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: Melasma is a common hypermelanosis that mainly affects women and has a negative impact on the quality of life. It is a chronic and recurrent condition, and a number of treatments have already been proposed.
Objective: Assessment of quality of life for women with melasma before and after treatment with botanical extracts and hydroquinone.
Methods: A clinical, phase IV, randomized, blinded study was conducted at a clinical research institute. Women (n = 56) aged 18-60, with phototypes I-IV, were randomized into two groups (epidermal or mixed melasma). The Melasma Quality of Life Scale was used to compare the patients'''''''' quality of life before and after the use of Bellis perennis, Glycyrrhiza glabra and Phyllanthus emblica botanical extracts twice a day (Group A), or 2% hydro- quinone used at night (Group B). The Melasma Area and Severity Index was used to assess the treatments'''''''' efficacy.
Results: Appearance, frustration, embarrassment and feeling less attractive were the Melasma Quality of Life Scale variables that had the greatest negative impact on quality of life at the beginning of the study. After 60 days of treatment, there was improvement in all MELASQoL aspects, with no statistical differences between the two groups.
Conclusion: The improvement in melasma patients'''''''' self esteem provided by the use of the botanical extracts matched that of 2% hydroquinone.

Keywords: MELASMA, QUALITY OF LIFE, PHYLLANTHUS EMBLICA

Introduction: Melasma is a chronic hyperpigmentation of the skin, characterized by irregular brownish spots distributed in areas exposed to the sun, common in Brazilian women. Due to facial involvement, it impacts on appearance, causing psychosocial and emotional discomfort, thus affecting patients' quality of life.
Objective: A double-blind, longitudinal, comparative and monocentric clinical study was conducted comparing the quality of life and the pigmentation intensity of melasma in women before and 60 days after oral use of Lingonberry (Vaccinium vitis idaea L.) extract in association with sunscreen as the only topical treatment.
Methods: The study investigated the influence of the presence of melasma on the quality of life of volunteers before and after 60 days of oral use of lingonberry extract (Vaccinium vitis idaea L.) in combination with topical sunscreen and in patients who just wore sunscreen through the Melasma Quality of Life Scale Scale. Comparative and standardized dermatoscopic photographs of the lesions had the intensity of the pigmentation evaluated by an optical density analysis program.
Results: Evaluation of the Melasma Quality of Life Scale indicated a reduction of the discomfort caused by the pathology after the use of the phytotherapic drug in association with the sunscreen, which did not occur in the group that used the sunscreen alone. The analysis of the pigmentation density in the photographs showed a significant reduction in the degree of pigmentation after the use of phytotherapic drug, as well as no alterations in the control group.
Conclusion: The use of lingonberry may contribute to the treatment of facial melasma.

Keywords: MELASMA; PHYTOTHERAPY; SKIN PIGMENTATION

Six patients underwent two sessions of microneedling associated to drug delivery on the face, hands or stretch marks, at three-week interval between sessions. Patients were evaluated using clinical analysis and objective measures. Compared to baseline, objective face analysis showed decrease in acne lesions and improvement in the skin texture. The evaluation of stretch marks showed great improvement, and face and hands presented excellent results compared to baseline. The association of microneedling to drug delivery for rejuvenation of the face and hands, and for the treatment of stretch marks presented promising results in our study.

Keywords: ADMINISTRATION, CUTANEOUS; HYALURONIC ACID; REJUVENATION; STRIAE DISTENSAE; TRANEXAMIC ACID; HYDROXYPROLINE

INTRODUCTION: Despite all the existing therapeutic tools, melasma continues to be a dermatological challenge. Therefore, the search for new treatment modalities aims to optimize results and reduce systemic side effects.
OBJECTIVE: Evaluate the clinical improvement of patients with melasma treated with robotic micro-needling associated to drug delivery of tranexamic acid.
MATERIAL AND METHODS: Seventeen women with melasma were selected to be treated during eight weeks with four fortnightly sessions of robotic microneedling associated to drug delivery of 1.0ml of 4mg/ml tranexamic acid. The group was evaluated before and after the treatment with the following parameters: photographic evolution evaluated by three examiners, self-evaluation with Melasma QoL and MASI improvement.
RESULTS: Fifteen Fitzpatrick phototype II to VI patients completed the study. Of those, 31.11% showed little or no improvement; 24.45% moderate to intermediate improvement; 33.33% significant improvement and 11.11% improved almost to resolution. In regards to MASI, there was a significant improvement, with a reduction from 21.33% to 11.19%.
CONCLUSIONS: The proposed association showed satisfactory results, constituting an innovative, replicable and safe therapeutic modality for the treatment of melasma.

Keywords: Combined modality therapy; Hyperpigmentation; Tranexamic acid