الفهرس 
AcknowledgementsOnly 14 pages are availabe for public view
 |  | from | 120 |  |  |
| | | from | 120 | | |
Abstract
The current study was carried out at the Dermatology, Venereology and Andrology outpatient clinic of Assiut University Hospitals, Egypt, in the period between July 2018 and March 2020. The study designed to compare the efficacy and safety of combined TCA 25% peeling and systemic metformin in treatment of melasma and evaluate impact of melasma on patients quality of life. Our study included 60 melasma patients divided randomly into 3 groups according to the different treatment modalities with twenty patients in each group. group A: (20 patients) received 25% TCA peeling and systemic metformin (1000mg/day). group B: (20 patients) received 25% TCA and systemic metformin (500mg metformin/day). group C: (20 patients) received 25%TCA peeling and placebo. The response to treatment was assessed with photographs taken for each patient before and after treatment, along with MASI, modified –MASI scores and Melasma Quality of life Scale (MELASQOL) questionnaire Arabic version at the baseline after one month of the last session. The age of the patients ranged from 20 to 52 years with a mean ± SD of 35.18 ± 7.09, the duration of illness ranged from one year to 25 years with mean ± SD of 5.94 ± 4.35 years. 98.3% of patients were females. Fitzpatrick skin phototypes of the patients were III and IV. The sun exposure and Pregnancy were the most prevalent triggering factors in the three treated groups. In our study TCA25% peeling was found to be effective in the three treatment groups. We found a significant decrease in the MASI and m MASI scores after treatment in the three treated groups. Comparing the three groups both MASI and m MASI scores after treatment were lower in patients treated with metformin (with both concentrations) than those treated with placebo only however, there was no statistical difference between them. Regarding the mean percentage of improvement in MASI score it was higher in both groups treated with metformin (metformin 1000 and metformin 500) than that in group treated with placebo with statistical significant difference between group A(TCA 25% and metformin 1000)and group C(TCA 25% and placebo). Grading the percentage of improvement in MASI score showed that 35% of patients treated with metformin 1000 showed excellent improvement compared to 10% and 5% in groups treated by metformin 500 and placebo respectively. Also grading the percentage of improvement by m MASI showed that 60%of patients treated with metformin 1000 had excellent improvement compared to45% and 35 in groups treated by metformin 500 and placebo respectively. Without any statistical significant difference between them. There was significant better results in epidermal melasma than mixed type regarding both MASI, m MASI scores and their mean percentage of improvement and when we compared the results of each group in the epidermal melasma there was a statistical significant improvement in group A treated by metformin 1000 and TCA 25% compared to both group B (metformin 500 and TCA 25%) and group C (placebo and TCA 25%) in the percentage of improvement of both MASI and m MASI scores after treatment. There was decrease in the impact of melasma on the patients quality of life in the three treated groups specially group A (metformin 1000 and TCA 25%) and group B (metformin 500 and TCA 25%) after treatment but without any significant difference between them. Epidermal melasma treated by metformin both 500 and 1000 showed obvious decrease in their impact on quality of life and better percentage of improvement compared to placebo group however this result was not statistical significant. There was direct correlation between decrease impact of melasma on patient’s quality of life and decrease the MASI and mMASI scores after treatment. According to the patient satisfaction, There was statistical significant higher satisfaction in group B treated by (metformin 500 and TCA 25%) compared to group C (placebo and TCA 25%).As regards the side effects in our study, after peeling by TCA 25% apart from burning sensation and erythema that occur during session and that usually last from 24-48 hrs no other side effects were detected. Common side effect detect in treated patients who received systemic metformin was GIT upset. It was statistically significant in group (A) (treated by TCA25 % and 1000 mg metformin).