الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 111 |  |  |
| | | from | 111 | | |
Abstract
Summary
Melasma is an acquired disorder of hyperpigmentation presenting over the face. Females in their reproductive age group are commonly affected, with cheek, nose, upper lip, and forehead being the predominant areas of involvement. However, it can occur over areas other than the face and also in men. It is classically known to affect females of Asian or Hispanic origin with Fitzpatrick skin Type III-V
Clinically, when the area of involvement is taken into consideration, it can be centrofacial, malar or mandibular. Based on histological and Wood’s lamp examination, it can be of epidermal, dermal, or mixed type. from an etiological point of view, it is related to high-intensity ultraviolet ray exposure, pregnancy, contraceptives, drugs, hormone therapy, and genetic abnormality. A predilection for facial skin and relative refractoriness to treatment makes patients cosmetically disfigured, along with putting them through intense psychological distress. It imparts a poor quality of life with adversely affected social interaction, recreation, and emotional wellbeing.
A variety of treatment options have been proposed and used in melasma. Topical modalities include Kligman’s formula, hydroquinone, and glycolic acid. Oral modality includes tranexamic acid. Procedure based modalities include chemical peels, microdermabrasion, and lasers.
Hyper pigmentation disorders corresponding intracellular signaling cascades that lead to the stimulation of melanogenesis it include Ultraviolet B hyper pigmentation and melasma. Use of anti-pigmenting agents developed so far can inhibit melanogenesis partially. However, topical agents used for hyper pigmented skin area are potent anti-melanogenic agents capable of suppressing constitutive pigmentation and this may lead to hypo pigmentation in surrounding areas
Melasma is characterized by symmetrical hyper pigmented macules and patches on the sun exposed area of the face, commonly on forehead, cheeks, lips and nose especially in women. It is an acquired pigmentary disorder. Its pathogenesis is not yet fully understood but the common risk factors for melasma include pregnancy, oral contraceptives, genetic factor, and Ultraviolet exposure. Most recently data supported that pathogenesis of melasma involves vascular growth factors, pathway modulator genes and inducible Nitric Oxide Synthase expression and down regulation of H19 genes with a still unresolved pathogenesis. A wide variety of treatments include hydroquinone, and tranexamic acid, azelaic acid, glycolic acid, laser, broad spectrum sunscreen and sun avoidance.
The aim of this study is to compare the efficacy of tranexamic acid (TA), Platelet-Rich Plasma (PRP) with micro needling vs Kligman-Willis formula in melasma.
This study was carried out at dermatology outpatient clinic at Beni-Suef University hospital, 45 participants divided into three groups; First group (A): 15 patients who received four sessions of micro needling with addition of topical tranexamic acid every two weeks, Second group (B): 15 patients who received four sessions of micro needling with addition of topical Platelet-Rich Plasma every two weeks, and Third group(C): 15 patients who received Kligman-Willis formula once daily 30 min before bedtime for 8 weeks. The study was carried out from 1st January 2019 to 1st January 2020
The main results of the study revealed that:
• no statistical significant difference (p-value > 0.05) between studied groups as regard age & sex.
• No statistical significant difference (p-value > 0.05) between studied groups as regard melasma type.
• Statistically significant difference (p-value < 0.05) between studied groups as regard skin type.
• Highly statistical significant difference (p-value < 0.001) between studied groups as regard melasma duration.
• No statistical significant difference (p-value > 0.05) between studied groups as regard involvement sites (forehead, right molar, left molar & chin).
• Statistically significant difference (p-value < 0.05) between studied groups as regard nose as involvement site.
• No statistical significant difference (p-value > 0.05) between studied groups as regard 1st week response.
• Statistically significant difference (p-value < 0.05) between studied groups as regard 3rd & 5th week response.
• Highly statistical significant difference (p-value < 0.001) between studied groups as regard 7th week response.
• Highly statistical significant differences (p-value < 0.001) of response follow up in Kligman group.
• No statistical significant differences (p-value > 0.05) of response follow up in PRP group.
• Statistically significant differences (p-value < 0.05) of response follow up in TA group.
Based on our findings, we recommend for further studies on larger sample size and for longer period of follow up to confirm our results and to assess if continuation on topical tranexamic acid therapy may prevent relapse of melasma.