Griffiths C E, Finkel L J, Ditre C M, Hamilton T A, Ellis C N, Voorhees J J
Department of Dermatology, University of Michigan Medical Center, Ann Arbor 48109-0314.
Br J Dermatol. 1993 Oct;129(4):415-21. doi: 10.1111/j.1365-2133.1993.tb03169.x.
Melasma is a common disorder of cutaneous hyperpigmentation predominantly affecting the faces of women. Little is known about the aetiology of melasma, and treatment is frequently disappointing. Topical tretinoin is of benefit in treating other forms of hyperpigmentation, for example liver spots, and we therefore investigated its effectiveness in melasma. Thirty-eight women completed a randomized, vehicle-controlled study, in which they applied 0.1% tretinoin (n = 19) or vehicle cream (n = 19) once daily to the face for 40 weeks. At the end of treatment 13 (68%) of 19 tretinoin-treated patients were clinically rated as improved or much improved, compared with 1 (5%) of 19 in the vehicle group (P = 0.0006). Significant improvement first occurred after 24 weeks of tretinoin treatment. Colorimetry (an objective measure of skin colour) demonstrated a 0.9 unit lightening of tretinoin-treated melasma and a 0.3 unit darkening with vehicle (P = 0.01); these results correlated with clinical lightening (r = 0.55, P = 0.0005). Histologically, epidermal pigment was reduced 36% following tretinoin treatment, compared with a 50% increase with vehicle (P = 0.002). Reduction in epidermal pigment also correlated with clinical lightening (r = -0.41, P = 0.01). Moderate cutaneous side-effects of erythema and desquamation occurred in 88% of tretinoin-treated and 29% of vehicle-treated patients. Topical 0.1% tretinoin produces significant clinical improvement of melasma, mainly due to reduction in epidermal pigment, but improvement is slow.
黄褐斑是一种常见的皮肤色素沉着紊乱疾病，主要影响女性面部。人们对黄褐斑的病因知之甚少，治疗效果也常常不尽人意。外用维甲酸对治疗其他形式的色素沉着，如老年斑，是有效的，因此我们研究了其对黄褐斑的治疗效果。38名女性完成了一项随机、赋形剂对照研究，她们每天一次将0.1%维甲酸（n = 19）或赋形剂乳膏（n = 19）涂抹于面部，持续40周。治疗结束时，19名接受维甲酸治疗的患者中有13名（68%）临床评定为改善或明显改善，而赋形剂组19名患者中只有1名（5%）改善（P = 0.0006）。维甲酸治疗24周后首次出现显著改善。比色法（一种皮肤颜色的客观测量方法）显示，接受维甲酸治疗的黄褐斑皮肤变浅0.9个单位，而使用赋形剂的皮肤变黑0.3个单位（P = 0.01）；这些结果与临床皮肤变浅情况相关（r = 0.55，P = 0.0005）。组织学上，维甲酸治疗后表皮色素减少36%，而使用赋形剂后表皮色素增加50%（P = 0.002）。表皮色素减少也与临床皮肤变浅相关（r = -0.41，P = 0.01）。88%接受维甲酸治疗的患者和29%接受赋形剂治疗的患者出现了中度皮肤副作用，如红斑和脱屑。外用0.1%维甲酸可使黄褐斑有显著的临床改善，主要是由于表皮色素减少，但改善过程缓慢。
