Microneedling with cutaneous delivery of topical agents for the treatment of melasma: A systematic review.
efficacy
melasma
microneedling
safety
systematic review
Journal
Journal of cosmetic dermatology
ISSN: 1473-2165
Titre abrégé: J Cosmet Dermatol
Pays: England
ID NLM: 101130964
Informations de publication
Date de publication:
Nov 2022
Nov 2022
Historique:
revised:
20
06
2022
received:
17
02
2022
accepted:
01
08
2022
pubmed:
8
8
2022
medline:
28
12
2022
entrez:
7
8
2022
Statut:
ppublish
Résumé
Melasma is an acquired hyperpigmentation disorder. Microneedling is an alternative treatment for melasma especially by improving penetration of pharmacological agents into the skin. The main objective of this review was to systematize and analyze available evidence on the efficacy and safety of microneedling alone or associated with topical agents in reducing skin stains and improving melasma-related quality of life in adult patients. Only randomized clinical trials were included. The following databases were consulted: MEDLINE, Embase, Cochrane, and the gray literature. The Cochrane risk-of-bias tool for randomized trials (RoB 2.0) was used to assess risk of bias. The search retrieved 719 records and seven studies were included. A total of 368 participants (96.19% women) were evaluated. Two studies were split-face. Most of the studies evaluated microneedling associated with tranexamic acid. High risk of bias was presented by most studies, especially in the safety outcome. A significant decrease was observed in the MASI, mMASI, or hemi-MASI scores, regardless of the topical agents associated. Meta-analysis was not possible due to the heterogeneity of the studies. Based on the results of this review, microneedling can, in association with topical agents or isolated, be used safely in the treatment of melasma in the clinical practice, obtaining results on reduction of stain severity and improvement of patients' quality of life.
Sections du résumé
BACKGROUND
BACKGROUND
Melasma is an acquired hyperpigmentation disorder. Microneedling is an alternative treatment for melasma especially by improving penetration of pharmacological agents into the skin.
OBJECTIVE
OBJECTIVE
The main objective of this review was to systematize and analyze available evidence on the efficacy and safety of microneedling alone or associated with topical agents in reducing skin stains and improving melasma-related quality of life in adult patients.
METHODS
METHODS
Only randomized clinical trials were included. The following databases were consulted: MEDLINE, Embase, Cochrane, and the gray literature. The Cochrane risk-of-bias tool for randomized trials (RoB 2.0) was used to assess risk of bias.
RESULTS
RESULTS
The search retrieved 719 records and seven studies were included. A total of 368 participants (96.19% women) were evaluated. Two studies were split-face. Most of the studies evaluated microneedling associated with tranexamic acid. High risk of bias was presented by most studies, especially in the safety outcome. A significant decrease was observed in the MASI, mMASI, or hemi-MASI scores, regardless of the topical agents associated. Meta-analysis was not possible due to the heterogeneity of the studies.
CONCLUSION
CONCLUSIONS
Based on the results of this review, microneedling can, in association with topical agents or isolated, be used safely in the treatment of melasma in the clinical practice, obtaining results on reduction of stain severity and improvement of patients' quality of life.
Substances chimiques
Tranexamic Acid
6T84R30KC1
Types de publication
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5680-5695Subventions
Organisme : Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro
ID : 210.136/2021
Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Grimes PE, Ijaz S, Nashawati R, Kwak D. New oral and topical approaches for the treatment of melasma. Int J Womens Dermatol. 2019;5(1):30-36. doi:10.1016/j.ijwd.2018.09.004
Neagu N, Conforti C, Agozzino M, et al. Melasma treatment: a systematic review. J Dermatolog Treat. 2021;33:1816-1837. doi:10.1080/09546634.2021.1914313
Ogbechie-Godec OA, Elbuluk N. Melasma: an up-to-date comprehensive review. Dermatol Ther. 2017;7(3):305-318. doi:10.1007/s13555-017-0194-1
Lima EDA, Lima M de A, Takano D.Microagulhamento: Estudo experimental e classificação da injúria provocada. Surg Cosmet Dermatol 2013;5(2):110-114. Accessed October 30, 2021. https://docs.bvsalud.org/biblioref/2016/10/2169/2013_110_ingles.pdf
