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International Journal of Dermatology Sep 2017Currently available treatment options for melasma include prevention of UV radiation, topical lightening agents, chemical peels, and light-based and laser therapies.... (Review)
Review
Currently available treatment options for melasma include prevention of UV radiation, topical lightening agents, chemical peels, and light-based and laser therapies. However, none have shown effective and sustained results, with incomplete clearance and frequent recurrences. There has been increasing interest recently in oral medications and dietary supplements in improving melasma. We sought to evaluate the efficacy and safety/tolerability of oral medications and dietary supplements for the treatment of melasma. Multiple databases were systematically searched for randomized clinical trials (RCTs) evaluating the use of oral medication for treatment of melasma alone or in combination with other treatments. A total of eight RCTs met inclusion criteria. Oral medications and dietary supplements evaluated include tranexamic acid, Polypodium leucotomos extract, beta-carotenoid, melatonin, and procyanidin. These agents appear to have a beneficial effect on melasma improvement. In conclusion, oral medications have a role in melasma treatment and have been shown to be efficacious and tolerable with a minimal number and severity of adverse events. Therefore, dermatologists should keep oral medications and dietary supplements in their armamentarium for the treatment of melasma.
Topics: Administration, Oral; Antifibrinolytic Agents; Antioxidants; Biflavonoids; Carotenoids; Catechin; Dietary Supplements; Humans; Melanosis; Melatonin; Phytotherapy; Plant Extracts; Polypodium; Proanthocyanidins; Randomized Controlled Trials as Topic; Tranexamic Acid
PubMed: 28239840
DOI: 10.1111/ijd.13578 -
Journal of Cosmetic Dermatology Apr 2023Various topical agents have been used to treat melasma; however, a large-scale evaluation among the currently available treatment is lacking. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Various topical agents have been used to treat melasma; however, a large-scale evaluation among the currently available treatment is lacking.
OBJECTIVES
The aim of this study was to evaluate the efficacy and safety of topical agents for melasma.
METHODS
The MEDLINE, Embase, Web of Science, Cochrane, and Alt-Healthwatch databases were searched in November 2021. Original studies that reported pre- and post-treatment Melasma Area Severity Index (MASI)/modified Melasma Area Severity Index (mMASI) scores and/or adverse effects (AEs) were eligible for inclusion. The main outcome was the efficacy analyzed by the changes in the pre- and post-treatment with standardized mean difference (SMD) of MASI/mMASI scores; the AEs were calculated with incidence proportion by the reported percentage of skin irritations.
RESULTS
A total of 45 studies (2359 patients) and 55 studies (4539 patients) met the inclusion criteria for efficacy and AEs, respectively. Hydroquinone (HQ) monotherapy (SMD -1.3, 95% CI [-1.6 to -1.0]), HQ-containing combination therapy (-1.4, [-1.7 to -1.1]), cysteamine (-1.6, [-2.0 to -1.2]), tranexamic acid (-1.5, [-2.0 to -1.1]), azelaic acid (-1.3, [-1.7 to -1.0]), and kojic acid (-0.9, [-1.3 to -0.5]) demonstrated comparable efficacy, while zinc sulfate did not exhibit statistically significant improvement (-1.2, [-2.7 to 0.4]). HQ-containing combination therapy (50.9%) and cysteamine (42.2%) demonstrated the highest incidence of irritation, while azelaic acid (18.7%), kojic acid (5.3%), and tranexamic acid (0.8%) revealed a lower risk.
CONCLUSIONS
In this meta-analysis, non-HQ agents except zinc sulfate may be considered as an alternative to HQ-containing agents. However, treatment should be guided by patient's tolerance, availability, and physicians' experience.
Topics: Humans; Treatment Outcome; Tranexamic Acid; Cysteamine; Zinc Sulfate; Melanosis
PubMed: 36566490
DOI: 10.1111/jocd.15566 -
Journal of the American Academy of... Dec 2021Vitiligo is a common depigmenting disorder caused by the autoimmune destruction of melanocytes. Some evidence suggests the involvement of melanocytes in the auditory... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Vitiligo is a common depigmenting disorder caused by the autoimmune destruction of melanocytes. Some evidence suggests the involvement of melanocytes in the auditory system in the disease process. However, the relationship between vitiligo and sensorineural hearing loss (SNHL) remains uncertain.
OBJECTIVE
We investigated the association between vitiligo and SNHL.
METHODS
In this systematic review and meta-analysis, EMBASE, MEDLINE, PubMed, and the Cochrane database were searched for studies examining the association between SNHL and vitiligo from inception to June 28, 2020.
