Topical and Systemic Therapies in Melasma: A Systematic Review

黄褐斑的外用和系统治疗：一项系统评价

Introduction: Melasma is an acquired disorder, which presents with well-demarcated, brown-colored hyperpigmented macules, commonly involving the sun-exposed areas such as the face. It is a chronic and distressing condition, affecting the patients' quality of life, and has been conventionally treated with "first-line" agents including hydroquinone (HQ) alone or as a part of a triple combination cream (TCC), while "second-line" options include chemical peels, and third line options include laser therapy.

Materials and methods: A systematic search was performed for all topical and systemic treatments for melasma up till May 4, 2021, using the PubMed and EMBASE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The search terms "melasma" and "treatment" were used to search for the relevant articles on both these databases, and a total of 4020 articles were identified. After removing the duplicate entries and screening the titles, abstracts, and full-text articles, we identified 174 randomized controlled trials (RCTs) or controlled clinical trials.

Results: Based on our review, HQ, TCCs, sunscreens, kojic acid (KA), and azelaic acid receive grade A recommendation. Further large-scale studies are required to clearly establish the efficacy of topical vitamin C, resorcinol, and topical tranexamic acid (TXA). Several newer topical agents may play a role only as an add-on or second-line drugs or as maintenance therapy. Oral TXA has a strong recommendation, provided there are no contraindications. Procyanidins, Polypodium leucotomos (PL), and even synbiotics may be taken as adjuncts.

Discussion: Several newer topical and systemic agents with multimodal mechanisms of action have now become available, and the balance seems to be tipping in favor of these innovative modalities. However, it is worth mentioning that the choice of agent should be individualized and subject to availability in a particular country.

引言：黄褐斑是一种获得性皮肤病，表现为边界清楚的褐色色素沉着斑，通常累及面部等日光暴露区域。它是一种慢性且令人痛苦的疾病，影响患者的生活质量，传统上使用“一线”药物治疗，包括单用氢醌（HQ）或外用三联乳膏（TCC），而“二线”选择包括化学剥脱，“三线”选择包括激光治疗。

材料与方法：根据系统评价和Meta分析首选报告项目（PRISMA）方案，使用PubMed和EMBASE数据库对截至2021年5月4日的所有黄褐斑外用和系统治疗进行了系统检索。使用检索词“melasma”和“treatment”在两个数据库中检索相关文章，共识别出4020篇文章。在去除重复条目并筛选标题、摘要和全文后，我们确定了174项随机对照试验（RCT）或对照临床试验。

结果：根据我们的综述，HQ、TCC、防晒霜、曲酸（KA）和壬二酸获得A级推荐。需要进一步的大规模研究来明确外用维生素C、间苯二酚和外用氨甲环酸（TXA）的疗效。几种较新的外用药物可能仅作为附加治疗、二线药物或维持治疗发挥作用。口服TXA有强推荐，前提是无禁忌证。原花青素、水龙骨（PL）甚至合生元可作为辅助治疗。

讨论：目前已有多种具有多模式作用机制的较新外用和系统药物可供使用，天平似乎正倾向于这些创新模式。然而，值得一提的是，药物的选择应个体化，并取决于特定国家的可获得性。

Sarkar R, Handog EB, Das A, Bansal A, Macarayo MJ, Keshavmurthy V, Narayan V, Jagadeesan S, Pipo E 3rd, Ibaviosa GM, Podder I, Bansal S. Topical and Systemic Therapies in Melasma: A Systematic Review. Indian Dermatol Online J. 2023 Oct 27;14(6):769-781.

20231027-黄褐斑的局部和全身疗法 系统回顾.pdf