medigraphic.com
ISSN 1405-1710 (Impreso)

2019, Número 2

Siguiente >>

Rev Cent Dermatol Pascua 2019; 28 (2)


Ácido tranexámico oral y tópico en el tratamiento del melasma. Revisión sistemática

Jurado Santa-Cruz F, Ortiz-Lobato L, Morales SMA, Peralta PML

Idioma: Español
Referencias bibliográficas: 44
Paginas: 53-64
Archivo PDF: 336.77 Kb.


RESUMEN

Antecedentes: El melasma es una discromía facial adquirida, cuya evolución es crónica y recurrente. Para el tratamiento del melasma, el ácido tranexámico es utilizado en diversas presentaciones como una opción prometedora. Existen numerosas publicaciones, pero pocas de ellas son ECA. El objetivo de este estudio fue evaluar la calidad metodológica y riesgo de sesgo en ECA con ácido tranexámico oral, tópico e intradérmico como monoterapia, y además su eficacia y seguridad. Metodología: Se realizó una búsqueda en PubMed, Ovid y SciELO hasta el año 2018 de ECA con tratamiento de ácido tranexámico en monoterapia vía tópica, oral o transdérmica. Asimismo, se aplicó la herramienta de riesgo de sesgo de Cochrane para la evaluación de la calidad por dos autores de forma independiente. Resultados: Se encontraron 255 artículos que utilizaron las palabras clave «tranexamic acid in melasma treatment»; de ellos, únicamente 14 cumplieron con los criterios de ECA. El riesgo de sesgo fue mayor en los rubros de aleatorización, cegamiento y reporte de resultados. Conclusiones: Se requiere mayor rigor metodológico en la realización de ensayos clínicos de melasma con ácido tranexámico independientemente de la vía de administración. La eficacia del ácido tranexámico oral como monoterapia es comparable con el tratamiento de primera línea (hidroquinona sola o en combinación), a diferencia de la administración tópica e intradérmica, donde observamos variabilidad en los resultados. Es necesario el uso de evaluaciones objetivas para la valoración de la severidad del melasma que disminuyan el riesgo de sesgo ocasionado por el cegamiento del estudio (paciente, personal y evaluador).


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Passeron T. Melasma pathogenesis and influencing factors- An overview of the latest research. J Eur Acad Dermatol Venereol. 2013; 27: 5-6.

  2. Demirkan S, Gündüz Ö, Sayan CD. Retrospective analysis of endemic melasma patients. Dermatol Reports. 2017; 9: 7027.

  3. Handog EB, Enriquez-Macarayo MJ. Melasma and vitiligo in brown skin. India: Springer; 2017. pp. 1-377.

  4. Handa S, De D, Khullar G, Radotra BD, Sachdeva N. The clinicoaetiological, hormonal and histopathological characteristics of melasma in men. Clin Exp Dermatol. 2018; 43: 36-41.

  5. Pandya A, Berneburg M, Ortonne JP, Picardo M. Guidelines for clinical trials in melasma. Pigmentation Disorders Academy. Br J Dermatol. 2006; 156: 21-28.

  6. Lee AY. Recent progress in melasma pathogenesis. Pigment Cell Melanoma Res. 2015; 28: 648-660.

  7. D’Elia MP, Brandão MC, de Andrade Ramos BR, da Silva MG, Miot LD, Dos Santos SE et al. African ancestry is associated with facial melasma in women: a cross-sectional study. BMC Med Genet. 2017; 18: 17.

  8. Cohen PR. Melasma treatment: a novel approach using a topical agent that contains an anti-estrogen and a vascular endothelial growth factor inhibitor. Med Hypotheses. 2017; 101: 1-5.

  9. Gupta AK, Gover MD, Nouri K, Taylor S. The treatment of melasma: a review of clinical trials. J Am Acad Dermatol. 2006; 55: 1048-1065.

  10. Rodrigues M, Pandya AG. Melasma: clinical diagnosis and management options. Australas J Dermatol. 2015; 56: 151-163.

  11. Jansen R, Osterwalder U, Wang SQ, Burnett M, Lim HW. Photoprotection: part II. Sunscreen: development, efficacy, and controversies. J Am Acad Dermatol. 2013; 69: 867.

