Cohen Philip R
Department of Dermatology, University of California San Diego, San Diego, CA, United States.
Med Hypotheses. 2017 Apr;101:1-5. doi: 10.1016/j.mehy.2017.01.020. Epub 2017 Feb 3.
Melasma is an acquired disorder of pigmentation that presents with asymptomatic symmetric darkening of the face. The pathogenesis of this condition is multifactorial and influenced by several factors including female sex hormones, genetic predisposition and ultraviolet light exposure. The management of melasma is usually directed at more than one of the causative etiologic factors and often incorporates a combination of topical agents, with or without the addition of physical modalities. Estrogen and angiogenesis are significant factors in the etiology of melasma. A useful addition to the therapeutic armentarium for treating melasma would include a topical agent that could effect both of these causative factors. Specifically, a topical preparation consisting of an anti-estrogen and a vascular endothelial growth factor inhibitor would accomplish this goal. Suitable candidates that target estrogen receptors and vascular endothelial growth factor are currently used in medical oncology as systemic antineoplastic agents. The anti-estrogen could be either a selective estrogen receptor modulator (such as tamoxifen or raloxifene) or an aromatase inhibitor (such as anastrozole or letrozole or exemestane). The vascular endothelial growth factor inhibitor would be bevacizumab. In conclusion, a novel-topically administered-therapy for melasma would combine an anti-estrogen and a vascular endothelial growth factor inhibitor.
黄褐斑是一种后天性色素沉着紊乱疾病，表现为面部无症状的对称性色素沉着。该病的发病机制是多因素的，受多种因素影响，包括女性性激素、遗传易感性和紫外线照射。黄褐斑的治疗通常针对多种致病因素，常采用局部用药联合或不联合物理治疗方法。雌激素和血管生成是黄褐斑病因中的重要因素。治疗黄褐斑的有效方法是添加一种能同时作用于这两种致病因素的局部用药。具体而言，一种由抗雌激素和血管内皮生长因子抑制剂组成的局部制剂可实现这一目标。目前在医学肿瘤学中用作全身抗肿瘤药物的、靶向雌激素受体和血管内皮生长因子的合适药物。抗雌激素可以是选择性雌激素受体调节剂（如他莫昔芬或雷洛昔芬）或芳香化酶抑制剂（如阿那曲唑、来曲唑或依西美坦）。血管内皮生长因子抑制剂将是贝伐单抗。总之，一种新型的局部给药治疗黄褐斑的方法将是抗雌激素和血管内皮生长因子抑制剂联合使用。
