Clinical Study On Treatment Of Melasma In Active Stage

Objective: According to the Expert Consensus on Diagnosis and Treatment of Melasma in China(2021 Edition),it is proposed that active melasma should be treated with systemic drugs such as glycyrrhizin and tranexamic acid in combination with functional skin care products.This study is based on the consensus to observe the efficacy and safety of the treatment of active melasma patients with compound glycyrrhizin,tranexamic acid and Winona light transparent whitening essence.Method: From May 2022 to January 2023,50 female patients with active melasma,aged 25-45 years old,who were treated in the outpatient department of dermatology of our hospital,were enrolled by reflection confocal microscopy(RCM)and slide pressure diagnosis.The subjects were divided into two groups,including 20 patients in treatment group and 30 patients in control group.The subjects in the treatment group received intravenous drip of compound glycyrrhizin 80mg/time,twice a week for 4 weeks,and then changed to oral tranexamic acid(250mg/time,twice a day)for 8 weeks,with a total course of 12 weeks.During the whole course of treatment,the subject needs to apply Winona Sunscreen and Winona Whitening Freckle-Reducing Essence externally.Patients in the control group were treated with Winona sunscreen and moisturizer.The patients in the two groups were photographed with VISIA and evaluated with Melasma Area Severity Index(MASI)at 0,4 and 12 weeks.Transepidermal water loss(TEWL),melanin index(MI),erythema index(EI),L*,a*,b* were measured by noninvasive scoring instrument and LAB spectrophotometer.Melasma Quality Of Life(MELASQOL)and Dermatology Life Quality Index(DLQI)were evaluated by questionnaire at 0 and 12 weeks.Statistical analysis was performed by SPSS 25.0 statistical software.The data were measured and the mean and standard deviation(χ±S)were calculated.Repeated measures analysis of variance was used.The enumeration data were analyzed by chi-square test.Results:1.4-week efficacy evaluation: All 50 enrolled patients completed the treatment.The MASI score of the treatment group after 4 weeks(8.70±2.46)was significantly lower than that before treatment(11.00±2.21),and the difference was statistically significant(P<0.001);The values of TEWL,EI,a* were significantly decreased and L* was significantly increased after treatment(P<0.05),but the values of MI and b* had no significant change.The decrease of MASI score(11.00-8.70=2.30)in treatment group was higher than that in control group(9.91-9.84=0.07).The decrease of MI,EI,a* and the increase of L* in treatment group were significantly higher than those in control group(P<0.05),but there was no significant difference in TEWL and b*.2.12-week efficacy evaluation: MASI score of treatment group after 12 weeks(6.72±1.93)was significantly lower than that before treatment(11.00±2.21)and after 4 weeks treatment(8.70±2.46),and the difference was statistically significant(P<0.001);The MI and b* values were significantly lower than those before treatment and 4 weeks after treatment(P<0.05).After 12 weeks,the TEWL and a* values in the treatment group were significantly lower than those before treatment,and the L* values were significantly higher than those before treatment,with statistically significant differences(P<0.05),but the EI had no significant changes compared with those before treatment,and was significantly higher than those after 4 weeks of treatment,with statistically significant differences(P<0.05).The decrease of MASI score in treatment group(11.00-6.72=4.28)was significantly higher than that in control group(9.91-9.65=0.26).The decrease of TEWL,MI,a* value,b* value and the increase of L* value in treatment group were significantly higher than those in control group(P<0.05),but EI had no significant difference.3.The MASI score,TEWL,MI,EI,L*,a* and b* of the control group were not significantly improved.There were no other obvious adverse reactions during the treatment.Conclusions:Compound glycyrrhizin,tranexamic acid anti-inflammatory treatment combined with external whitening skin care products in the treatment of active melasma patients safe and effective.