  12. Lakhdar H, Zouhair K, Khadir K, Essari A, Richard A, Seité S et al. Evaluation of the effectiveness of a broad-spectrum sunscreen in the prevention of chloasma in pregnant women. J Eur Acad Dermatol Venereol. 2007; 21: 738-742.

  13. Sheth VM, Pandya AG. Melasma: a comprehensive update: part I. J Am Acad Dermatol. 2011; 65: 689-697.

  14. Verallo-Rowell V. The role of sunscreens in the therapy of melasma. Clin Drug Invest. 1995;10: 49-56.

  15. Shankar K, Godse K, Aurangabadkar S, Lahiri K, Mysore V, Ganjoo A et al. Evidence-based treatment for melasma: expert opinion and a review. Dermatol Ther (Heidelb). 2014; 4: 165-186.

  16. Sarkar R, Arora P, Garg VK, Sonthalia S, Gokhale N. Melasma update. Indian Dermatol Online J. 2014; 5: 426-435.

  17. Jutley GS, Rajaratnam R, Halpern J, Salim A, Emmett C. Systematic review of randomized controlled trials on interventions for melasma: an abridged Cochrane review. J Am Acad Dermatol. 2014; 70: 369-373.

  18. Chan R, Park KC, Lee MH, Lee ES, Chang SE, Leow YH et al. A randomized controlled trial of the efficacy and safety of a fixed triple combination (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%) compared with hydroquinone 4% cream in Asian patients with moderate to severe melasma. Br J Dermatol. 2008; 159: 697-703.

  19. Chiam LYT. “Exogenous ochronosis”. In: Silverberg N, Durán- McKinster C, Tay YK (eds). Pediatric skin of color. New York: Springer; 2015.

  20. Na JI, Choi SY, Yang SH, Choi HR, Kang HY, Park KC. Effect of tranexamic acid on melasma: a clinical trial with histological evaluation. J Eur Acad Dermatol Venereol. 2013; 27: 1035-1039.

  21. Del Rosario E, Florez-Pollack S, Zapata L Jr, Hernandez K, Tovar- Garza A, Rodrigues M et al. Randomized, placebo-controlled, doubleblind study of oral tranexamic acid in the treatment of moderate-tosevere melasma. J Am Acad Dermatol. 2018; 78: 363-369.

  22. Karn D, Kc S, Amatya A, Razouria EA, Timalsina M. Oral tranexamic acid for the treatment of melasma. Kathmandu Univ Med J (KUMJ). 2012; 10: 40-43.

  23. Padhi T, Pradhan S. Oral tranexamic acid with fluocinolone-based triple combination cream versus fluocinolone-based triple combination cream alone in melasma: an open labeled randomized comparative trial. Indian J Dermatol. 2015; 60: 520.

  24. Puri N. Oral tranexamic acid versus triple combination for the treatment of melasma. J Expt Derm Res. 2015; 1: 018.

  25. Colferai MMT, Miquelin GM, Steiner D. Evaluation of oral tranexamic acid in the treatment of melasma. J Cosmet Dermatol. 2018. doi: 10.1111/jocd.12830.

  26. Atefi N, Dalvand B, Ghassemi M, Mehran G, Heydarian A. Therapeutic effects of topical tranexamic acid in comparison with hydroquinone in treatment of women with melasma. Dermatol Ther (Heidelb). 2017; 7: 417-424.

  27. Ebrahimi B, Naeini FF. Topical tranexamic acid as a promising treatment for melasma. J Res Med Sci. 2014; 19: 753-757.

  28. Banihashemi M, Zabolinejad N, Jaafari MR, Salehi M, Jabari A. Comparison of therapeutic effects of liposomal Tranexamic Acid and conventional Hydroquinone on melasma. J Cosmet Dermatol. 2015; 14: 174-177.

  29. Yoo J, Ahn H, Kim MS, Jue MS, Choi KH. Efficacy of topical tranexamic acid in treatment of melasma. Korean J Dermatol. 2017; 55: 283-289.

