EDITORIAL ESPANOL:

====================

Hola amigos DERMAGICOS, el melasma, patología difícil de tratar, reto para todo dermatólogo, ácido azelaico, hidroquinona, ácido Kójico, laser, tretinoína, ácido glicólico y muchos otros más. Estas 11 referencias nos ilustran algo el tema. Últimamente asociado a helicobacter Pylori. 

Dermagic se despide hasta Enero, entrando en receso a partir del día de hoy, envie 23 ediciones que espero hallan gustado, Feliz Navidad Para todos y Feliz año nuevo...si tengo algo de tiempo liberare los MIÉRCOLES una edición corta.

Saludos,,,

José

 EDITORIAL ENGLISH:

===================

Hello DERMAGIC'S friends, the melasma, pathology difficult to treat,a challenge for all dermatologist, azelaic acid, hydroquinone, Kojic acid, laser, tretinoin, glycolic acid and many other more. These 11 references illustrate us something the topic. Lately associated to Helicobacter Pylori. 

DERMAGIC says goodbye until January, entering in recess starting from today's day, send 23 editions that I wait you find liked, Merry Christmas For all and Happy new year...If I have time I will liberate on Wednesdays a short edition,, 

Greetings,,,

José

======================================================================

DERMAGIC/EXPRESS(23)

======================================================================

MELASMA 

======================================================================

1.) Laser treatment of pigmented lesions.

2.) Glycolic acid peels in the treatment of melasma among Asian women.

3.) Utilizing the ultraviolet (UV detect) camera to enhance the appearance of photodamage and other skin conditions.

4.) Treatment of melasma with Jessner's solution versus glycolic acid: a comparison of clinical efficacy and evaluation of the predictive ability of Wood's light examination.

5.) Melasma of the forearms.

6.) Effect of pituitary and ovarian hormones on human melanocytes in vitro.

7.) Common disorders of pigmentation: when are more than cosmetic cover-

ups required?

8.) Melanin hyperpigmentation of skin: melasma, topical treatment with azelaic acid, and other therapies.

9.) The combination of glycolic acid and hydroquinone or kojic acid for the treatment of melasma and related conditions.

10.) Enhancement of the depigmenting effect of hydroquinone by cystamine and buthionine sulfoximine.

11.) Melasma. Etiologic and therapeutic considerations.

========================================================================

1.) Laser treatment of pigmented lesions.

========================================================================

Goldberg DJ

Department of Dermatologic Surgery, New Jersey Medical School, Newark, USA.

Dermatol Clin (UNITED STATES) Jul 1997 15 (3) p397-407 ISSN: 0733-8635

Language: ENGLISH

Document Type: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL 

Journal Announcement: 9709

Subfile: INDEX MEDICUS

Several pigment-specific lasers can effectively treat epidermal and dermal 

pigmented lesions without complications using the basic principles of selective 

photothermolysis. Although such pigmented lesions as solar lentigines and nevi of 

Ota are relatively easy to treat using pigment-specific laser technology, cafe-au-

lait macules and melasma show variable responses to treatment. New, long-pulsed 

pigment-specific lasers may prove to further enhance the clinical results obtained in 

resistant pigmented lesions and other conditions. (43 References)

========================================================================

2.) Glycolic acid peels in the treatment of melasma among Asian women.

========================================================================

Lim JT; Tham SN

National Skin Centre, Singapore.

Dermatol Surg (UNITED STATES) Mar 1997 23 (3) p177-9 ISSN: 1076-0512

Language: ENGLISH

Document Type: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL 

Journal Announcement: 9708

Subfile: INDEX MEDICUS

BACKGROUND: Melasma is a common disorder of facial hyperpigmentation among Asian 

women. Many modalities of treatment are available but none is satisfactory. 

OBJECTIVE: This study was undertaken to see if glycolic acid peels are effective and 

safe in the treatment of melasma and fine facial wrinkling. METHODS: Ten Asian women 

with moderate to severe melasma were recruited into the study. The women had twice 

daily applications of a cream containing 10% glycolic acid and 2% hydroquinone 

(Neostrata AHA Age Spot and Skin Lightening Gel) to both sides of the face, and 

glycolic acid peels every 3 weeks (20-70%) to one-half of the face using Neostrata 

Skin Rejuvenation System. All patients had to use a sunblock (SPF 15%). At regular 

intervals and at the end of 26 weeks (or after eight peels) the degree of improvement 

of pigmentation and fine facial wrinkling on each side of the face were assessed. 