Hou A, Cohen B, Haimovic A, Elbuluk N. Microneedling: a comprehensive review. Dermatol Surg. 2017;43(3):321-339. doi:10.1097/DSS.0000000000000924
Cassiano D Espósito AC, Hassun K, Lima E de A, Bagatin E, Miot H Early clinical and histological changes induced by microneedling in facial melasma: a pilot study. Indian J Dermatol Venereol Leprol 2019;85(6):638-641. doi:10.4103/ijdvl.ijdvl_44_19
Bailey AJM, Li HOY, Tan MG, Cheng W, Dover JS. Microneedling as an adjuvant to topical therapies for melasma: a systematic review and meta-analysis. J Am Acad Dermatol. 2021;86:797-810. doi:10.1016/j.jaad.2021.03.116
Wu SZ, Muddasani S, Alam M. A systematic review of the efficacy and safety of microneedling in the treatment of melasma. Dermatol Surg. 2020;46(12):1636-1641. doi:10.1097/DSS.0000000000002763
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA statement: an updated guideline for reporting systematic reviews. BMJ. 2020;372:n71. doi:10.1136/bmj.n71
Cochrane Handbook for Systematic Reviews of Interventions Cochrane Training. Accessed October 30, 2021. https://training.cochrane.org/handbook/current
Pandya AG, Hynan LS, Bhore R, et al. Reliability assessment and validation of the melasma area and severity index (MASI) and a new modified MASI scoring method. J Am Acad Dermatol. 2011;64(1):78-83.e2. doi:10.1016/j.jaad.2009.10.051
Mekawy KMM, Sadek A, Seddeik Abdel-Hameed AK. Micro-needling versus fractional carbon dioxide laser for delivery of tranexamic acid in the treatment of melasma: A split-face study. J Cosmet Dermatol. 2021;20(2):460-465. doi:10.1111/jocd.13537
Balkrishnan R, McMichael AJ, Camacho FT, et al. Development and validation of a health-related quality of life instrument for women with melasma. Br J Dermatol. 2003;149(3):572-577. doi:10.1046/j.1365-2133.2003.05419.x
Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). 2019. Accessed October 30, 2021. https://drive.google.com/file/d/19R9savfPdCHC8XLz2iiMvL_71lPJERWK/view
Kaur A, Bhalla M, Pal Thami G, Sandhu J. Clinical efficacy of topical tranexamic acid with microneedling in melasma. Dermatol Surg. 2020;46(11):e96-e101. doi:10.1097/DSS.0000000000002520
Budamakuntla L, Loganathan E, Suresh D, et al. A randomised, open-label, comparative study of tranexamic acid microinjections and tranexamic acid with microneedling in patients with melasma. J Cutan Aesthet Surg. 2013;6(3):139-143. doi:10.4103/0974-2077.118403
Cassiano D, Esposito ACC, Hassun K, et al. Efficacy and safety of microneedling and oral tranexamic acid in the treatment of facial melasma in women: an open, evaluator-blinded, randomized clinical trial. J Am Acad Dermatol. 2020;83(4):1176-1178. doi:10.1016/j.jaad.2020.02.002
Shamsi Meymandi S, Mozayyeni A, Shamsi Meymandi M, Aflatoonian M. Efficacy of microneedling plus topical 4% tranexamic acid solution vs 4% hydroquinone in the treatment of melasma: a single-blind randomized clinical trial. J Cosmet Dermatol. 2020;19(11):2906-2911. doi:10.1111/jocd.13392
Bergmann CLMDS, Pochmann D, Bergmann J, et al. The use of retinoic acid in association with microneedling in the treatment of epidermal melasma: efficacy and oxidative stress parameters. Arch Dermatol Res. 2021;313(8):695-704. doi:10.1007/s00403-020-02140-8
Saleh FY, Abdel-Azim ES, Ragaie MH, Guendy MG. Topical tranexamic acid with microneedling versus microneedling alone in treatment of melasma: clinical, histopathologic, and immunohistochemical study. J Egypt Women's Dermatol Soc. 2019;16(2):89-96. doi:10.4103/JEWD.JEWD_25_19
Liu Y, Wu S, Wu H, Liang X, Guo D, Zhuo F. Comparison of the efficacy of melasma treatments: a network meta-analysis of randomized controlled trials. Front Med. 2021;8:713554. doi:10.3389/fmed.2021.713554
Ebrahim HM, Said Abdelshafy A, Khattab F, Gharib K. Tranexamic acid for melasma treatment: a Split-face study. Dermatol Surg. 2020;46(11):e102-e107. doi:10.1097/DSS.0000000000002449
Gowda A, Do BH, Ezaldein H, Do MM. A systematic review examining the potential adverse effects of microneedling. J Clin Aesthet Dermatol. 2021;14(1):45-54. doi:10.1371/journal
Alster TS, Graham PM. Microneedling: a review and practical guide. Dermatol Surg. 2018;44(3):397-404. doi:10.1097/DSS.0000000000001248
Ramaut L, Hoeksema H, Pirayesh A, Stillaert F, Monstrey S. Microneedling: where do we stand now? A systematic review of the literature. J Plast Reconstr Aesthet Surg. 2018;71(1):1-14. doi:10.1016/j.bjps.2017.06.006