| Objective:Melasma, also known as "black macules","liver spots""facial dirt" recorded in ancient chinese texts, is a condition that affects the face. Occurrence is higher in females than males, with females aged21-55. Etiology is unknown, with sunlight, pregnancy, hormonal changes and sleep as possible factors. Main mechanisms include an overproduction or excessive transportation of melanin, resulting in its over-accumulation in the epidermal or dermal skin layers. Traditional Chinese Medicine theories believe that the cause of melasma is highly related to the loss in regulation of the functional aspects of the liver, spleen and kidney. However, this study proposes yet another theory-the theory of pathogens residing at the minute vessels found in the skin layer. Despite countless research done worldwide, there is still no effective treatment method or procedure. Most methods are capable of reducing the intensity and area of the macules but are incapable of complete removal. Even so, there is still a possibility of recurrence. This study hence proposes a new Chinese formula, in line with the theory as mentioned earlier, in hope to gain new sight and approach to the treatment of melasma. This study also compares the use of the MASI score versus the Melasma Scoring Method used in China for quality assessment.Methods:This research has collected a total of144patients who visited the hospital from April2013to January2014that complied with the diagnostic criteria. All patients were given a self-derived prescription in powder form to be mixed with water and consumed ten minutes after meals twice daily. Follow-ups were conducted every4weeks, up to a period of12weeks. Patient details and data such as MASI score, China’s melasma score, and a TCM symptoms score were collated for each visit. In addition, all patients were instructed to apply sunscreen of SPF30daily.Results:Among the144patients, onset age distribution was18-49, while duration lasted between3and120months. Correlation between duration and MASI score was0.368, while correlation between onset age and MASI score was0.270.50.69%has no obvious cause, while19.44%was due to sun exposure, and15.28%was due to pregnancy. A total of90patients completed4weeks’worth of treatment, while66completed8weeks’treatment.42patients completed12weeks of treatment. There’s statistical significance for MASI scores after4,8, and12weeks of treatment. China’s Melasma Scoring Method was only statistically significant for patients after12weeks of treatment.73.8%of patients treated for12weeks have a decrease in MASI score while11.9%had decrease in china’s melasma score, as compared to the27.8%of patients treated for4weeks that had a decrease in MASI score, and1.1%had decrease in china’s melasma score. As for TCM symptoms score,87.8%recorded a lower score after4weeks’treatment, and subsequently100%after12weeks of treatment.Discussion:Among the patients with no known cause, these patients could have an underlying condition yet to be diagnosed, or present as subclinical abnormalities, such as thyroidal changes which have yet to be detected. Other patients have causes due to sun exposure and pregnancy. Melanin serves as to absorb UVB in preventing damage to subcutaneous tissue, but research as yet to explain why melasma is formed instead of an equal skin darkening on the face, since the face has almost equal sun exposure. Pregnant women have higher levels of estrogens and this may indirectly cause the increased production and transportation of melanin. Post-partum females, according to Chinese Medicine theory, are mostly in a state of deficiency and stasis. The lack of qi and blood causes a lack of nourishment to the face, thus forming melasma. In other cases, as a result of deficiency and stasis, blood circulation is affected, causing stasis on the face, hence forming melasma It is observed that85.42%of the patients have soft tongue, which is an indication of a deficiency syndrome.83.33%has sleep disorders, indicating that sleep could affect hormones involved in the circadian rhythm, thus indirectly causing melasma.70.83%has reported to have blood clots during menstruation, indicating a sign of stasis. Some patients are unable to return to the hospital for a follow-up due to distance. Other patients are unwilling to consume Chinese medicine for12weeks, or find the cost a problem, or find that the treatment effect and duration is below their expectation, hence these patients fail to follow up. The change in MASI is more significant than that of the Melasma Scoring Method. This could be due to the fact that china’s melasma score is highly subjective when it comes to pigmentation color, while melasma areas larger than4cm2are considered as severe. The MASI score considers these factors, and has added in a homogeneity factor for pigment darkness. In addition, the area is counted as a percentage of the patient’s face, and divided into6points instead of3. Despite all these considerations, MASI score is still a relatively subjective scoring method. There is a need for more advanced, more accurate diagnostic tools that could measure both color and total area accurately. The self-derived prescription alleviates other symptoms, as seen from the statistical significance of TCM symptoms score after4,8and12weeks of treatment.100%of the patients have a reduction in TCM symptom score after12weeks of treatment. The self concluded prescription contains herbs that can activate blood and clear collateral vessels, at the same time nourish the liver and kidney. This prescription also considers herbs with anti-oxidant properties, or herbs that could replenish elements in the body, as well as herbs that can inhibit endothelial factors, or inhibit tyrosinase, with the ultimate purpose of reducing melanin production and transportation, thus reducing melasma. |
PDF Full Text Request