Introduction: Melasma is an acquired hypermelanosis of sun-exposed areas. The pathophysiology of melasma is uncertain. The most important factor in the development of melasma is exposure to sunlight, but it has also seems to be related to hormonal and vascular factors, genetic predisposition, and proteins related to tyrosinase. Due to its refractory and recurrent nature, the treatment of melasma is often diffi cult. The goals of treatment often include prevention or reduction of the affected area with the fewest possible adverse effects. The principles of therapy include protection against UV radiation, the inhibition of activity of the melanocytes and melanin synthesis. Objective: To perform a systematic review to identify the most effective and safe treatment, including topical treatments, oral treatments and surgical procedures for the melasma. Method: The study was conducted in the period from February 5th to March 15th 2009, using three databases: MEDLINE (1966-2009), Cochrane Library and LILACS. After establishing criteria for the selection of studies,the best controlled and comparative studies were described individually. Results: 703 articles in MEDLINE, 89 in LILACS and 100 in Cochrane Library have been detected, and from 143 articles 10 were descriptive studies (6,99%), 30 were reviews (20,97%), and 103 were randomized controlled trials (72,03%). Descriptive studies and reviews were analyzed together. Forty two articles with the best design were chosen for individual description. Twelve of 42 included controlled studies (28,57%) and 30/42 were comparative (71,43%), like split face 18 from 42 (42,86%) or parallel groups, 24 from 42 (57,14%), and 34 from 42 randomized (80,95%). Eight (19,05%) studies had the ideal design, i.e., blind placebo-controlled. Limitations: Heterogeneity of the studies, few with good methodological quality. Conclusions: The use of broad-spectrum sunscreen is important, as is topical hydroquinone, the most common treatment for melasma. Other skin-lightening agents include retinoic acid, azelaic acid, kojic acid and others. Combination therapies increase efficacy as compared with monotherapy. Chemical and physical peels, laser treatments, and intense pulsed light therapy are additional modalities that have been used to treat melasma.

Keywords: MELASMA, HYPERPIGMENTATION, CHLOASMA, TREATMENT

Introduction: Melasma is an acquired hypermelanosis of multifactorial etiology and diffi cult to treat. Tranexamic acid (TA) has been studied as an alternative therapy. Objective: To evaluate the effi cacy and safety of TA in treatment of melasma, comparing the use of localized microinjection versus topical therapy. Material and Method: Eighteen women with melasma were selected and treated for 12 weeks. Group A: at-home topical application of TA 3% twice a day. Group B: intradermal injections of TA (4 mg/ml) weekly. Before and after treatment, the groups were compared according to the following parameters: photographic evolution, MASI evolution, self-assessment and colorimetry. Results: Seventeen patients completed the study. In group A, photographic evaluation showed improvement in 12,5%, worsening in 50%, and 37.5% had no change. In group B, there was improvement in 66.7% and 22.2% had no change. For the MASI, there was signifi cant improvement (p = 0.0026), with no difference between treatments (p = 0.6512). In group A selfassessment, 37.5% of the patients rated as good and 50% as imperceptible. In group B, 66.7% rated as good and 33.3% as imperceptible. Colorimetric evaluation showed significant improvement on both treatments (p = 0.0008). Conclusion: Although the subjective clinical evaluation has demonstrated the superiority of injected treatment, in objective evaluation, both treatments were significantly effective, presenting TA as a promising new therapeutic option for melasma.

Keywords: TRANEXÂMIC ACID, MELASMA, THERAPEUTICS, THERAPY

Introduction: Complaints about wrinkles and flaccidity in the periocular region are frequent. Blepharopeeling, associated with the Baker-Gordon formula, and the application of ablative fractional CO2 lasers are considered effective options in the treatment of the periocular region. Objective: To compare the techniques, recovery process and results of blepharopeeling and fractional CO2 lasers in the periorbital region. Methods: Comparative split-face study of patients with dermatochalasis and moderate rhytids. Blepharopeeling was applied on the right side of the face, and the fractional CO2 laser was used on the left side of the face. Results were assessed through photographic analysis, measurements of the superior palpebral fold and clinical improvement. Results: Patients (n=11) demonstrated clinical and photographic improvement using both methods. The recovery time was longer for the phenol peeling. No significant differences were observed in the measurements of the superior palpebral fold. Conclusion: While both therapeutic modalities were found to be effective in the treatment of periorbital aging, blepharopeeling produced greater clinical improvement of palpebral flaccidity.

Keywords: PHENOL, LASER THERAPY, EYELIDS, SKIN AGING

Introduction: In 2006 the US Food and Drug Administration approved the use of fractional photothermolysis for the treatment of melasma. Objectives:To evaluate the treatment of melasma patients with fractional photothermolysis. Methods: Patients with a clinical diagnosis of melasma (n = 20) received three non-ablative laser sessions at 4-week intervals.The parameters used were: pulse = 15 ms, and progressively increasing energies in each session (8, 10 and 12 J). Results were evaluated using the Melasma Area and Severity Index and colorimetry analysis (with indices ITA, L, a, b) at baseline and 4 weeks after the last session. Results: Female patients (n = 18), with ages between 23 and 48 and Fitzpatrick phototypes from II to IV, completed the study. One patient did not complete both Melasma Area and Severity Index evaluations.There was a statistically significant decrease in the Severity Index (p <0.0001, CI = 95%) and an average increase in the colorimetry indices L (p = 0.0003, CI = 95%) and ITA (p = 0.0017, CI = 95%), meaning a decrease in the pigmentation. Conclusions: Fractional photothermolysis is a safe and effective option in the treatment of melasma, and should be considered an alternative to conventional methods.

Keywords: MELANOSIS, LASERS, COLORIMETRY