Systematic review of randomized controlled trials on interventions for melasma: an abridged Cochrane review

黄褐斑干预措施随机对照试验的系统评价：Cochrane综述节选版

Background: Multiple treatments exist for melasma; they are often substandard and associated with side effects.

Objectives: We sought to assess the effectiveness of interventions used in the management of all types of melasma.

Methods: We undertook a systematic review using the methodology of the Cochrane Collaboration.

Results: We included 20 studies with a total of 2125 participants covering 23 different treatments. A meta-analysis was not possible because of the heterogeneity of treatments. Triple-combination cream (hydroquinone, tretinoin, and fluocinolone acetonide) was more effective at lightening melasma than hydroquinone alone (relative risk 1.58, 95% confidence interval 1.26-1.97) or any of the agents in a dual-combination cream. Azelaic acid (20%) was significantly more effective than 2% hydroquinone (relative risk 1.25, 95% confidence interval 1.06-1.48) at lightening melasma. In 2 studies where tretinoin was compared with placebo, objective measures demonstrated significant reductions in the severity. However, only in 1 study did participants rate a significant improvement (relative risk 13, 95% confidence interval 1.88-89.74).

Limitations: There was poor methodology, a lack of standardized outcome assessments, and short duration of studies.

Conclusions: The current limited evidence supports the efficacy of multiple interventions. Randomized controlled trials on well-defined participants with long-term outcomes are needed.

背景：黄褐斑存在多种治疗方法；这些方法往往不够理想，并伴有副作用。

目的：我们旨在评估用于管理所有类型黄褐斑的干预措施的有效性。

方法：我们采用Cochrane协作网的方法学开展了一项系统评价。

结果：我们纳入了20项研究，共2125名参与者，涵盖23种不同的治疗方法。由于治疗措施的异质性，无法进行Meta分析。三联乳膏（氢醌、维A酸和氟轻松）在淡化黄褐斑方面比单用氢醌（相对危险度1.58，95%置信区间1.26-1.97）或双联组合霜中的任一成分更有效。20%壬二酸在淡化黄褐斑方面显著优于2%氢醌（相对危险度1.25，95%置信区间1.06-1.48）。在2项将维A酸与安慰剂进行比较的研究中，客观指标显示严重程度显著降低。然而，仅在一项研究中参与者评价有显著改善（相对危险度13，95%置信区间1.88-89.74）。

局限性：方法学质量差、缺乏标准化的结局评估以及研究持续时间短。

结论：当前有限的证据支持多种干预措施的有效性。需要在定义明确的参与者中开展具有长期结局的随机对照试验。

Jutley GS, Rajaratnam R, Halpern J, Salim A, Emmett C. Systematic review of randomized controlled trials on interventions for melasma: an abridged Cochrane review. J Am Acad Dermatol. 2014 Feb;70(2):369-73.

Systematic review of randomized .pdf