Effect of tranexamic acid on melasma: a clinical trial with histological evaluation
Effect of tranexamic acid on melasma: a clinical trial with histological evaluation
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DOI：
10.1111/j.1468-3083.2012.04464.x
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发表时间：
2013-08-01
影响因子：
9.2
通讯作者：
Park, K. -C.
中科院分区：
文献类型：
--
作者：
Na, J. I.;Choi, S. Y.;Park, K. -C.
背景黄褐斑与表皮色素沉着、基底膜薄弱、血管增生和肥大细胞增多有关。氨甲环酸(TXA)是一种纤溶酶抑制剂，据报道，局部注射可以改善黄褐斑。然而，口服和外用TXA对黄褐斑的影响还没有得到很好的研究，其潜在的机制还不清楚。目的探讨血栓素A口服和外用治疗黄褐斑的疗效。方法从2010年3月至7月，对25例妇女进行为期8周的临床研究。志愿者被指示每天三次服用两片TXA，并每天两次使用TXA外用药物，持续8周。治疗前和治疗8周后，在每次就诊期间，使用皮肤镜((R))测量皮肤色素沉着和红斑，并收集8名受试者的皮肤活检。Fontana-Masson、抗CD31、抗类胰蛋白酶和抗IV型胶原染色。结果22例受试者完成研究，研究期内未发生严重不良反应。皮损黑素指数(MI)平均评分明显下降。有趣的是，皮损周围皮肤的MI分数增加了。皮损和皮损周围皮肤的红斑指数评分也显示出类似的模式。组织学分析显示，表皮色素沉着、血管数量和肥大细胞计数显著减少。所有标本均未见IV型胶原染色。结论TXA减少了黄褐斑相关的表皮色素沉着，并逆转了黄褐斑相关的真皮变化，如血管数量和肥大细胞数量的增加。
Background Melasma is associated with epidermal hyperpigmentation, weak basement membrane, vascular proliferation and increased numbers of mast cell. Tranexamic acid (TXA), a plasmin inhibitor, is reported to improve melasma when injected locally. However, the effects of oral and topical TXA on melasma have not been well studied and the underlying mechanism remains unclear. Objectives To elucidate the effects of oral and topical TXA on melasma. Methods A clinical study was conducted with 25 women for 8weeks from March to July 2010. Volunteers were instructed to take two TXA tablets three times a day and apply a TXA topical agent twice a day for 8weeks. Skin pigmentation and erythema was measured using a Mexameter((R)) during each visit and skin biopsies were collected from eight subjects before and 8weeks after treatment. Fontana-Masson, anti-CD31, antitryptase and antitype IV collagen staining was performed. Results Twenty-two subjects completed the study and no serious adverse events occurred during the study period. The mean lesional melanin index (MI) scores decreased significantly. Interestingly, the MI scores for the perilesional skin increased. The erythema index scores of lesional and perilesional skin also showed a similar pattern. Histological analysis showed significant reduction of epidermal pigmentation, vessel numbers and mast cell counts. Type IV collagen staining was not observed in all specimens. Conclusion TXA decreased epidermal pigmentation associated with melasma and also reversed melasma-related dermal changes, such as vessel number and increased numbers of mast cells.