Any skin irritation or side effects were also noted. Assessment was by an 

independent dermatologist, the patients themselves, and the use of the Munsell color 

chart and photographs. The nonparametric Wilcoxon Rank-Sum test was used for 

statistical analysis. RESULTS: The melasma and fine facial wrinkling improved on 

both sides of the face. The side that received glycolic acid peels did better but 

the results were not statistically significant (P > 0.059). CONCLUSION: A cream 

containing 10% glycolic acid and 2% hydroquinone (Neostrata AHA Age Spot and Skin 

Lightening Gel) improved melasma and fine facial wrinkling in Asian women. In 

combination with glycolic acid peels at 3-week intervals the lightening of melasma is 

subjectively much better. This improvement does not reach statistical significance 

and the sample size is small (n = 10).

========================================================================

3.) Utilizing the ultraviolet (UV detect) camera to enhance the appearance of photodamage and other skin conditions.

========================================================================

Fulton JE Jr

Dermatol Surg (UNITED STATES) Mar 1997 23 (3) p163-9 ISSN: 1076-0512

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9708

Subfile: INDEX MEDICUS

BACKGROUND: Ultraviolet (UV) light (Wood's light) has been used since 1903 to 

document alterations in the pigment of the skin. The development of standard UV 

photographic methods has allowed better opportunities for patient education and the 

monitoring of their therapeutic progress. OBJECTIVE: To incorporate standardized UV 

photography into our cosmetic dermatology practice as a tool for patient teaching and 

monitoring therapeutic programs. METHODS: Patients with Fitzpatrick Type I to III 

skin types were photographed with visible and ultraviolet light. The resultant 

photographic prints were discussed with the patient. When appropriate, therapeutic 

programs to reverse the findings were instituted for these patients. Follow-up 

photographs were used to document changes. RESULTS: The UV camera became a useful 

tool in our practice. One picture was worth a thousand words. The UV camera 

documented pigment changes, melasma, vitiligo, and posttraumatic or postsurgical 

hypopigmentation. The UV camera was also useful to monitor treatment programs 

designed to redistribute the pigment. CONCLUSION: The UV camera should become an 

integral part of sun damage detection both in the physician's office and in the 

community. Not only does the camera document pigmentary changes but it also 

========================================================================

4.) Treatment of melasma with Jessner's solution versus glycolic acid: a comparison of clinical efficacy and evaluation of the predictive ability of Wood's light examination.

========================================================================

Lawrence N; Cox SE; Brody HJ

Department of Dermatologic Surgery, University of Dentistry and Medicine New Jersey 

Cooper Hospital/UMC, Marlton, USA.

J Am Acad Dermatol (UNITED STATES) Apr 1997 36 (4) p589-93 ISSN: 0190-9622

Language: ENGLISH

Document Type: CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; JOURNAL ARTICLE 

Journal Announcement: 9706

Subfile: INDEX MEDICUS

BACKGROUND: Melasma can be resistant to topical therapy. OBJECTIVE: Our purpose 

was to evaluate the efficacy of superficial peels in conjunction with topical 

tretinoin and hydroquinone in patients with melasma and to evaluate the ability of 

Wood's light examination to predict response to treatment. METHODS: We measured 

increased light reflectance in melasma areas with a colorimeter. Clinical 

observations were scored through an index designed to weigh numerically homogeneity, 

intensity of color, and area of melasma. RESULTS: Colorimetric analysis showed an 

average lightening of 3.14 +/- 3.1 on the glycolic acid-treated side and 2.96 +/- 

4.84 on the Jessner's solution-treated side. There was no statistically significant 

difference between the right and left. There was an overall decrease in melasma area 

and severity of 63%. CONCLUSION: Superficial peels hasten the effects of topical 

therapy in melasma. Wood's light examination did not help predict response to 

treatment.

========================================================================

5.) Melasma of the forearms.

========================================================================

O'Brien TJ; Dyall-Smith D; Hall AP

Department of Dermatology, The Geelong Hospital, Australia.

Australas J Dermatol (AUSTRALIA) Feb 1997 38 (1) p35-7 ISSN: 0004-8380

Language: ENGLISH

Document Type: JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES 

Journal Announcement: 9706

Subfile: INDEX MEDICUS

Melasma of the forearms seems to be a relatively common sign which is, to our 

knowledge, not reported in the literature. It seems that it may be more common in 

older patients and especially in postmenopausal women on supplementary oestrogen. 