RESULTS
A total of 14 case-control studies with 938 patients with vitiligo were included. The meta-analysis showed a significant association of SNHL with vitiligo (odds ratio [OR] 6.02 [95% confidence interval {CI} 3.41-10.62]). The association remained significant after adjustment of study quality and publication bias, with ORs of 5.30 (95% CI 1.53-18.35), and 3.45 (95% CI 1.75-6.81), respectively.
LIMITATIONS
Heterogenous definition and measurement of hearing loss and racial differences are potential sources of bias.
CONCLUSION
The evidence to date supports an association of SNHL with vitiligo. These results suggest audiologic assessment for early recognition and management of hearing loss in patients with vitiligo.
Topics: Deafness; Hearing Loss; Hearing Loss, Sensorineural; Humans; Vitiligo
PubMed: 33359081
DOI: 10.1016/j.jaad.2020.12.029 -
The Cochrane Database of Systematic... Jan 2006Around 1% of the world's population has vitiligo, which causes a loss of skin colour in patches. The methods currently available to treat vitiligo are largely... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Around 1% of the world's population has vitiligo, which causes a loss of skin colour in patches. The methods currently available to treat vitiligo are largely unsatisfactory and vary widely between cultures and within health systems.
OBJECTIVES
To assess the effects of interventions used to manage vitiligo.
SEARCH STRATEGY
We searched the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED and other databases (last searched September 2004). Reference lists of articles and conference proceedings were searched. Authors of reviews were contacted.
SELECTION CRITERIA
Randomised controlled trials (RCTs).
DATA COLLECTION AND ANALYSIS
At least two reviewers independently assessed study eligibility and methodological quality and carried out data extraction. The included studies compared different interventions and used different outcome measures so we considered it inappropriate to combine their results.
MAIN RESULTS
Nineteen trials with a total of 1350 participants were included. The RCTs generally had low numbers of participants and only RCTs of repigmentation and not other methods of managing vitiligo were able to be included. In one study, potent topical steroids resulted in better repigmentation than placebo and they were also better than oral psoralens plus sunlight in another study (RR 4.70 95% CI 1.14 to 19.39) although their long-term use is limited by adverse effects. Two studies suggested that topical calcipotriol enhanced repigmentation rates from PUVAsol and PUVA when compared with placebo. Another two studies showed higher repigmentation rates with oral PUVAsol versus placebo plus sunlight (RR 19.20 95% CI 1.21 to 304.50 in 79 adults and RR 2.29 95% CI 1.14 to 4.58 in a study of 50 children). The safety of these interventions was poorly described and none of the studies was able to demonstrate long term benefits. Very few studies were carried out on children or included segmental vitiligo. No trials evaluating micropigmentation, melanocyte transplantation, depigmentation or cosmetic camouflage could be found. Despite the fact that the main impact of vitiligo is psychosocial only one study on psychological therapy was found and it is awaiting assessment.
AUTHORS' CONCLUSIONS
This review has found some evidence to support existing therapies for vitiligo, but the different designs and outcome measurements, lack of quality of life measures and adverse effect reporting in the studies limit the usefulness of their findings. There is a pressing need for high quality randomised trials using standardised measures of repigmentation and which address relevant clinical outcomes including quality of life.
Topics: Humans; PUVA Therapy; Randomized Controlled Trials as Topic; Steroids; Vitiligo
PubMed: 16437451
DOI: 10.1002/14651858.CD003263.pub3 -
Archives of Dermatological Research Dec 2023There is increasing demand for natural and sustainable products for the treatment of dermatologic conditions. This systematic review aims to critically analyze published... (Review)
Review
There is increasing demand for natural and sustainable products for the treatment of dermatologic conditions. This systematic review aims to critically analyze published randomized controlled trials (RCTs) and provide evidence-based recommendations on the therapeutic use of curcumin for a variety of dermatological diseases. A systematic search of published literature was performed on July 18, 2023 using PRISMA guidelines for turmeric or curcumin for the treatment of skin diseases. Clinical recommendations were made based on the Oxford Centre for Evidence-Based Medicine guidelines. We identified 18 original randomized controlled trials for use of turmeric or curcumin for psoriasis, radiation dermatitis, oral lichen planus, pruritis, vitiligo, tinea capitis, facial erythema, and scarring. Psoriasis, cesarean section scar, and pruritus received grade of recommendation B. Radiation dermatitis, oral lichen planus, vitiligo, tinea capitis, and facial redness received grade of recommendation C or D. Curcumin was demonstrated to have an excellent safety profile in all clinical trials analyzed. Further research is required to determine optimal dosing and treatment parameters of turmeric. Additional, larger, RCTs and non-RCTs should be conducted to further investigate the safety and efficacy of curcumin as a treatment option for dermatological diseases.
