Comparison between Intralesional Triamcinolone and Kligman's Formula in Treatment of Melasma

  • Gholamreza Eshghi Department of Dermatology, Psoriasis Research Center, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran.
  • leila khezrian Department of Dermatology, Psoriasis Research Center, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran.
  • Fariba Esna Ashari Department of Dermatology, Psoriasis Research Center, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran.
Keywords: Melasma, Triamcinolone, Kligman's formula, Injection

Abstract

Melasma is a common acquired skin disorder. While different treatments are currently being used, in many cases it is refractory to treatment. According to the effects of topical steroids in decreasing skin pigmentation, we studied the efficacy of this new method for treatment of melasma. A total of 42 women with facial melasma, admitted to the department of dermatology of Hamadan, were enrolled in the study. They were divided randomly into two groups (A and B), group A (case) received subepidermal triamcinolone injections with a dose of 4mg per cc and 5mm  intervals until complete blanching of melasma lesions, and group B (control) received Kligman's formula (hydroquinone5%, tretinoin 0.1%, and dexamethasone 0.1%). At the first visit, we completed the MASI score papers, and we repeated that at weeks 4 and 8 of the study. We followed them for two months, every two weeks. At each visit, side effects and clinical response to treatment were noted. A decrease in MASI was observed in both group (11.57 ± 4.33 vs 9.31 ± 3.75 at 4th week and vs 8.01 ± 3.1 at 8th week, P-value < 0.001 in group A, and 10.46 ± 5.61 vs 9.76 ± 5.21 at 4th week and vs 8.96 ± 4.96 at 8th week, P-value< 0.001 in group B). In comparison between 2 groups, response to treatment was much better in group A than group B (P-value<0.001). In comparison to topical treatments, based on these findings, triamcinolone microinjection is a new, safe and strong therapeutic method for treatment of melasma.

References

Kunachak S, Leelaudomlipi P, Wongwaisayawan S. Dermabrasion: a Curative Treatment for Melasma. Aesthetic Plast Surg 2001;25(2):114-7.

Lynde CB, Kraft JN, Lynde CW. Topical Treatments for Melasma and Postinflammatory Hyperpigmentation. Skin Therapy Lett 2006;11(9):1-6.

Blognia JL, Joriizzo JL, Rapini RP, editors. Dermatology. 2nd ed. St. Louis: Mosby; 2008: p. 1052-54.

Ni Z, Mu Y, Gulati O. Treatment of Melasma with Pycnogenol. Phytother Res 2002;16(6):567-71.

Situm M, Kolić M, Bolanca Z, et al. Melasma--updated treatments. Coll Antropol 2011;35(Suppl 2):315-8.

Mcleod SD, Ranason M, Masone RS. Effect of estrogens on human melanocytes in vitro. J Steroid Biochem Mol Biol 1994;49(1):9-14.

Jackson R. A statement on melasma. Can Med Assoc J 1977;116(11):1224-6.

Chan R, Park KC, Lee MH, et al. A randomized controlled trial of the efficacy and safety of a fixed triple combination (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%) compared with hydroquinone 4% cream in Asian patients with moderate to severe melasma. Br J Dermatol 2008;159(3):697-703.

Gupta AK, Gover MD, Nouri L, et al. The treatment of melasam: A review of clinical trials. J Am Acad Dermatol, 2006;55(6):1048-65.

Lee JH, Park JG, Lim SH, et al. Localized Intradermal Microinjection of Tranexamic Acid for Treatment of Melasma in Asian Patients: A Preliminary Clinical Trial. Dermatol Surg 2006;32(5):626-31.

Rendon M, Berneburg M, Arellano L, et al. Treatment of melasma. J Am Acad Dermatol 2006;54(5 Suppl 2): S272-81.

Grimes PE. Melasma, etiologic and therapeutic considerations. Arch Dermatol 1995;131(12):1453-7.

Taylor S. Objective and Subjective Measures of Melasma.J Cosmet Dermatol 2007;20(2): 93-5.

Rivas SH, Pandia AG. Treatment of Melasma with Topical Agents, Peels and Lasers: An Evidence-Based Review. Am J Clin Dermatol 2013;14(5):359-76.

Monteiro RC, Kishore BN, Bhat R M, et al. A Comparative Study of the Efficacy of 4% Hydroquinone vs0.75% Kojic Acid Cream in the Treatment of Facial Melasma. Indian J Dermatol 2013;58(2):157-63.

Baumann L. Melasma and Its Newest Therapies. Cosmetic Dermatology 2007; 20(6):346-53.

Guevara IL, Pandya AG. Safety and efficacy of 4% hydroquinone combined with 10% glycolic acid, antioxidants, and sunscreen in the treatment of melasma. Int J Dermatol 2003;42(12):966-72.

Taylor SC, Torok H, Jones T, et al. Efficacy and Safety of a New Triple-Combination Agent for the Treatment of Facial Melasma Agent for the Treatment of FacialMelasma. Cutis 2003;72(1):67-72.

Hengge UR, Ruzicka T, Schwartz RA, et al. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol 2006;54(1):1-15.

Jonathan D, Allen R. Choosing Topical Corticosteroids. Am Fam Physician 2009;79(2):135-40.

Fridman SJ, Butle DF, Pittlkow MR. Perilesional linear atrophy and hypopigmentation after intralesioanl corticosteroid therapy. J Am Acad Dermatol 1988;19(3):537-41.

Jang WS, Park J, Yoo KH, et al. Branch-shaped Cutaneous Hypopigmentation and Atrophy after Intralesional Triamcinolone Injection. Ann Dermatol 2011;23(1):111-4.

Phiampphongsant T. Treatment of melasma:a review with personal experience. Int J Dermatol 1998;37(12):897-903.

Published
2016-02-01
How to Cite
1.
Eshghi G, khezrian leila, Esna Ashari F. Comparison between Intralesional Triamcinolone and Kligman’s Formula in Treatment of Melasma. Acta Med Iran. 54(1):67-71.
Section
Original Article(s)