The pigmentary change is macular and may be confluent or speckled. Like facial 

chloasma there is a sharp line of demarcation at the margins. In some, there seems 

to be an element of erythema. (6 References)

========================================================================

6.) Effect of pituitary and ovarian hormones on human melanocytes in vitro.

========================================================================

Maeda K; Naganuma M; Fukuda M; Matsunaga J; Tomita Y

Shiseido Research Center, Yokohama, Japan.

Pigment Cell Res (DENMARK) Aug 1996 9 (4) p204-12 ISSN: 0893-5785

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9705

Subfile: INDEX MEDICUS

Normal human melanocytes in culture became enlarged and dendritic after a 2-day 

incubation with either the pituitary (beta-MSH, a potent analog of alpha-MSH, ACTH, 

FSH and LH) or the ovarian (estradiol, estriol and progesterone) hormones. Under the 

same experimental conditions, pituitary hormones also increased both the tyrosinase 

activity and tyrosinase-related protein-1 (TRP-1) while ovarian hormones increased 

TRP-1 but not tyrosinase activity. The results suggest that pituitary and ovarian 

hormones possibly induce hyperpigmentation of the skin by stimulating the 

melanogenesis in epidermal melanocytes, and that estradiol and progesterone may be 

involved in the pathogenesis of melasma (chloasma) usually developing between early 

adulthood and menopause in which a high concentration of serum ovarian hormones was 

maintained.

========================================================================

7.) Common disorders of pigmentation: when are more than cosmetic cover-

ups required?

========================================================================

AU: Hacker-SM

SO: Postgrad-Med. 1996 Jun; 99(6): 177-86

ISSN: 0032-5481

LA: ENGLISH

AB: The many types of pigmentation disorders may present in diverse forms and distributions and have various causes. They can be inherited (eg, vitiligo, familial periorbital hyperpigmentation), acquired (eg, postinflammatory pityriasis alba, idiopathic guttate hypomelanosis, Becker's nevus, melasma), infectious (eg, tinea versicolor), benign and self-limiting (eg, isolated cafe au lait spots, photocontact dermatitis), or a sign of more serious underlying disease (eg, multiple cafe au lait spots, malignant acanthosis nigricans). Primary care physicians see many patients with skin complaints and can often accomplish the early recognition and appropriate treatment that is paramount to cost-effective medicine. In many cases, an important aspect of patient care is education toward realistic expectations, because even with referral and use of extensive treatment, cosmetic results may be disappointing. Assuring patients that the disorder is not dangerous and providing tips on sunscreen and cosmetic use may be the best approach in some cases.

AN: 96281717

========================================================================

8.) Melanin hyperpigmentation of skin: melasma, topical treatment with azelaic acid, and other therapies.

========================================================================

AU: Breathnach-AS

SO: Cutis. 1996 Jan; 57(1 Suppl): 36-45

ISSN: 0011-4162

LA: ENGLISH

AB: Clinical studies of patients with melasma have shown that topical 20 percent azelaic acid is superior to 2 percent hydroquinone and as effective as 4 percent hydroquinone, without the latter's undesirable side effects. Tretinoin appears to enhance this effect of azelaic acid. Azelaic acid with tretinoin caused more skin lightening after three months than azelaic acid alone, and a higher proportion of excellent responders at the end of treatment. The effect of azelaic acid can be attributed to its ability to inhibit the energy production and/or DNA synthesis of hyperactive melanocytes, and partially to its antityrosinase activity. This may also account for the beneficial effect on postinflammatory hyperpigmentation. Destruction of malignant melanocytes by a combination of the same activities, enhanced by the greater permeability of tumoral cells to azelaic acid, may account for the clinical effects of azelaic acid observed in lentigo maligna and individual lesions of primary melanoma.

AN: 96252106

========================================================================

9.) The combination of glycolic acid and hydroquinone or kojic acid for the treatment of melasma and related conditions.