Topics: Humans; Curcumin; Lichen Planus, Oral; Vitiligo; Psoriasis; Tinea Capitis; Dermatitis
PubMed: 38085369
DOI: 10.1007/s00403-023-02754-8 -
Dermatologic Therapy Mar 2021Drug-induced acanthosis nigricans is an uncommon subtype of acanthosis nigricans and the data on this topic is not well understood by clinicians as it is presently... (Review)
Review
Drug-induced acanthosis nigricans is an uncommon subtype of acanthosis nigricans and the data on this topic is not well understood by clinicians as it is presently limited in the literature. Previous reports of drug-induced acanthosis nigricans have simply consisted of a list of drugs possibly implicated in causing acanthosis nigricans. Several drugs listed are based on single case reports without biopsy confirmation, report of clearing on stopping the drug or reporting on whether acanthosis nigricans recurred with drug rechallenge. A comprehensive literature search was conducted using PubMed, EMBASE(Ovid), Cochrane Library, Scopus, and Web of Science electronic databases. The authors screened the initial result of the search strategy by title and abstract using the following inclusion criteria: eligible studies included those with patients who developed acanthosis nigricans secondary to a drug. This study is the first to comprehensively review the drugs that have been implicated in the development of acanthosis nigricans. A total of 38 studies were included in the systematic review, and a total of 13 acanthosis nigricans inducing drugs were identified. Nicotinic acid and insulin were the two most significant drugs that were reported to cause acanthosis nigricans. By using the results of this study, we created a revised classification system of drug-induced acanthosis nigricans which can be used as a concise framework for clinicians to refer to.
Topics: Acanthosis Nigricans; Biopsy; Drug Eruptions; Humans; Neoplasm Recurrence, Local; Pharmaceutical Preparations
PubMed: 33480113
DOI: 10.1111/dth.14794 -
Expert Review of Clinical Pharmacology 2023Compound glycyrrhizin (CG) is widely used to treat vitiligo in China, and the efficacy and adverse events (AEs) of CG for vitiligo need further analysis. This study... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Compound glycyrrhizin (CG) is widely used to treat vitiligo in China, and the efficacy and adverse events (AEs) of CG for vitiligo need further analysis. This study aimed to systematically reevaluate the efficacy and safety of CG in the patients with vitiligo.
RESEARCH DESIGN AND METHODS
Eight literature databases were searched up to 31 December 2022, and randomized controlled trials which compared CG plus conventional treatments with conventional treatments alone were included.
RESULTS
17 studies with 1492 patients were included. The pooled results showed that the combination of CG and conventional treatments was superior to conventional treatments alone in the total efficacy rate (risk ratio (RR) = 1.54, 95% confidence interval (CI) = 1.40 to 1.69, < 0.00001), cure rate (RR = 1.62, 95%CI = 1.32 to 1.99, < 0.00001), the levels of serum IL-6, TNF-α, IL-17, and TGF-ß, and the ratio of CD4/CD8 T cell in blood. Moreover, few patients suffered from the mild and tolerable AEs of CG.
CONCLUSIONS
CG plus conventional treatments is an effective treatment for vitiligo with mild and tolerable AEs. More high-quality and large-sample studies are required in the future to provide more evidence of CG for vitiligo.
PROSPERO REGISTRATION
CRD42023401166.
Topics: Humans; Vitiligo; Glycyrrhizic Acid; Treatment Outcome; Tumor Necrosis Factor-alpha; Psoriasis
PubMed: 37218470
DOI: 10.1080/17512433.2023.2213887 -
Pediatric Dermatology Sep 2021Vulvar vitiligo (VV) and vulvar lichen sclerosus (VLS), both feature skin and mucosal hypo-/depigmentation. The aim of this study was to describe the clinical and... (Review)
Review
Vulvar vitiligo (VV) and vulvar lichen sclerosus (VLS), both feature skin and mucosal hypo-/depigmentation. The aim of this study was to describe the clinical and dermoscopic features of VV and VLS in the pediatric population, providing diagnostic clues, and to define their association. We performed a systematic literature review of the clinical and dermoscopic features of pediatric VV and VLS. An observational study was conducted on children affected by VLS associated with VV, referred to the Dermatology Unit of the Sant'Orsola Polyclinic in Bologna, Italy. Medical history, age at diagnosis, ethnicity, clinical and dermoscopic features, and symptoms were recorded for all patients. 124 cases of VLS and 10 cases of VV were reviewed. Clinical manifestations included hypo-/depigmented patches in both conditions, while ecchymosis/purpura and fissures/erosion were observed in VLS. Symptoms including pruritus, pain, or burning were reported only by VLS patients. In our study five patients with VLS associated with VV were retrieved. Clinical features included well-demarcated depigmented patches in VV and translucent areas, erythema, ecchymoses/purpura, and labial fusion in VLS. Dermoscopy showed white structureless areas with a whipped cream-like appearance, linear or dotted vessels, white chrysalis-like structures, erosion and red-purpuric blotches in VLS and reduced pigment network or pigment absence, intralesional spots of residual pigmentation and telangiectasias in VV. Symptoms were present in all patients. Both VV and VLS show hypo-/depigmented patches. In the presence of associated symptoms, possible VLS should be investigated with clinical and dermoscopic examination to achieve a prompt diagnosis.
