of meridian cosmetology on E2 and PRGE. METHODS: Three hundreds cases of chloasma were randomized into a meridian cosmetology group and a western medication group according to the visit sequence, 150 cases in each one. In the meridian cosmetology group, the meridian regulation, acupuncture based on pattern/syndrome differentiation [at the body acupoints such as Qihai (CV 6), Xuehai (SP 10), Zusanli (ST 36), Sanyinjiao (SP 6), Ganshu (BL 18), Pishu (BL 20) and Shenshu (BL 23), etc.] and the local surrounding needling therapy on the chloasma skin lesion were adopted. In the western medication group, the oral administration of Vitamin C and E was prescribed for 3 months. The clinical efficacy was observed for the patients in the two groups. Additionally, 30 cases were collected from the meridian cosmetology group randomly for the detection of estrogen (E2) and progestin (PRGE) before and after treatment. RESULTS: The effective rate in the meridian cosmetology group was 92.6% (126/136), which was superior to 67.0% (75/112) in the western medication group (P < 0.05). For the patients collected from the meridian cosmetology group, as compared with that before treatment, E2 level was decreased (P < 0.01) and PRGE level was increased (P < 0.05). CONCLUSION: The meridian cosmetology achieves the superior efficacy as compared with the western medication group for the chloasma and it can regulate the levels of E2 and PRGE.

[Rhubarb induced change of tumor necrosis factor-alpha level in guinea pig model of melanosis coli and its significance].

OBJECTIVE: To study the induced change of tumor necrosis factor alpha (TNF-alpha) level in serum and colon tissue of guinea pig model with melanosis coli and its significance induced by rhubarb (RB). METHODS: One hundred and twelve guinea pigs of clean grade were randomly divided into four groups: the 16 in the normal group (untreated) and the 3 RB groups (32 in each) treated with low (3 g/kg d), medium (6 g/kg d), and high (12 g/kg d) dose of rhubarb respectively, administered by gastrogavage for 60 successive days. All guinea pigs were sacrificed at the terminal of the experiment and their blood serum and colon tissue were taken for detecting TNF-alpha level and TNF-alpha mRNA expression qualitatively and quantitatively using ELISA and RT-PCR. RESULTS: Compared with the normal group, serum and colonic tissue levels of TNF-alpha and TNF-alpha mRNA expression in the RB groups were higher significantly (P<0.01), while no significant difference was found among the later three groups (P>0.05). CONCLUSION: RB could induce change of TNF-alpha level in serum and colon tissue of guinea pig with melanosis coli.

Q-switched alexandrite laser-assisted treatment of melasma: 2-year follow-up monitoring.

Melasma is a common disorder of hyperpigmentation involving sun exposed face and neck areas. Three clinical patterns of melasma are recognized: the centrofacial, the malar, and the mandibular ones. Several factors have been implicated in the pathogenesis of this disorder including pregnancy, oral contraceptive therapy, sun exposure, genetic factors, cosmetics, and race. This condition is most frequently observed in women and affects all racial groups; however, it is commonly found in darker-complexioned individuals (skin types IV through VI) and in Asian women who live and work under strong sunlight exposure for long periods. Melasma is very difficult to treat and often resistant to therapy. Treatment of melasma includes various hypopigmenting agents, chemical peeling, and laser surgery with unsatisfactory results. We report 3 cases of facial melasma successfully treated with a Q-switched Alexandrite laser.

The pigment of melanosis coli: a lectin histochemical study.

