Department of Dermatology, Zhejiang Chinese Medical University, Hangzhou Third People's Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
Department of Dermatology, Hangzhou Third People's Hospital, Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
Lasers Med Sci. 2024 Apr 29;39(1):118. doi: 10.1007/s10103-024-04066-3.
Although patients with refractory melasma have been treated using various methods, there is still no precise definition or summary of the therapies. To define refractory melasma and conduct a review of the treatments, we searched for relevant publications in PubMed, Web of Science, and the Cochrane Library, and a total of 35 references were obtained. Refractory melasma can be roughly defined as an ineffective treatment for melasma, including topical bleaching agents, chemical peels, laser therapy, microdermabrasion for more than six months, or chemical peels treated more than six times. Meanwhile, physicians should be careful when treating patients with darker skin and dermal or mixed types of melasma since these individuals do not respond well to treatment. Lasers combined with other methods, especially different types of lasers or topical agents, are considered more effective than monotherapy. Oral tranexamic acid (TXA) is a prospective cure for refractory melasma. Other methods include a combination of chemical peels, microneedling, or injections with additional therapies. In conclusion, we were able to provide a rough definition of refractory melasma and list the available therapies. According to the literature, the most prevalent treatment is laser combination therapy. However, laser treatment should be considered only after topical agents and chemical peeling have failed. Considering its side effects, efficacy, and safety, oral TXA may be a better option, but more research is needed to make a firm conclusion. Moreover, maintenance therapy is required after treatment.
尽管已经有多种方法用于治疗难治性黄褐斑患者，但目前仍没有对该疾病的精确定义或疗法总结。为了定义难治性黄褐斑并对治疗方法进行综述，我们在 PubMed、Web of Science 和 Cochrane Library 中搜索了相关文献，共获得 35 篇参考文献。难治性黄褐斑大致可定义为对黄褐斑的治疗无效，包括外用美白剂、化学换肤、激光治疗、微磨削治疗超过 6 个月，或化学换肤治疗超过 6 次。同时，对于肤色较深和真皮/混合性黄褐斑患者，医生在治疗时应谨慎，因为这些患者的治疗效果不佳。激光联合其他方法，尤其是不同类型的激光或外用药物，被认为比单一疗法更有效。口服氨甲环酸（TXA）是治疗难治性黄褐斑的一种有前途的方法。其他方法包括化学换肤、微针或注射与其他疗法的联合应用。总之，我们能够对难治性黄褐斑进行大致定义并列出可用的治疗方法。根据文献，最常见的治疗方法是激光联合治疗。然而，只有在外用药物和化学换肤治疗失败后才应考虑激光治疗。考虑到其副作用、疗效和安全性，口服 TXA 可能是更好的选择，但仍需要更多的研究来得出明确的结论。此外，治疗后需要维持治疗。