========================================================================

AU: Garcia-A; Fulton-JE Jr

SO: Dermatol-Surg. 1996 May; 22(5): 443-7

ISSN: 1076-0512

LA: ENGLISH

AB: BACKGROUND: Melasma continues to be a difficult problem. Although the cause is genetic, the condition is aggravated with sunlight, birth control pills, and pregnancy. Although hydroquinone is effective and has been available for years, a new product, kojic acid, has the advantage of being pharmaceutically more stable and, also, a tyrosinase inhibitor. OBJECTIVE: To evaluate on melasma and related conditions two similar formulations of glycolic acid/hydroquinone and glycolic acid/kojic acid. The therapeutic index of the two formulations is examined. METHODS: Thirty-nine patients were treated with kojic acid on one side of the face and hydroquinone in a similar vehicle on the other side of the face. The results were documented by a clinical investigator and with Wood's light examination combined with ultraviolet light photography. RESULTS: Fifty-one percent of the patients responded equally to hydroquinone and kojic acid. Twenty-eight percent had a more dramatic reduction in pigment on the kojic acid side; whereas 21% had a more dramatic improvement with the hydroquinone formulation. These results were not statistically different. The kojic acid preparation was more irritating. CONCLUSION: Both glycolic acid/kojic acid and glycolic acid/hydroquinone topical skin care products are highly effective in reducing the pigment in melasma patients. Both formulations should be available to the dermatologist to satisfy the patient's preferences.

AN: 96217439

========================================================================

10.) Enhancement of the depigmenting effect of hydroquinone by cystamine and buthionine sulfoximine.

========================================================================

AU: Bolognia-JL; Sodi-SA; Osber-MP; Pawelek-JM

SO: Br-J-Dermatol. 1995 Sep; 133(3): 349-57

ISSN: 0007-0963

LA: ENGLISH

AB: Glutathione (GSH) performs several important biological functions, including quenching of reactive oxygen species, and protection of cells from toxic compounds such as quinones. The first step in the synthesis of GSH is catalysed by gamma-glutamylcysteine synthetase, an enzyme which is inhibited by cystamine and buthionine sulfoximine (BSO). In this study, we examined the possibility that the effect of hydroquinone (HQ) on pigmentation could be potentiated by inhibiting the production of GSH. In vitro studies using melanoma cell lines demonstrated that both cystamine and BSO could potentiate the inhibitory effects of HQ on tyrosinase activity and melanin content. A synergistic decrease in hair pigmentation was observed when a combination of HQ (2 or 4%) and BSO (5%) was applied to the dorsal skin of C57BL mice. In black hairless guinea-pigs, the application of HQ plus either BSO or cystamine resulted in a significant decrease in epidermal pigmentation when compared with any of the agents alone. The possibility exists that in the future a combination of HQ plus cystamine or BSO could be used to treat disorders such as melasma and post-inflammatory hyperpigmentation.

AN: 96142559

========================================================================

11.) Melasma. Etiologic and therapeutic considerations.

========================================================================

AU: Grimes-PE

SO: Arch-Dermatol. 1995 Dec; 131(12): 1453-7

ISSN: 0003-987X

LA: ENGLISH

AB: BACKGROUND: Melasma is a common acquired symmetric hypermelanosis characterized by irregular light- to gray-brown macules and patches involving sun-exposed areas of skin. Etiologic factors in the pathogenesis of melasma include genetic influences, exposure to UV radiation, pregnancy, hormonal therapies, cosmetics, phototoxic drugs, and antiseizure medications. OBSERVATIONS: Melasma is often a therapeutically challenging disease, and current treatments include hypopigmenting agents, chemical peels, and lasers. Hypopigmenting agents include phenolic and nonphenolic derivatives. Phenolic agents include hydroquinone and hydroquinone combination preparations. Despite controversies regarding the issue of hydroquinone-induced ochronosis, hydroquinone remains the most effective topically applied bleaching agent approved by the Food and Drug Administration for the treatment of melasma. Nonphenolic bleaching agents include tretinoin and azelaic acid. Superficial, medium, and deep chemical peels are more often used in lighter-complexioned patients. Such peels should be used with caution in blacks. Although lasers have demonstrated significant efficacy in the treatment of a variety of hyperpigmentary disorders, their precise efficacy and place in the therapy of melasma have yet to be established. CONCLUSIONS: In the hierarchy of therapies for melasma, the treating physician must consider the devastating psychosocial impact of pigmentary imperfections within the realm of the benefits and risks associated with each treatment.

AN: 96094883

======================================================================

DATA-MÉDICOS/DERMAGIC-EXPRESS No (23) 09/12/98 DR. JOSE LAPENTA R. DERMATÓLOGO

======================================================================

Produced by Dr. José Lapenta R. Dermatologist
Venezuela 1.998-2.024

Producido por Dr. José Lapenta R. Dermatólogo Venezuela 1.998-2.0024

Tlf: 0414-2976087 - 04127766810