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Different dermoscopy pigmentation patterns of melasma patients: A, pseudoreticular pattern; B, globular pattern; C, dotted pattern; D, arcuate pattern; E, visible telangiectasis; F, perifollicular pattern
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Background
Melasma is a hard‐to‐manage disorder with considerable relapsing behavior. Dermoscopy emerged to help in comprehensive evaluation of pigmentary disordes and melasma.
Objective
To evaluate the potential role of dermoscopy in assessing melasma and monitoring the efficacy of 1064‐nm low‐fluence Q‐switched neodymium:yttrium‐aluminum‐garnet...
Citations
... Here, we focused on the following dermoscopic findings of pigmentary and vascular elements according to Abdel Hay et al. [13] : pseudo-reticular network, globular pattern, dotted pattern, arcuate pattern, visible telangiectasia, and perifollicular pigmentation. We rated the performance of those elements on a 4-point scale from 0 to 3, ranging from non-detectable to obvious, and calculated a total score for each hemiface. ...
Purpose: Melasma remains a refractory skin condition that needs to be actively explored. Azelaic acid has been used for decades as a topical agent to improve melasma through multiple mechanisms, however, there is a lack of research on its combination with laser therapy. This study evaluated the effectiveness of isolated treatment with topical 20% azelaic acid and its combination with 755-nm picosecond laser in facial melasma patients. Methods: A randomized, evaluator-blinded, controlled study was conducted on 30 subjects with facial melasma in a single center from October 2021 to April 2022. All subjects received topical 20% azelaic acid cream (AA) for 24 weeks, and after 4 weeks, a hemiface was randomly assigned to receive 755-nm picosecond (PS) laser therapy once every 4 weeks for 3 treatments. Treatment efficacy was determined by mMASI score evaluations, dermoscopic assessment, reflectance confocal microscopy (RCM) assessments and patient’s satisfaction assessments (PSA). Results: Treatment with 20% azelaic acid, with or without picosecond laser therapy, significantly reduced the hemi-mMASI score (P < 0.0001) and resulted in higher patient satisfaction. Improvements in dermoscopic and RCM assessments were observed in both sides of the face over time, with no difference between the two sides. RCM exhibited better dentritic cell improvement in the combined treatment side. No patients had serious adverse effects at the end of treatment or during the follow-up period. Conclusion: The additional use of picosecond laser therapy showed no clinical difference except for subtle differences detected by RCM assessments.
The study was registered in the Chinese Clinical Trial Registry (ChiCTR2100051294; 18 September 2021).
... 13 There was increased vascularization in 29 (72.5%) of patients and this is in line with the study done by Abdal hay, et al 14 and Kim et al (2007). 15 The patterns seen in melasma in our study were thin pigment network, brown granules, arcuate structures, honeycomb figures, telangiectasia . In conclusion, Dermoscope is a simple, convenient, without side effects and easy to use to diagnose and follow up patients of melasma. ...
Melasma, is a chronic acquired disorder of hypermelanosis of skin which is exposed to ultraviolet radiation. The clinical presentation is most often in the form of hyperpigmented patches over the face in three common patterns: Centrofacial, malar and mandibular. It is commonly seen in pigmented skin phenotypes (Fitzpatrick skin types III-V). The disease has an impact on the quality of life of patients. Dermoscopy is an in vivo noninvasive technique used to examine pigmented and amelanotic skin lesions. The technique is performed using a hand-held self-illuminating device called dermatoscope that visualizes features present under the skin surface.
: To study dermoscopic (dermatoscopic) features of melasma and to distinguish between epidermal and dermal melasma based on dermoscopic features.
: This study was conducted in an OPD in a clinic on 40 patients of melasma. Dermoscopy was done and their dermatoscopic features were recorded, melasma was classified as epidermal or dermal depending on dermatoscopic features.
: Dermatoscopic features of melasma seen were – Accentuation of pseudoreticular pigment network, light to dark brown in colour sparing of the periappendageal region (follicular and sweat gland openings), brown granules, blue- gray perifollicular accentuation honeycomb like reticular pattern and arcuate pigmented lines. 18 patients (45%) showed epidermal type 9 patients (22.5%) revealed dermal type of melasma, 13 patients showed mixed features (epidermal and dermal). Melasma with steroid abuse showed marked erythema and telangiectasia.
Dermatoscope is a valuable aid to diagnose, classify and to monitor treatment of melasma.
