Mawu Ferra Olivia, Christopher Paulus Mario
Department of Dermatology and Venereology, Faculty of Medicine, Sam Ratulangi University/R. D. Kandou Hospital, Manado, North Sulawesi, Indonesia.
Arch Dermatol Res. 2024 Dec 14;317(1):117. doi: 10.1007/s00403-024-03571-3.
Currently, hydroquinone serves as topical treatment of choice for melasma. However, its long-term use was associated with melanocyte toxicity. Cysteamine is an aminothiol that possesses antioxidant and depigmenting properties, therefore potentially suitable for treating melasma. This study aims to analyze the efficacy and safety of cysteamine 5% cream for the management of melasma. A comprehensive search was conducted on the Europe PMC, Medline, Scopus, and Cochrane Library databases up until June 22nd, 2024. This review incorporates randomized controlled trials (RCTs) that examines the comparison between cysteamine and placebo or hydroquinone in melasma patients. We employed random-effect models to analyze the odds ratio and standardized mean difference (SMD) for presentation of the outcomes. A total of 7 RCTs were incorporated. The results of our meta-analysis showed cysteamine 5% was more effective than placebo in reducing the Melasma Area and Severity Index (SMD - 0.84; 95% CI - 1.19, - 0.49, p < 0.00001, I = 0%), but showed no significant difference when compared with hydroquinone 4% (SMD 0.16; 95% CI - 0.22, 0.53, p = 0.42, I = 55%). In terms of safety, the incidence of adverse events (AEs) like erythema, irritation, burning, itching, and dryness were higher in the cysteamine 5% than placebo. However, the incidence of these AEs was similar between cysteamine 5% and hydroquinone 4%. This study suggests that cysteamine 5% cream may become suitable alternative of topical hydroquinone for the management of melasma due to similar efficacy and safety profile.
目前，对苯二酚是黄褐斑局部治疗的首选药物。然而，长期使用会导致黑素细胞毒性。半胱胺是一种具有抗氧化和色素脱失特性的氨基硫醇，因此可能适用于治疗黄褐斑。本研究旨在分析5%半胱胺乳膏治疗黄褐斑的有效性和安全性。截至2024年6月22日，对欧洲生物医学中心（Europe PMC）、医学期刊数据库（Medline）、Scopus数据库和考克兰图书馆数据库进行了全面检索。本综述纳入了随机对照试验（RCT），该试验考察了半胱胺与安慰剂或对苯二酚在黄褐斑患者中的比较。我们采用随机效应模型分析比值比和标准化均数差（SMD）以呈现结果。总共纳入了7项随机对照试验。我们的荟萃分析结果显示，5%半胱胺在降低黄褐斑面积和严重程度指数方面比安慰剂更有效（SMD -0.84；95%置信区间 -1.19，-0.49，p<0.00001，I=0%），但与4%对苯二酚相比无显著差异（SMD 0.16；95%置信区间 -0.22，0.53，p=0.42，I=55%）。在安全性方面，5%半胱胺组出现红斑、刺激、灼烧、瘙痒和干燥等不良事件（AE）的发生率高于安慰剂组。然而，5%半胱胺组和4%对苯二酚组这些不良事件的发生率相似。本研究表明，由于疗效和安全性相似，5%半胱胺乳膏可能成为局部使用对苯二酚治疗黄褐斑的合适替代药物。
