Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials
Background: Melasma is an acquired pigmentation disorder with challenges in treatment because of its refractory nature and high risk of recurrence.Objectives: This study aimed to compare the efficacy and side effects of 14 common therapies for melasma using a systematic review and network meta-analy...
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| Format: | Article |
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Frontiers Media S.A.
2021-09-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.713554/full |
| _version_ | 1818865639452835840 |
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| author | Yi Liu Shanshan Wu Haixuan Wu Xuelei Liang Dechao Guo Fenglin Zhuo |
| author_facet | Yi Liu Shanshan Wu Haixuan Wu Xuelei Liang Dechao Guo Fenglin Zhuo |
| author_sort | Yi Liu |
| collection | DOAJ |
| description | Background: Melasma is an acquired pigmentation disorder with challenges in treatment because of its refractory nature and high risk of recurrence.Objectives: This study aimed to compare the efficacy and side effects of 14 common therapies for melasma using a systematic review and network meta-analysis (NMA).Methods: The PubMed, Embase, and Cochrane Library databases were searched till December 2020 using the melasma area and severity index as a therapeutic index. A total of 59 randomized controlled trials (RCTs) met the inclusion criteria and were selected.Results: The ranking of relative efficacy compared with placebo in descending order was Q-switched Nd:Yag 1,064-nm laser (QSND), intense pulsed light, ablative fractional laser (AFL), triple combined cream (TCC), topical vitamin C, oral tranexamic acid (oTA), peeling, azelaic acid, microneedles (MNs), topical tranexamic acid (tTA), tretinoin, picosecond laser, hydroquinone (HQ), and non-AFL. Moreover, QSND was more effective than HQ and tTA against melasma. The ranking of percentage (%) of side effects in ascending order for each of 14 therapies with more than 80 participants was tretinoin (10.1%), oTA (17.6%), HQ (18.2%), AFL (20.0%), QSND (21.5%), TCC (25.7%), tTA (36.75%), peeling (38.0%), and MN (52.3%). Taking both efficacy and safety into consideration, TCC was found to be the most favorable selection among the topical drugs for melasma. QSND and AFL were still the best ways to treat melasma among photoelectric devices. oTA as system administration was a promising way recommended for melasma. Among 31 studies, 87% (27/31) studies showed that the efficacy of combination therapies is superior to that of single therapy. The quality of evidence in this study was generally high because of nearly 50% of split-face RCTs.Conclusions: Based on the published studies, this NMA indicated that QSND, AFL, TCC, and oTA would be the preferred ways to treat melasma for dermatologists. However, more attention should be paid to the efficacy and safety simultaneously during the clinical application. Most of the results were in line with those of the previous studies, but a large number of RCTs should be included for validation or update.Systematic Review Registration: identifier: CRD42021239203. |
| first_indexed | 2024-12-19T10:50:45Z |
| format | Article |
| id | doaj.art-7f0aae94df39432da37b934e21b0f727 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-19T10:50:45Z |
| publishDate | 2021-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-7f0aae94df39432da37b934e21b0f7272022-12-21T20:25:01ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-09-01810.3389/fmed.2021.713554713554Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled TrialsYi Liu0Shanshan Wu1Haixuan Wu2Xuelei Liang3Dechao Guo4Fenglin Zhuo5Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaNational Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaDepartment of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaDepartment of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaDepartment of General Surgery, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, ChinaDepartment of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaBackground: Melasma is an acquired pigmentation disorder with challenges in treatment because of its refractory nature and high risk of recurrence.Objectives: This study aimed to compare the efficacy and side effects of 14 common therapies for melasma using a systematic review and network meta-analysis (NMA).Methods: The PubMed, Embase, and Cochrane Library databases were searched till December 2020 using the melasma area and severity index as a therapeutic index. A total of 59 randomized controlled trials (RCTs) met the inclusion criteria and were selected.Results: The ranking of relative efficacy compared with placebo in descending order was Q-switched Nd:Yag 1,064-nm laser (QSND), intense pulsed light, ablative fractional laser (AFL), triple combined cream (TCC), topical vitamin C, oral tranexamic acid (oTA), peeling, azelaic acid, microneedles (MNs), topical tranexamic acid (tTA), tretinoin, picosecond laser, hydroquinone (HQ), and non-AFL. Moreover, QSND was more effective than HQ and tTA against melasma. The ranking of percentage (%) of side effects in ascending order for each of 14 therapies with more than 80 participants was tretinoin (10.1%), oTA (17.6%), HQ (18.2%), AFL (20.0%), QSND (21.5%), TCC (25.7%), tTA (36.75%), peeling (38.0%), and MN (52.3%). Taking both efficacy and safety into consideration, TCC was found to be the most favorable selection among the topical drugs for melasma. QSND and AFL were still the best ways to treat melasma among photoelectric devices. oTA as system administration was a promising way recommended for melasma. Among 31 studies, 87% (27/31) studies showed that the efficacy of combination therapies is superior to that of single therapy. The quality of evidence in this study was generally high because of nearly 50% of split-face RCTs.Conclusions: Based on the published studies, this NMA indicated that QSND, AFL, TCC, and oTA would be the preferred ways to treat melasma for dermatologists. However, more attention should be paid to the efficacy and safety simultaneously during the clinical application. Most of the results were in line with those of the previous studies, but a large number of RCTs should be included for validation or update.Systematic Review Registration: identifier: CRD42021239203.https://www.frontiersin.org/articles/10.3389/fmed.2021.713554/fullmelasmaefficacytreatmentcomparisonnetwork meta-analysis |
| spellingShingle | Yi Liu Shanshan Wu Haixuan Wu Xuelei Liang Dechao Guo Fenglin Zhuo Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials Frontiers in Medicine melasma efficacy treatment comparison network meta-analysis |
| title | Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials |
| title_full | Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials |
| title_fullStr | Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials |
| title_full_unstemmed | Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials |
| title_short | Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials |
| title_sort | comparison of the efficacy of melasma treatments a network meta analysis of randomized controlled trials |
| topic | melasma efficacy treatment comparison network meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.713554/full |
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