... 6 Mixed melasma gives mixed results, with enhancement in certain areas and no enhancement in others. 7 Dermoscopy is a non-invasive, in vivo technique primarily used to examine skin lesions. It allows the visualisation of subsurface skin structures that are usually not visible to the naked eye. ...
Objective: To find the concordance of Dermoscopic and Wood’s lamp findings in melasma patients. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Kharian Pakistan, from Nov 2020 to Sep 2021. Methodology: A total of sixty patients clinically classified as melasma were enrolled in the study. Clinical assessment was done, and patients were examined with Wood’s lamp and Dermoscope, and findings were recorded. Results: The results of concordance of Wood’s lamp findings and Dermoscopic findings were significant as analysed by Kappa Statistics where value of k was 0.597 and p-value was <0.001. Conclusion: Dermoscopy is a newer and more advanced tool. It should be used as a screening and diagnostic tool for melasma and other pigmentation disorders in our Outpatient Departments for earlier subtyping of melasma, deciding the treatment choice and predicting prognosis.
... This quick guide demonstrates the value of dermoscopy before, during, and after the treatment of a wide variety of vascular and other skin lesions with laser and/or intense pulsed light (IPL). Abdel Hay et al., 2020 [13] Dermoscopy as a useful tool for evaluating melasma and assessing the response to 1064-nm Q-switched Nd: YAG laser. ...
... Abdel et al. [13] have demonstrated the "dermoscopic score of pigmentary and vascular elements" and displayed significant change and confirmed the improvement and concluded dermoscopy is superior to other methods for melasma evaluation. Dermoscopy helps to track the pigment improvement at onset and following subsequent sessions of low-fluence laser toning. ...
Lasers have revolutionized the interventional dermatology field over the last two decades. Dermatologic conditions previously untreatable are now treated with lasers and lights. A large number of laser systems with advances in technologies have expanded applications of lasers for conditions like birth marks, acne scars, wrinkles, pigmentation, etc. Newer avenues and protocols are now set to treat skin conditions with lasers. The applicability of laser for any indication is dependent on laser tissue interaction which is well documented. For a successful outcome with laser therapy, a right end point of treatment should be achieved. The laser physician often adjusts parameters for laser therapy depending on tissue response, the ultimate aim being achieving optimum outcome with minimum side effects. Gadget based skin evaluation techniques are now an integral part of dermatology and are extending to interventional dermatology too. Application of dermoscopy before, during, and after lasers in various indications has been documented and reviewed. The representative cases highlighted in article emphasize the added dimension to non-invasive diagnostic capabilities of a dermatologist by enabling subsurface microscopy and enhancing therapy outcomes, and incorporation of these into daily practice offers value addition to not only evaluation but also gauging response to therapies. Use of dermoscopy before, during, and after laser therapies is an invaluable non-invasive tool to assess the right indication, initiate appropriate priming, achieve good end point, gauge untoward side effects, achieve good results, and engage patient confidentiality. Comparison of high magnification digital images is also enabled by digital videodermoscopy. Structured studies and protocols are needed to standardize the use of dermoscopy integrated with laser procedures.
... Te total mMASI score for each side ranges from 0 to 12. (iii) Dermoscopic evaluation: Te same physician used a Canon-600D camera (Canon Inc., Tokyo, Japan) and a portable dermoscope (DermLite, Dana Point, USA) to evaluate the fxed parts of the patients guided by anatomical indicators. Te dermoscopic score was calculated based on the dermoscopic score of pigmentary and vascular elements in melasma [21], divided into six dermoscopic fndings (pseudoreticular network, globular pattern, dotted pattern, arcuate pattern, visible telangiectasia, and perifollicular pigmentation), and scored from 0 to 3 points for each (0: not detected, 1: hardly detected, 2: detected, and 3: obvious). (iv) Te melanin index (MI): MI was measured at baseline, 4, 8, and 16 weeks using a spectrophotometer (Cortex Technology, Hadsund, Denmark) placed directly on the skin lesions for 2 min in a room with constant temperature (20-24°C) and humidity (28-38%). ...
... In particular, our study evaluated treatment responses in melasma using dermoscopic scoring, which visualizes the clinical patterns of skin structures that are not visible to the naked eye. Previous studies have reported that dermoscopic evaluation is superior to other evaluation tools such as Wood's light, in terms of pigmentation and vascularity detection [21,43,44]. Our study found a signifcant improvement in the pseudoreticular network and globular pattern after picosecond ND-YAG laser treatment. ...
