| Objective(1)To investigate the evaluation index of melasma staging.(2)To investigate the safety and efficacy of a cream containing herbal mixture for melasma.Methods(1)Melasma staging:A total of 195 patients with a clinical diagnosis of melasma were enrolled from First Affiliated Hospital of Kunming Medical University.The skin with lesion enlarged,color darker,erythema,red occured after scratching or lesion faded after compressing with glass belongs to the active stage,on the contrary,it is in the stable stage.Dermoscopy,Mexameter18 and LAB were used to observe skin lesions of different stage of melasma.Reflectance confocal microscopy(RCM)was used to observe the activity of dendritic cells(DMA),inflammatory cells and melanin in the lesions of melasma patients.Dermoscopy was used to observe the number of vessels in the lesions.Mexameter 18 was used to measure the melanin index(MI)and erythema index(EI).The color of the lesions was measured by LAB spectrophotometer.(2)Clinical observation:A total of 90 volunteers with melasma were enrolled in this randomized,double-blind,controlled clinical study and they were randomly divided into 3 groups(A,B and C).Patients in group A were treated with a cream containing herbal mixture,while groups B and C were treated with arbutin cream and placebo,respectively,twice daily for 12 weeks.Facial images were collected by VI SI A at 0,4,8 and 12 weeks,and MASI scores were recorded.Mexameter 18 was used to measure the melanin index(MI)and erythema index(El).Reflectance confocal microscopy(RCM)was used to observe the changes of inflammatory cells in the lesions.Adverse events and satisfaction degree were evaluated every 4 weeks.Results(1)Melasma staging:There were 115 patients(59.0%)in the active stage of melasma and 80 patients(41.0%)in the stable stage.DMA score in active stage(35.08±10.59)were significantly higher than that of the stable stage(15.06 ± 9.20)(P<0.05).There were statistically significantly difference in quantity of inflammatory cell and blood vessels between two stage of melasma(P<0.05).Erythema index(EI)in active stage of melasma(376.35 ± 61.39)were higher than that of the stable stage(320.36±62.40)(P<0.05).A-value in active stage of melasma(13.28±1.75)were higher than that of the stable stage(12.34±1.78)(P<0.05).However there were no siginificant differences in the quantity of melenin、melanin index(MI)、L-value and B-value.(2)Clinical observation:Although MASI scores declined significantly in both groups A and B(P<0.05),a greater reduction was seen in group A(13.00-9.82=3.18 for group A;12.65-10.84=1.81 for group B).Moreover,the cream containing herbal mixture,but not arbutin cream and placebo,significantly reduced El and density of inflammatory cells after 12-week treatment(P<0.05).There were no significant changes in MASI score,El value and inflammatory cells after 12-week treatment in group C(P>0.05).No adverse reactions were observed in either group A or group C.In group B,two subjects experienced mild erythema and itching,which disappeared after stop using the arbutin cream.Conclusion(1)Melasma could be divided into active stage or stable stage respectively according to its clinical manifestations,DMA score,quantity of inflammatory cells and blood vessels,EI and A-value.In the active stage,the skin with lesion enlarged,color darker,erythema,red occured after scratching or lesion faded after compressing with glass,meanwhile,the number of DMA,inflammatory cells,blood vessels,El value and A value were higher.On the contrary,it is in the stable stage.(2)The cream containing herbal mixture is safe and effective for melasma. |
