Ramírez-Oliveros Joaquín Felipe, de Abreu Luciana, Tamler Carla, Vilhena Paula, de Barros Mayara Hamilko
Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro - Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil;
Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro - Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil.
Skinmed. 2020 Jan 1;18(1):38-40. eCollection 2020.
A 42-year-old woman with phototype V, presented a 9-year history of refractory centrofacial melasma to topical bleaching agents and peelings, untreated for the last 90 days. One session of microneedling with 1.5 mm needles was performed with hydroquinone 4% sterile serum drug delivery; after 3 days, modified Kligman's formula (hydroquinone 4% + fluocinolone acetonide 0.01% + tretinoin 0.05%) and broad-spectrum sunscreen SPF 70 were introduced for daily use. After 30 days, a significant improvement was observed in the clinical outcome (Figure 1) and the quality of life of the patient. These parameters were measured using Melasma Area and Severity Index (MASI) scale, with an 82.5% decrease, and Melasma Quality of Life Scale - Brazilian Population (MELASQoL-BP), with a 60% decrease. Dermatoscopic analysis (polarized videodermatoscopy x20) of the glabellar region revealed lighting of the pseudoreticular pigment network, diffuse light to dark brown background, and reduction in vascularity and telangiectasias (Figure 2). At the 5-month follow-up, there had been no relapse. The patient continued to use a broad-spectrum sunscreen along with the topical regiment.
一名42岁的V型皮肤女性，有9年顽固性面部中央黄褐斑病史，对局部漂白剂和化学剥脱治疗无效，近90天未治疗。采用1.5毫米针头进行了一次微针治疗，并使用4%氢醌无菌血清给药；3天后，开始每日使用改良的Kligman配方（4%氢醌+0.01%醋酸氟轻松+0.05%维甲酸）和SPF 70广谱防晒霜。30天后，临床疗效（图1）和患者生活质量有显著改善。这些参数使用黄褐斑面积和严重程度指数（MASI）量表测量，下降了82.5%，使用黄褐斑生活质量量表-巴西人群（MELASQoL-BP）测量，下降了60%。眉间区域的皮肤镜分析（偏振视频皮肤镜x20）显示假网状色素沉着网络变淡，背景为弥漫性浅至深棕色，血管和毛细血管扩张减少（图2）。在5个月的随访中，没有复发。患者继续使用广谱防晒霜以及局部用药方案。