... Our study found a signifcant improvement in the pseudoreticular network and globular pattern after picosecond ND-YAG laser treatment. Te PTP-mode Q-switched ND-YAG laser also showed a signifcant reduction in the globular pattern, consistent with a previous study [21]. In the vascular components of melasma, both laser treatments did not change in our study. ...
Melasma is a challenging pigmentation disorder to treat, and although low-fluence 1064 nm picosecond ND-YAG lasers have shown potential for treating benign pigmented disorders, data on the use of this laser for melasma treatment are currently insufficient. In this prospective split-face study, twenty-four patients with melasma on the face were enrolled and randomly assigned to receive treatment on one side of the face either with a low-fluence 1064 nm picosecond ND-YAG laser or with a low-fluence PTP mode 1064 nm Q-switched ND-YAG laser. Laser treatment was performed 5 times at intervals of 2 weeks, with evaluation conducted before each treatment and 2 months after the completion of 5 treatments. Clinical pictures using a standardized, digital photographic system and dermoscopy were taken on each day of the visit. The modified melasma area severity index (mMASI), melanin index (MI), dermoscopic scores of the pigmentary and vascular elements in melasma, pain during laser treatment, and patient satisfaction score were recorded. Twenty-one participants completed the study, and from week 2 in both groups, a significant decrease in mMASI and MI were confirmed. Although no statistically significant difference was observed, the decrease in mMASI and MI were greater in the 1064 nm picosecond ND-YAG laser group than in the 1064 nm Q-switched ND-YAG laser group. The 1064 nm picosecond ND-YAG laser group showed significant improvement in the pseudoreticular network and globular pattern of dermoscopic features between week 0 and week 16, while significant improvement in the globular pattern was shown in the 1064 nm Q-switched ND-YAG laser group. No significant difference was observed between the two groups in terms of the patient satisfaction score and pain during laser treatments. Notably, no adverse events were observed in either group. In conclusion, our study demonstrated that a low-fluence 1064 nm picosecond ND-YAG laser is as effective and safe in the treatment of melasma as a low-fluence PTP mode 1064 nm Q-switched ND-YAG laser.
... 16,17 Studies have shown that dermoscopy is a favorable method for evaluating melasma, it helps to classify it objectively, according to the depth of melanin deposition in the skin layers, as well as to visualize the vascular component and the detailed modifications in the treatment monitoring. 11,18,19,[20][21][22][23][24] The basic dermoscopic criteria and terminology standardized by the International Dermoscopy Society with validation for skin of color has been recently described 9 to characterize dermoscopic structures of facial hyperpigmented dermatoses in dark-skinned patients and to identify possible clues that may help the differential diagnosis of clinically similar conditions. Dermoscopic colors seen in melasma: brown (relates to melanin in the basal layer of epidermis or superficial dermis) and gray (correlated to melanin in the papillary dermis). ...
Background:
Melasma is a common hypermelanosis characterized by symmetrical brownish macules, especially on the face. Histologic analysis demonstrates increased epidermal and dermal melanin. Dermoscopy is useful to estimate the depth of the melanin and may help in the diagnosis and classification of melasma, with therapeutic importance.
Objectives:
To evaluate the diagnostic concordance of dermoscopic classification of epidermal or mixed subtypes of melasma and the correlation between dermoscopic and histopathological findings.
Methods:
Twenty-eight women with facial melasma, phototypes III to V, ages between 30 and 61 years were selected. Based on the evaluation of clinical and dermoscopic images, two independent observers classified melasma into epidermal or mixed subtypes. The intra and interobserver concordances were calculated. Histopathological analysis of epidermal melanin extension and maximum number of melanophages per high-power field (400X; HPF) have been assessed. Association between the melanophages count and the dermoscopic classification was evaluated.
Results:
Intraobserver agreement was 82.1%, and between observers, from 78.6% to 89.3%, according to the Kappa index. Histopathology revealed increased intraepidermal melanin and the presence of dermal melanophages in all the samples. Ten or more melanophages / HPF was significantly associated with mixed melasma.
Conclusions:
Moderate to substantial concordance in the dermoscopic classification of melasma was found, and the correlation between this classification and the dermal melanophages count have been suggested. Intradermal component of every case of melasma should be considered for therapeutic and prognostic purposes.