BACKGROUND: The compositional nature of the pigment of melanosis coli is essentially unknown. Previous histochemical studies suggested that this pigment has certain similarities with lipofuscin (i.e., age-dependent pigment) and ceroids (i.e., pathologically derived pigments) and that it may contain, therefore, polymerized glycolipids and glycoproteins. However, the saccharide composition of this pigment was never explored by lectin histochemical procedures, which was the main object of this study. METHODS: Colonoscopic biopsy specimens from eight patients with melanosis coli and from three normal control subjects were studied by fluorescent microscopy and by standard and lectin histochemistry. The number of apoptoses in the lining colonic epithelium was also evaluated histologically. RESULTS: Apoptotic bodies were significantly more numerous in patients with melanosis coil than in control subjects. The pigment that accumulates in macrophages of the lamina propia showed autofluorescence, sudanophilia, acid-fastness, and positiveness to PAS and Schmorl's reactions, all of which are common to lipofuscin and ceroids, plus an intense argentaffin reaction abolished by bleaching, indicative of a melanic substance. Lectin histochemistry showed, in decreasing order of frequency, the presence of alpha-D-mannose, sialic acid, beta-D-galactose (lactose), gal-beta-(1-3)acetyl-galactosamine, alpha-D-galactose, and alpha-L-fucose, but no terminal alpha-D-acetyl-galactosaminyl residues. CONCLUSIONS: The significant increase of apoptotic bodies in the lining colonic epithelium indicated that this type of cell death is not due to the natural programmed cell renewal, but to the action of laxatives. Because the autofluorescent pigment of melanosis coli contains melanin (as well as glycoconjugates) and is not dependent on age but on the use of anthranoid laxatives, it should be categorized as a "melanized ceroid." The lectin affinities of this pigment indicated that it contains a substantial number of saccharide residues almost similar to those found in the ceroid pigment of human aortic atheromas. These findings and considerations on the metabolism and pharmacokinetics of anthranoids suggested that the apoptotic epithelial cells, rather than the laxatives, may be the source of the pigment saccharides, whereas the precursors of the melanic substance may be derived from the anthranoids.

Pseudomelanosis duodeni in an adolescent male: case report and review of the literature.

Pseudomelanosis duodeni is rarely seen in children. It manifests endoscopically as peppery speckles in the duodenal mucosa. This pigment corresponds principally to accumulation of ferrous sulfide in macrophages within the lamina propria. We report the case of a 16-year-old boy with ectodermal dysplasia who underwent renal transplantation for vesicoureteral reflux and later developed epigastric pain. Endoscopic and pathologic findings in the duodenal mucosa were typical of pseudomelanosis duodeni. A review of the literature reveals shared clinical features among reported adult and pediatric cases, including chronic renal failure, use of antihypertensive medication and oral iron supplementation, and/or presence of gastric hemorrhage.

Pseudomelanosis duodeni: a case report with electron-probe X-ray analysis.

Pseudomelanosis of the duodenum is rare. Only 17 cases have been documented in the world literature. A 59-year-old man presented to Bankstown Hospital, New South Wales with dysphagia. On endoscopy, he was found to have melanosis of the duodenum in addition to oesophageal ulceration. It has been previously suggested that the pigment ferrous sulphide is derived from gastro-intestinal bleeding and lodged in the macrophages. A detailed examination of the pigment, including X-ray probe micro-analysis at various levels of the intestinal epithelium as well as in macrophages is presented.

Clinical and ultrastructural studies in duodenal pseudomelanosis.

Nine patients with duodenal pseudomelanosis are described: seven had endstage renal failure while one other patient had undergone renal transplantation. Eight of the nine had been on oral iron supplements. The pigment stained positively with Perls' stain for iron in five patients, positively with the Masson-Fontana method normally used to identify melanin in one, and positively with both methods in three. Electron probe x-ray analysis of the pigment on samples from six patients showed iron to be present in all six, while sulphur was present in five. Varying sulphur content of the pigment in different patients could account for differences in histochemical characteristics. Iron was also shown in the duodenal biopsies of 34 of 48 uraemic patients on oral iron supplements, but was present in only 22 of 120 patients endoscoped for miscellaneous conditions (p less than 0.001). We postulate that the pigment of duodenal pseudomelanosis is derived from iron absorbed from the lumen.