New progress in the treatment of chloasma
2018/10/3
At present, the first-line treatment of chloasma is topical 4% hydroquinone cream, which can be used alone or triple therapy (4% hydroquinone cream + 0.01% fluocinolone cream + 0.05% vitamin A cream, TCC), but long-term The safety of using hydroquinone is worrying (such as contact dermatitis, brownish yellow disease or carcinogenicity). In recent years, a lot of research on the treatment of chloasma has been carried out at home and abroad, and many new drugs have emerged.
First, oral medication
The mechanism by which tranexamic acid is used to treat chloasma is not known. Studies have shown that on the basis of topical hydroquinone and sunscreen cream, oral administration of tranexamic acid can increase the efficacy of chloasma.
Second, topical drug treatment
Topical drugs have always been the main method for the treatment of chloasma, and the effect on epidermal melasma is good.
1. Hydroquinone: 4% hydroquinone cream is a common drug for treating chloasma. Hydroquinone inhibits the synthesis of DNA and RNA by melanocytes while competing with the substrate tyrosine of tyrosinase to reduce the conversion of tyrosine to melanin.
2, tranexamic acid: can also be applied locally.
3. Lignin Peroxidase: It is an active enzyme extracted from Phanerochaete chrysosporium. Since the molecular structure of lignin is similar to melanin, lignin peroxidase has the ability to degrade melanin. Under the excitation of H2O2, lignin peroxidase can achieve the effect of quickly eliminating chloasma.
4. Phenylalanine: It can be used as an antagonist of melanin and β-adrenergic receptors.
5. Zinc: By inhibiting the absorption of copper ions, tyrosinase lacks copper ions and loses its activity.
6.
Western sorrel essence: Western sorrel is an extract of the evergreen
Dianthus genus, which can inhibit the activity of tyrosinase.
7.
Diacetyl-Bermidine and transforming growth factor β1 biomimetic
oligopeptide 68: inhibits the activity of tyrosinase, and
diacetyl-Bertaldine keeps tyrosinase in a state of inhibition based on
this principle.
8, Ding Leisin: can inhibit the tyrosine and tyrosine-related protein 1, to achieve the purpose of treating chloasma.
9.
Flutamide: It is a non-steroidal antiandrogen. The mechanism of
treating chloasma is still unclear. It is speculated that it may reduce
the α melanocyte stimulating hormone and activate more cyclophosphamide. The production of melanin.
Third, laser treatment
Laser removal of chloasma is based on the theory of "selective photothermolysis." The main lasers used to treat chloasma are:
1, non-invasive non-stripping laser:
(1) Q-switched laser: It is the most commonly used laser for treating chloasma. Mainly
include: Q switch Nd: YAG 1 064 laser, Q switch Nd: YAG frequency 532
laser, Q switch ruby laser and Q switch alexandrite laser. Among them, the Q-switch Nd:YAG 1 064 laser large spot, small energy, multiple treatment treatment mode is widely used.
(2)
Strong pulsed light: Compared with the Q-switched laser, the strong
pulsed light has low energy and low penetrating power, and is not easy
to cause tissue damage and post-inflammatory pigmentation.
2, invasive stripping laser:
Carbon dioxide laser and holmium laser. Directly
grinding the epidermis area and dermal papilla layer, destroying
melanocytes, the effect is significant but it is easy to cause
post-inflammatory hyperpigmentation in Asian melasma patients. There are
few reports in domestic research.
3. Between invasive and non-invasive:
Dot matrix laser. Both
the advantages of the exfoliation laser have obvious advantages, and
the non-exfoliation laser has the characteristics of quick healing and
less pigmentation.
Fourth, exfoliation treatment
1.
Chemical exfoliating agent: The traditional chemical exfoliating agent
can directly remove the melanin in the epidermis by limiting the
exfoliation of epidermal cells, and the curative effect on refractory
chloasma is better. Common
chemical exfoliating agents include salicylic acid, retinoic acid,
glycolic acid, glycolic acid, and trichloroacetic acid.
2,
physical grinding: including skin grinding and microdermabrasion, by
grinding epidermal cells to promote new epidermal hyperplasia, the
former reaches the dermal papilla or dermal reticular layer; the latter
only removes the upper layer of the epidermis.
V. Chinese medicine treatment
Over
the years, various Chinese medicine practitioners have summed up the
classic ancient prescriptions for treating chloasma, including Xiaoyao
San, Danggui Shaoyao San, Liuwei Dihuang Pill, Xuefu Zhuyu Decoction,
Dahuang Zhechong Pill, Guizhi Fuling Pill and Bazhen Deco. Certain curative effect. Chinese
patent medicines made from classic prescriptions have also begun to be
applied, such as Dan Xiaoyao Capsule, Xuefu Zhuyu Decoction, Bazhen Yimu
Capsule, Xiaojin Capsule, etc.
In
summary, with the deepening of the pathogenesis of chloasma, vascular
growth factor, melanogenesis gene, H19 gene, inducible nitric oxide
synthase, Wnt channel regulatory gene discovery, chloasma Treatment provides new ideas.