... It can evaluate the type of melasma by inspecting the color pattern and depth of pigmentation in addition to the assessment of treatment response. [9][10][11] This study aimed to assess and compare the efficacy of TXA intradermal microinjection alone versus its combination with low-power, low-density fractional CO 2 laser in a sequential pattern in the treatment of melasma. ...
... A proposed score was given to each individual variable where "not detected 5 0", "hardly detected 5 1", "detected 5 2", and "obvious 5 3". 11 The total dermoscopy score (TDS) was calculated by adding the 6 variables' scores. ...
Background:
Melasma is a challenging pigmentation disorder.
Objective:
To assess and compare the efficacy of tranexamic acid (TXA) intradermal microinjection alone versus its combination with low-power, low-density fractional CO2 laser in a sequential pattern in melasma.
Patients and methods:
This study included 29 patients with melasma. Half of the face was randomly assigned to fractional CO2 laser; the other half to TXA. This split-face session was repeated every 6 weeks for 3 sessions. In between, TXA was applied to the full face every 2 weeks. Treatment duration was 4 months. Dermoscopy, melanin index (M.I), and erythema index (E.I) were evaluated at baseline and 4 weeks after the last session.
Results:
Melanin index, E.I, total dermoscopic score and different dermoscopic patterns of pigmentation, and vascular features showed significant reduction posttreatment on both sides of the face. No statistically significant difference was found regarding the degree and percentage of improvement in M.I, E.I, and total dermoscopic score between both sides.
Conclusion:
Tranexamic acid microinjection alone or combined with low-power, low-density fractional CO2 laser in a sequential pattern are comparatively effective and safe for melasma treatment; however, combined treatment is recommended. Dermoscopy is an essential noninvasive tool in the assessment of melasma and monitoring patients' response to treatment.
... Erythema and burning were the most common side effects. In this study, the participant numbers for NAFL (27), PICO (20), AA (64), tVC (31), and IPL (47) were too less to be statistically analyzed. Given each treatment with more than 80 participants was considered significant, the ranking of side effects with percentage (n/N%) in ascending order was tretinoin (10.19%), oTA (17.65%), ...
... Definitely, large-spot and low-energy QSND has been widely used to treat melasma, and the curative effect is obvious (24)(25)(26). Abdel et al. confirmed the effectiveness of QSND for melasma by observing the changes in dermatoscopy and in vivo confocal microscopy (27,28). IPL ranked second with only three studies, and IPL-based combination therapy was discussed in two studies. ...
Background: Melasma is an acquired pigmentation disorder with challenges in treatment because of its refractory nature and high risk of recurrence.
Objectives: This study aimed to compare the efficacy and side effects of 14 common therapies for melasma using a systematic review and network meta-analysis (NMA).
Methods: The PubMed, Embase, and Cochrane Library databases were searched till December 2020 using the melasma area and severity index as a therapeutic index. A total of 59 randomized controlled trials (RCTs) met the inclusion criteria and were selected.
Results: The ranking of relative efficacy compared with placebo in descending order was Q-switched Nd:Yag 1,064-nm laser (QSND), intense pulsed light, ablative fractional laser (AFL), triple combined cream (TCC), topical vitamin C, oral tranexamic acid (oTA), peeling, azelaic acid, microneedles (MNs), topical tranexamic acid (tTA), tretinoin, picosecond laser, hydroquinone (HQ), and non-AFL. Moreover, QSND was more effective than HQ and tTA against melasma. The ranking of percentage (%) of side effects in ascending order for each of 14 therapies with more than 80 participants was tretinoin (10.1%), oTA (17.6%), HQ (18.2%), AFL (20.0%), QSND (21.5%), TCC (25.7%), tTA (36.75%), peeling (38.0%), and MN (52.3%). Taking both efficacy and safety into consideration, TCC was found to be the most favorable selection among the topical drugs for melasma. QSND and AFL were still the best ways to treat melasma among photoelectric devices. oTA as system administration was a promising way recommended for melasma. Among 31 studies, 87% (27/31) studies showed that the efficacy of combination therapies is superior to that of single therapy. The quality of evidence in this study was generally high because of nearly 50% of split-face RCTs.
Conclusions: Based on the published studies, this NMA indicated that QSND, AFL, TCC, and oTA would be the preferred ways to treat melasma for dermatologists. However, more attention should be paid to the efficacy and safety simultaneously during the clinical application. Most of the results were in line with those of the previous studies, but a large number of RCTs should be included for validation or update.
Systematic Review Registration: identifier: CRD42021239203.
