Shen Sihao, Yao Huiyi, Zhu Yuan, Xiang Wenzhong
Department of Medical Cosmetology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, China.
Department of Dermatology, Hangzhou Third People's Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
J Cosmet Dermatol. 2025 Jul;24(7):e70329. doi: 10.1111/jocd.70329.
Cordyceps is a valuable Chinese herbal medicine known for its various components with antioxidant properties, which may theoretically improve melasma. This study aimed to evaluate the efficacy of a new skin-lightening cosmetic containing Cordyceps extract (referred to as Cordyceps essence) in treating female patients with melasma.
Sixty-two women with melasma were enrolled and randomly assigned to two groups for 12 weeks of treatment. Group A received oral tranexamic acid (TXA) combined with topical hydroquinone cream, while Group B received oral TXA combined with topical Cordyceps essence. Changes in the Melasma Area and Severity Index (MASI), melanin index (MI), and erythema index (EI) were monitored and assessed before and after treatment. Patient-reported satisfaction and adverse events were also recorded. Additionally, a metabolomic analysis was conducted on 15 randomly selected patients from Group B.
After 12 weeks of treatment, intra-group comparisons revealed that MASI scores, MI, and EI significantly decreased in both Group A and B compared to baseline (p < 0.05). However, inter-group comparisons showed no statistical differences in MASI scores, MI, or EI between the two groups after treatment (p > 0.05). Adverse reactions occurred in 4 people (13.8%) in Group A and 1 person (3.3%) in Group B. Patient satisfaction with treatment was similar in both groups. The metabolomic analysis identified significant differences in 29 metabolites and 15 metabolic pathways after treatment (p < 0.05).
Our study demonstrated that both oral TXA combined with hydroquinone cream and oral TXA combined with Cordyceps essence significantly improved melasma in women. However, the incidence of adverse reactions was lower with topical Cordyceps essence than that with hydroquinone cream. Cordyceps essence appeared to be a promising alternative for patients intolerant to hydroquinone cream. Metabolomic analysis revealed that modulation of melanogenesis-related metabolites, enhanced antioxidant activity, and improved skin barrier function collectively contributed to the clinical improvement in melasma severity. The improvement of melasma with oral TXA and topical Cordyceps essence may be closely linked to changes in endogenous differential metabolites in the skin and the regulation of amino acid metabolic pathways.
冬虫夏草是一种珍贵的中药材，其多种成分具有抗氧化特性，理论上可能改善黄褐斑。本研究旨在评估一种含有冬虫夏草提取物的新型美白化妆品（简称冬虫夏草精华）治疗女性黄褐斑患者的疗效。
招募62名黄褐斑女性患者，随机分为两组，进行为期12周的治疗。A组口服氨甲环酸（TXA）联合外用氢醌霜，而B组口服TXA联合外用冬虫夏草精华。在治疗前后监测并评估黄褐斑面积和严重程度指数（MASI）、黑色素指数（MI）和红斑指数（EI）的变化。还记录了患者报告的满意度和不良事件。此外，对B组随机选取的15名患者进行了代谢组学分析。
治疗12周后，组内比较显示，A组和B组的MASI评分、MI和EI与基线相比均显著降低（p < 0.05）。然而，组间比较显示，治疗后两组之间的MASI评分、MI或EI无统计学差异（p > 0.05）。A组有4人（13.8%）出现不良反应，B组有1人（3.3%）出现不良反应。两组患者对治疗的满意度相似。代谢组学分析确定治疗后29种代谢物和15条代谢途径存在显著差异（p < 0.05）。
我们的研究表明，口服TXA联合氢醌霜和口服TXA联合冬虫夏草精华均能显著改善女性黄褐斑。然而，外用冬虫夏草精华的不良反应发生率低于氢醌霜。冬虫夏草精华似乎是不耐受氢醌霜患者的一种有前景的替代选择。代谢组学分析表明，调节黑色素生成相关代谢物、增强抗氧化活性和改善皮肤屏障功能共同促成了黄褐斑严重程度的临床改善。口服TXA和外用冬虫夏草精华改善黄褐斑可能与皮肤内源性差异代谢物的变化和氨基酸代谢途径的调节密切相关。
