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Abstract
Facial hyperpigmentation is a broad term usually reflecting an increased amount of melanin either within the epidermis,the dermis, or both. Many factors might be responsible for facial hyperpigmentation and the increased pigment might be a local phenomenon or a manifestation of a generalized disorder. In addition, the hyperpigmentation might be acquired, congenital,or inherited.
Melasma is one of the causes of facial hyperpigmentation. It is a common cosmetic problem.
Treatment of melasma and other facial pigmentations has always been challenging and discouraging. Different modalities of treatment have been used but none of which is satisfactory. Those treatmens include several topical hypopigmenting agents eg:. Topical hydroquinone 2 to 4% alone or in combination with tretinoin 0.05 to 0.1%,Topical azelaic acid 15 to 20%,Topical kojic acid, and topical glycolic acid, etc .Also chemical peels using trichloroacetic acid, Jessner’s solution, Unna’s paste, [alpha]-hydroxy acid preparations, kojic acid, and salicylic acid. And laser therapies.
Mesotherapy is the technique of using micro injections of conventional or homeopathic compounds, for example, vitamins, minerals or amino acids, to deliver a healing or corrective treatment to a specific area of the body.
Many substances have been used in mesotherapy for depigmentation. The following chemicals act as antioxidants and are claimed to decrease pigmentation, such as: Glutathione, Ascorbic acid, Glycolic acid or Pyruvate .
Glutathione is an ubiquitous compound found in our bodies. It has many biologic functions, it has also been implicated in skin lightening. Glutathione induces the formation of pheomelanin from dopaquinone, resulting in the reduction of eumelanin formation .
Glutathione was mostly used as whitening agent and dark spots remover in the form of systemic therapy via oral and intra venous roots, and it was recommended by dermatologists and skin care experts. It also has many functions as it nourishes skin,makes skin stay supple,smooth,fresh and radiant,removes blemishes,prevents pimples,it also has anti-aging and anti-wrinkles effect,treats skin ulceration, and enhances healing of wounds.
Another recently used depigmenting agent is tranexamic acid, it prevents the production of melanin,and gradually minimize the hyperpigmentation caused by sun exposure. It helps to restore damaged skin caused by UVA,UVB, pollution and other environmental factors.
Kojic acid is another depigmenting agent,it is a fungal metabolic product that inhibits the activity of tyrosinase besides being a potent antioxidant. Kojic acid is used in concentrations of 1–4% for the treatment of hyperpigmentation disorders.
The aim of this work was to compare the safety and efficacy of localized intradermal microinjection (Mesotherapy) of glutathione versus a combination of tranexamic acid and kojic acid for treatment of melasma.
In our study 5 patients aged 28-51 with mean age 40 with melasma at malar region of at least 2 years duration and with mean duration 9.2 years ,underwent 6-10 treatment sessions of localized intradermal micro injections into their melasma lesions using Glutathione at the left malar area and a combination of kojic acid and tranexamic acid for the right malar area.
The melasma lesions on both sides started to improve after the second session and the improvement was progressing till the sixth session but the improvement became slower after the sixth session even in patients who completed 10 sessions.
In all patients and in both malar areas the darkness of melasma started to lighten first then the area involved started to decrease.
The response in both malar areas was variable in the patients it ranged from minimal to marked improvement And patients with epidermal type of malasma responded to treatment much better than patients with mixed and dermal types of melasma.
On evaluating the reduction of the mean MASI score we found that it decreased after treatment in both malar areas.
The reduction in MASI was statistically significant in the right malar area injected with the combination of kojic acid and tranexamic acid But it was statistically insignificant in the left malar area injected with glutathione.