... Dermoscopic features of melasma include light/dark brown, grey or blue pseudonetwork (pigmentation with follicular and appendages ostia sparing) and, less commonly, telangiectasias (which are usually less thick than steroid overuse-induced vessels) as well as pigmented annular or arcuate structures, dots and globules [49][50][51][52][53][54]. ...
... The role of dermoscopy in therapeutic management of melasma has been investigated by several studies including patients treated with either topical treatments (tranexamic acid, hydroquinone, and combinations of hydroquinone, glycolic acid and hyaluronic acid) or laser therapies [49][50][51][52][53][54]. Besides the use of this technique in following up lesions changes during the treatment to see the attenuation/regression of pigmentary and vascular structures, dermoscopic examination also has a role in predicting therapeutic response in melasma as it allow one to establish the deepness of the lesions, i.e. epidermal (dark to light brown colour and sharp edges), dermal (grey to blue colour with ill-defined margins with or without annular/arcuate pigmented structures) or mixed (combination of dermoscopic findings), with the last two variants being notoriously more resistant to therapies [49][50][51][52][53][54]. ...
... The role of dermoscopy in therapeutic management of melasma has been investigated by several studies including patients treated with either topical treatments (tranexamic acid, hydroquinone, and combinations of hydroquinone, glycolic acid and hyaluronic acid) or laser therapies [49][50][51][52][53][54]. Besides the use of this technique in following up lesions changes during the treatment to see the attenuation/regression of pigmentary and vascular structures, dermoscopic examination also has a role in predicting therapeutic response in melasma as it allow one to establish the deepness of the lesions, i.e. epidermal (dark to light brown colour and sharp edges), dermal (grey to blue colour with ill-defined margins with or without annular/arcuate pigmented structures) or mixed (combination of dermoscopic findings), with the last two variants being notoriously more resistant to therapies [49][50][51][52][53][54]. ...
Besides the well-known use in supporting the non-invasive diagnosis of non-tumoral dermatoses (general dermatology), dermoscopy has been shown to be a promising tool also in predicting and monitoring therapeutic outcomes of such conditions, with the consequent improvement/optimization of their treatment. In the present paper, we sought to provide an up-to-date overview on the use of dermoscopy in highlighting response predictor factors and evaluating therapeutic results in the field of general dermatology according to the current literature data. Several dermatoses may somehow benefit from such applications, including inflammatory conditions (psoriasis, lichen planus, dermatitis, granulomatous conditions, erythro-telangiectatic rosacea, Zoon balanitis and vulvitis, cutaneous mastocytosis, morphea and extra-genital lichen sclerosus), pigmentary disorders (vitiligo and melasma) and infectious dermatoses (scabies, pediculosis, demodicosis and viral warts).
Background
Melasma is a common pigmentary and photoaging disorder. Although various treatments, including 1,064‐nm Q‐switched neodymium‐doped yttrium aluminum garnet (QS‐Nd: YAG) laser toning, are available for melasma, results are often unsatisfactory.
Objective
We aimed to determine the efficacy and safety of 532‐nm QS‐Nd: YAG laser (shortwave toning) in patients with melasma and facial rejuvenation.
Methods
Fifty‐two patients were recruited to receive either 1,064‐nm QS‐Nd: YAG laser or 532‐nm QS‐Nd: YAG laser every 2 weeks for 8 sessions and a 2‐month follow‐up visit in a randomized controlled double‐blinded study. The primary outcome measure was the Melasma Area and Severity Index (MASI) score. Dermoscope and high‐frequency ultrasound (HFUS) were used to assess the improvement of melasma and photoaging.
Results
532‐nm QS‐Nd: YAG laser achieved significantly higher improvement in the MASI score ( P = 0.000). The Dermoscopic melasma score (DMS) displayed significant change and confirmed the improvement. HFUS showed a significant decrease in the thickness of the subepidermal low‐echogenic band (SLEB) and increases in dermal thickness and dermal density in both groups ( P = 0.000 for all). The rate of very satisfied responses was significantly higher in the 532‐nm laser group ( P = 0.001). There was no significant difference in the visual analog scale pain assessment score ( P = 0.248) and recurrence rate ( P = 0.734) between the two groups.
Conclusion
532‐nm QS‐Nd: YAG laser (shortwave toning) proved to be an effective and safe treatment for melasma and rejuvenation. Shortwave toning was significantly better for pigmentation clearance, while 1,064‐nm laser showed better improvement in skin rejuvenation.
