The Therapeutic Use of Antioxidants for Melasma

August 2020 | Volume 19 | Issue 8 | Original Article | 788 | Copyright © August 2020


Published online July 31, 2020

Kayla M. Babbush BSa, Remy A. Babbush BSb, Amor Khachemoune MD FAAD FACMSc

aDivision of Dermatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY bDepartment of Food Science, Cornell University, Ithaca, NY cDepartment of Dermatology, State University of New York Downstate, Brooklyn, NY USA; Department of Dermatology, Veterans Health Administration, Brooklyn, NY

Abstract
Melasma is a chronic dermatologic condition with an incompletely understood pathogenesis and well-demonstrated impact on patient quality of life. Melasma is a common cause for seeking dermatologic care, and with no universally efficacious therapy or cure, com-bination treatment is the best approach for many cases. Numerous studies have demonstrated the role of oxidative stress in patients with melasma, prompting investigation into several antioxidants for melasma therapy. In this review, we discuss the well-defined role of oxidative stress in melasma and the therapeutic efficacy of various antioxidants for patients suffering from melasma. We focus our discussion on studies investigating the role of vitamin C, azelaic acid, cysteamine, glutathione, carotenoids, and numerous other antioxidants in disorders of hyperpigmentation. There is promising evidence for the use of these antioxidants, as topical, oral, and intra-venous preparations, both in isolation and in conjunction with other melasma therapies.

J Drugs Dermatol. 2020;19(8):788-792. doi:10.36849/JDD.2020.5079

INTRODUCTION

Melasma is a chronic and acquired skin disorder of hyperpigmentation that presents with symmetric hypermelanosis of sun exposed areas, especially the face. Disease prevalence, ranging from 1 to 50%, varies with gender, ethnicity, skin phenotype, and sun exposure.1

The pathogenesis of melasma is incompletely understood, which poses a challenge for disease management. Causative factors include genetics, ultraviolet (UV) radiation, cosmetics, pregnancy, hormonal therapy, phototoxic drugs, and various medications.1,2

Melasma is evaluated by Melasma Area and Severity Index (MASI) score, modified MASI (mMASI) score, Melasma Quality of Life Scale (MelasQoL), colorimetry, and mexametry.

With a well demonstrated impact on quality of life, melasma is a common cause for seeking dermatologic care. There is no universally efficacious therapy, so combination treatment is preferred. Therapies include topical hypopigmenting agents, laser treatment, microneedling, chemical peels, radiofrequency, and oral medications.1 Furthermore, it is critical for patients to avoid exacerbating factors.

The skin, a protective organ critical in homeostasis, is the site of numerous biochemical processes, including the generation of free radicals, namely reactive oxygen and nitrogen species. Reactive oxygen species (ROS) are necessary for biological signaling processes, but, in excess, ROS can damage biomolecules.3 There is clear evidence of oxidative stress in melasma.4,5

Antioxidant Therapy in Melasma
Vitamin C
Vitamin C, or ascorbic acid, is a potent antioxidant with a myriad of research on its role in numerous diseases. It is a ROS scavenger and can regenerate various other antioxidants. Vitamin C and magnesium ascorbyl phosphate (MAP), a vitamin C derivative, have been investigated for their role in treating melasma. Oral vitamin C supplementation has been studied for treatment of hyperpigmentation disorders. Hayakawa et al investigated the role of oral vitamins C and E, both alone and in combination, in patients with chloasma and pigmented contact dermatitis. The combination group had the most significant response, but all experienced significant reductions in skin luminosity differences between hyperpigmented and normal skin areas.6 Similarly, Handog et al found oral combination therapy with vitamins A, C, E, and procyanidin effective for treating Filipino women with melasma.7

Vitamin C cream has been investigated as a topical remedy for melasma, by both direct skin and ultrasound application. In a comparison of hydroquinone and ascorbic acid cream for melasma, there was significantly greater subjective