  30. Kanechorn Na Ayuthaya P, Niumphradit N, Manosroi A, Nakakes A. Topical 5% tranexamic acid for the treatment of melasma in Asians: a double-blind randomized controlled clinical trial. J Cosmet Laser Ther. 2012; 14: 150-154.

  31. Budamakuntla L, Loganathan E, Suresh DH, Shanmugam S, Suryanarayan S, Dongare A et al. A randomised, open-label, comparative study of tranexamic acid microinjections and tranexamic acid with microneedling in patients with melasma. J Cutan Aesthet Surg. 2013; 6: 139-143.

  32. Steiner D, Feola C, Bialeski N, de Morais e Silva FA, Antiori ACP, Addor FAS et al. Study evaluating the efficacy of topical and injected tranexamic acid in treatment of melasma. Surg Cosmet Dermatol [Internet]. 2009; 1: 174-177. Disponible en: http://www.scopus.com/ inward/record.url?eid=2-s2.0-80053628428&partnerID=40&md5=5 b15ae0ca3cc9e204ede0a7569897770

  33. Xu Y, Ma R, Juliandri J, Wang X, Xu B, Wang D et al. Efficacy of functional microarray of microneedles combined with topical tranexamic acid for melasma: A randomized, self-controlled, split-face study. Medicine (Baltimore). 2017; 96: e6897.

  34. Sharma R, Mahajan VK, Mehta KS, Chauhan PS, Rawat R, Shiny TN. Therapeutic efficacy and safety of oral tranexamic acid and that of tranexamic acid local infiltration with microinjections in patients with melasma: a comparative study. Clin Exp Dermatol. 2017; 42: 728-734.

  35. Lajevardi V, Ghayoumi A, Abedini R, Hosseini H, Goodarzi A, Akbari Z et al. Comparison of the therapeutic efficacy and safety of combined oral tranexamic acid and topical hydroquinone 4% treatment vs. topical hydroquinone 4% alone in melasma: a parallel-group, assessor- and analyst-blinded, randomized controlled trial with a short-term followup. J Cosmet Dermatol. 2017; 16: 235-242.

  36. Shin JU, Park J, Oh SH, Lee JH. Oral tranexamic acid enhances the efficacy of low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet laser treatment for melasma in Koreans: a randomized, prospective trial. Dermatol Surg. 2013; 39: 435-442.

  37. Saki N, Darayesh M, Heiran A. Comparing the efficacy of topical hydroquinone 2% versus intradermal tranexamic acid microinjections in treating melasma: a split-face controlled trial. J Dermatolog Treat. 2018; 29: 405-410.

  38. Kumar V, Xu Y. Unusual presentation of metastatic sebaceous carcinoma and its response to chemotherapy: is genotyping a right answer for guiding chemotherapy in rare tumours? Curr Oncol. 2015; 22: e316-e319.

  39. Pazyar N, Yaghoobi R, Zeynalie M, Vala S. Comparison of the efficacy of intradermal injected tranexamic acid versus hydroquinone cream in the treatment of melasma. Clin Cosmet Investig Dermatol. 2019; 12: 115-122.

  40. Chung JY, Lee JH, Lee JH. Topical tranexamic acid as an adjuvant treatment in melasma: Side-by-side comparison clinical study. J Dermatolog Treat. 2016; 27: 373-377.

  41. Kim HJ, Moon SH, Cho SH, Lee JD, Kim HS. Efficacy and safety of tranexamic acid in melasma: a meta-analysis and systematic review. Acta Derm Venereol. 2017; 97: 776-781.

  42. Taraz M, Niknam S, Ehsani AH. Tranexamic acid in treatment of melasma: A comprehensive review of clinical studies. Dermatol Ther. 2017; 30. doi: 10.1111/dth.12465. Epub 2017 Jan 30.

  43. Bala HR, Lee S, Wong C, Pandya AG, Rodrigues M. Oral tranexamic acid for the treatment of melasma: a review. Dermatol Surg. 2018; 44: 814-825.

  44. Zhang L, Tan WQ, Fang QQ, Zhao WY, Zhao QM, Gao J et al. Tranexamic acid for adults with melasma: a systematic review and meta-analysis. Biomed Res Int. 2018; 2018: 1683414.




2020     |     www.medigraphic.com