الفهرس 
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Abstract
Melasma is a common dyschromia that often motivates the search for dermatological care as it results in cosmetic disfigurement that impairs the patient’s quality of life. It is a common cosmetic problem in our society due to excessive sun exposure, high Fitzpatrick skin phototype and lack of continous use of sunscreen.
The process of pigmentation in melasma is very complex, and more research is required to elucidate the intricacies of pathogenesis, and thereby target newer therapies against this psychologically distressing disorder. Newer drugs, which may have better properties like stability in formulations, lesser irritation, fewer side effects, better skin penetration and enhanced potency, will be the answer for the future. They may further be investigated to provide an appropriate therapeutic tool for this frustrating disorder.
Vitamin C is a known depigmenting agent that interrupts the key steps of melanogenesis but is not toxic to melanocytes. It also has an antioxidant, antinflammatory and photoprotective effect. As Vit. C is hydrophilic, there is a marked interest to find methods of efficient transepidermal delivery of the stable active compound.
Transdermal delivery of drugs is a novel method of drug delivery, which is becoming popular all over the world. This mode of drug delivery bypasses the effects of digestive tract and first-pass liver metabolism and, therefore, it provides more consistent and reliable means of drug delivery than the oral route. When compared with intravenous injections, transdermal drug delivery is safer and less painful.
It was in 1998 that use of microneedles was reported to facilitate the penetration of high molecular weight drugs through stratum corneumand hair folliclesMicroneedles create micropores in the epidermis, without disturbing the the dermal nerves. These micropores facilitate an increase in skin permeability for many compounds. These microchannels are reversible in nature and close within a few hours of microporation. This reversible nature of microchannels is very advantageous for the controlled delivery of cosmetic agents/therapeutic compounds.
In our study, the efficacy of microneedling with topical vitamin C 20% in treatment of melasma was evaluated. The study included 30 adult females with epidermal melasma. All patients received 6 sessions at 2 week interval and came for follow up after 3 months. During the whole treatment and follow up period the patients did not use any topical medications at home except for sunscreen. Clinical assessment was done by calculation of MASI and digital photos taken at each session.
At the last session all patients showed improvement. The baseline MASI score (mean=8.61) decreased to 5.75 (P value <0.0001) in the 6th session. Percentage improvement in the 6th session was about 36.87. After 3 months follow up, 5 patients (16.7%) showed recurrence. Recurrence occurred due to recurrence of the predisposing factors as sun exposure, pregnancy and use of hormonal contraceptives.
We can conclude that microneedling with topical vitamin C is a promising treatment option for epidermal melasma especially in fair skinned patients. It is a safe treatment modality with nearly no side effects so it can be used as a maintenance therapy without the known side effects of classical treatments of melasma specially the classical triple combination (Hydroquinone, steroids and retinoids).
Further comparative studies are recommended to compare the efficacy of this novel combination with other treatment options of melasma. Also microneedling alone should be studied as a sole therapeutic option for melasma. Also it should be included in further studies with other depigmenting agents as a method of transdermal drug delievery in treatment of melasma.