The Clinical Efficacy Of Q Switch 1064nm Lasers Combined With Stamp Microneedling Importing Tranexamic Acid Into Skin In The Treatment Of Melasma

Background:Melasma is an acquired hyperpigmentation disorder most commonly affecting women,and it is characterized by irregular brown-gray macules and patches on the face.Suspicious risk factors include sun exposure,oral contraceptives,pregnancy,family history,endocrine disorders.There are 4 clinical patterns:butterfly type,centrofacial type,mandibular and Generalized type.According to the location of pigment deposition,it can be classified into epidermal,dermal,and mixed-type.Melasma is a chronic,relapse and refractory disease.The goal for effective treatment of melasma includes removal of the excess melanin in the epidermis and dermis,as well as suppression of further melanogenesis.Various treatments,including topical,oral,resurfacing techniques,as well as numerous light and laser treatments,Chinese Medicine have been used for treatment of melasma,both alone and in combination.Topical drugs that can inhibit pigmentation have some effect on melasma,but due to the barrier of the stratum corneum,it cannot be absorbed through the skin entirely,so the effect of treatment was limited.In 1998,Henry first reported the use of microneedling in transdermal administration,which increased the transdermal absorption rate of experimental drugs by a factor of 1000,and it was then applied to the treatment of melasma.More and more evidence has shown significant efficacy and safety for melasma treatment using microneedling.Compared with the commonly used roller microneedling,stamp microneedleing can act vertically on the skin,with smaller wounds,denser arrangements,and easier access to the superficial dermis of the skin,and it was followed by a shorter convalescence and less complications.Tranexamic acid is commonly used as an anticoagulant drug in clinical.It has a similar structure with tyrosine,which was the the key enzyme in the process of melanogenesis,so it can competitively inhibit tyrosinase,finally suppressing melanogenesis.Tranexamic acid can be used for the treatment of melasma by oral,microinjection and microneedling.Compared with microinjection,microneedles has less trauma and a higher absorption rate,and it can avoids the coagulation system disorder that may caused by oral tranexamic acid.In recent years,Growing evidence has shown significant efficacy and safety for melasma treatment using low-fluence and large-spot Q-switched neodymium-dopedttriumaluminium garnet laser(QS-Nd:YAG lasers).Early treatment is effective,however,treatment resistance and recurrence appear in the later stage,and the fellowing repeated treatments increase the risk of pigmentation and depigmentation after inflammation.Objective:To observe the efficacy of stamp microneedling importing tranexamic acid into skin alone and combined with Q Switch 1 064nm laser to treat melasma.The main adverse effects and recurrence rate were also observed.Method:This is a split-face comparative open trial conducted on 17 female patients,including 11 centrofacial type(64.7%),4 butterfly type(64.7%),and 2 Generalized type(11.8%)aged from 29?64,with a 2?20 years'course of disease,who have been diagnosed as melasma in Tianli Cosmetic Hospital,Dalian from September 2018 to September 2019.Patients underwent melasma therapy using stamp microneedling importing tranexamic acid on their both side and QS-Nd:YAG lasers(in 1064nm wavelength,6?8Hz frequency,8mm spot,1.5?2.0J/cm~2)on their right side,the laser were first taken in 2 weeks after microneedling.Left side of each patient was control group(stamp microneedling+tranexamic acid)and right side of each patient was treatment group(stamp microneedling+tranexamic acid+laser).Each of the therapy was done for 3 times with 1-month intervals and the course of treatment lasts for 3months.Photographs and VISIA of front sides,right sides and left sides were taken before and after each treatments.Patients'modified Melasma Area and Severity Scoring(m MASI)was assessed by the same doctor at initiation,1 month after treatment and a 3months follow up.The adverse effects and recurrence rate were also observed.Results:Mean score of m MASI prior to intervention of left side was 4.34±2.13 and right side was 4.31±2.34 No significant difference was found(P>0.05).Mean score of m MASI after study initiation had decrease to 2.11±1.28(p<0.001)in left side and1.38±1.07(p<0.001)in right side,and there were significant efficacy in reduction of m MASI score in each side.Comparison between two groups showed more reduction of m MASI score in right side than in left side,but the difference was not statistically significant(p>0.05).The effective rate was 76.4%in control group and 82.3%in treatment group.In 3 months follow up,mean score of m MASI was 2.23±1.21 in control group and1.34±0.88 in treatment group.Compared with initiation,differences were statistically significant in both group,and the difference between 2 group was statistically significant(P<0.05).Compared with the time 1 month after treatment,score of m MASI of control group was increased slightly.According to Percentage of Decrease in m MASI,2 patient in control group had a relapse and no one in treatment group have relapse.The recurrence rate was 11.8%in control group and 0 in treatment group.Serious adverse effect were not seen in all patients during the trail.The satisfaction rate is 70.6%in control group and88.2%in treatment group?Conclusion:Stamp Microneedling importing tranexamic acid into skin is safe and effective in the treatment of melasma,and the combination of Stamp Microneedling and Q switch 1064 nm laser is more effective than microneedling alone.The treatment is safe with rare adverse reactions and received high satisfaction.