Topics: Child; Female; Humans; Lichen Sclerosus et Atrophicus; Observational Studies as Topic; Skin; Vitiligo; Vulvar Lichen Sclerosus
PubMed: 34561885
DOI: 10.1111/pde.14771 -
The Cochrane Database of Systematic... Jan 2010Around one per cent of the world's population has vitiligo, a disease which causes white patches on the skin. There are a variety of treatments available, most of which... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Around one per cent of the world's population has vitiligo, a disease which causes white patches on the skin. There are a variety of treatments available, most of which are unsatisfactory.
OBJECTIVES
To assess all interventions used to manage vitiligo.
SEARCH STRATEGY
In November 2009 we updated searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library (Issue 4, 2009), MEDLINE, EMBASE, AMED, PsycINFO, LILACS and ongoing trials databases.
SELECTION CRITERIA
Randomised controlled trials (RCTs).
DATA COLLECTION AND ANALYSIS
At least 2 review authors independently assessed study eligibility and methodological quality, and carried out data extraction. Two of the 57 included studies could be combined for meta-analysis.
MAIN RESULTS
In this update, 57 trials, including 19 from the original review, were assessed with 3139 participants. Most of the RCTs, which covered a wide range of interventions, had fewer than 50 participants. All of the studies assessed repigmentation, 6 measured cessation of spread, and 5 investigated the effect of treatment on quality of life.Most of the studies assessed combination therapies which generally reported better results. New interventions include monochromatic excimer light (MEL), Polypodium leucotomos, melanocyte transplantation, oral antioxidants, Chinese zengse pill, and pimecrolimus. We analysed the data from 28 studies that met our outcome criteria of improvement in quality of life and greater than 75% repigmentation.Fifteen analyses from studies comparing various interventions showed a statistically significant difference between the proportions of participants achieving more than 75% repigmentation. The majority of analyses showing statistically significant differences were from studies that assessed combination interventions which generally included some form of light treatment.Topical preparations, in particular corticosteroids, reported most adverse effects. However, in the combination studies it was difficult to ascertain which treatment caused these effects. None of the studies was able to demonstrate long-term benefits. Very few studies were conducted on children or included segmental vitiligo. We found one study of psychological interventions and none evaluating micropigmentation, depigmentation, or cosmetic camouflage.
AUTHORS' CONCLUSIONS
This review has found some evidence from individual studies to support existing therapies for vitiligo, but the usefulness of the findings is limited by the different designs and outcome measurements and lack of quality of life measures. There is a need for follow-up studies to assess permanence of repigmentation as well as high quality randomised trials using standardised measures and which also address quality of life.
Topics: Combined Modality Therapy; Humans; PUVA Therapy; Quality of Life; Randomized Controlled Trials as Topic; Steroids; Vitiligo
PubMed: 20091542
DOI: 10.1002/14651858.CD003263.pub4 -
Dermatologic Therapy Dec 2022Melasma is a recurrent hypermelanosis disorder characterized by the appearance of brownish and symmetrical spots on the skin. It affects the quality of life and is... (Meta-Analysis)
Meta-Analysis Review
Melasma is a recurrent hypermelanosis disorder characterized by the appearance of brownish and symmetrical spots on the skin. It affects the quality of life and is resistant to available treatment approaches. Cysteamine has been reported as a promising depigmenting agent for melasma treatment and following formulation enhancement, its use is being reported. This review aimed to evaluate the efficacy of the use of depigmenting formulations containing 5% cysteamine in the treatment of patients with melasma. A systematic search was performed in PubMed, Science Direct, and Scielo databases until December 27, 2021, based on criteria selected by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Statistical analysis was performed with Review Manager 5.4 software. The risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomized Trials. A total of six studies containing 120 melasma patients treated with 5% cysteamine were included in this meta-analysis. The meta-analysis demonstrated that 5% cysteamine is effective for the treatment of patients with melasma (MD 6.26 [95% CI 3.68-8.83], p < 0.0001, I = 86%). In this review, through meta-analysis allows concluding that 5% cysteamine is effective in the treatment of melasma and presents a low probability of side or adverse effects.
Topics: Humans; Cysteamine; Quality of Life; Melanosis
PubMed: 36285354
DOI: 10.1111/dth.15961