Treating melasma with oral tranexamic acid
Melasma is a pigmentary disorder that is challenging to treat and especially common in people of Asian descent. Recently, oral tranexamic acid (TA) has shown potential for treating this condition.
This study evaluated treatment outcomes and adverse effects of oral TA treatment for melasma in an Asian population. The authors looked at data collected from January 2010 to June 2014 from patients who received oral TA for melasma in a tertiary dermatology centre.
The results of the study showed that a majority of the 561 patients who took part over a 4-month period saw an improvement in their melasma. The study also showed that 56 patients had no improvement, while two patients saw their skin condition worsen. Interestingly, patients in the study without a family history of melasma had better response rates than those with family history.
In conclusion to this study, the authors feel that oral TA may be an effective treatment for melasma.
Outside-the-box treatments for chronic pruritus
There is a need for new treatment options for patients experiencing chronic pruritus. Therapeutic treatments are often not effective, have poor clinical evidence and are mostly off-label products.
Over the years, there has been a lot of research into the identification of potential targets for the treatment of chronic pruritus. There are many new medications on the market aimed at treating pruritus along, with many ongoing clinical trials. This article details pharmacological developments leading to the potential new drugs in the treatment of chronic pruritus.
Do apps for eczema conform with clinical guidelines?
Eczema is a complex skin condition that requires patient monitoring and patient education. At present, no studies are available that show how apps can support patients with eczema to self-manage. The aim of this study was to evaluate the quality and comprehensiveness of English, Chinese and Spanish self-management eczema smartphone apps for patients.
A systematic assessment of eczema apps available from July to November 2018 was carried out. Assessment criteria were based on conformance with international eczema guidelines. A total of 98 apps were looked at. The results showed that 82 provided educational information, 38 tracked functions and 13 did both. The authors also found that 34% of apps provided misleading information regarding treatment and in the details on the progression of eczema.
Only 15% of these apps actually provided information on pharmacological therapies supported by international guidelines, and only 16% gave information on non-pharmacological therapies. Of the 38 apps that had a tracking function, 82% measured specific symptoms, disease severity or skin condition, and 89% helped users to record medication usage, including application of topicals.
In conclusion, the authors felt that the eczema apps studied had not yet reached their potential, and that, with the wide difference in their quality, quality assurance mechanisms for health apps are needed, as well as guidance for clinicians that would enable them to make personalised recommendations for patients and caregivers.
Acne vulgaris relates to differences in the skin microbiome
As the skin microbiome plays an important role in the pathogenesis and development of acne, this study was conducted to further investigate the facial skin microbiome of acne and microbiome differences related to different grades of acne.
In order to conduct this study, the authors took skin swabs from 67 people with acne and nine people without acne. The swabs and the skin microbiomes were then analysed using 16S rRNA gene sequencing.
The results showed that, in comparison with the healthy patients, the acne patients harboured significantly altered skin microbiomes. The skin microbiomes of patients with grade 1–3 acne were similar, but patients with grade 4 acne showed a significantly different skin microbiome compared with grade 1–3 acne, including increased alpha diversity and increased proportions of four Gram-negative bacteria (Faecalibacterium, Klebsiella, Odoribacter and Bacteroides).
In conclusion, the authors found that the acne patients had an altered skin microbiome, and more significant dysbiosis was found in patients with grade 4 acne. The authors also hope that their results may provide evidence for the pathogenic mechanisms of acne and microbial-based strategies to avoid and treat acne, especially grade 4 acne.
Phototherapy as a treatment for itching
Skin itching is an extremely frequent and hugely distressing symptom associated with several skin conditions and systemic diseases.
There is increasing professional awareness of the pathophysiology of itchy skin, and there is an increased interest in the development of new treatments that specifically act on targets involved in the transmission and perception of itching.
Over the years, phototherapy has been used as an effective treatment for various kinds of chronic itching, but the mechanisms behind the antipruritic effect of phototherapy are less well known. To date, there are no randomised controlled trials of the use of phototherapy that requires patients to undergo repeated treatments.
The author states that, as phototherapy devices are expensive, it is rarely recommended as a treatment method for chronic pruritic diseases and is used only as a last recourse by dermatologists. He then concludes that there is a wide range of pruritic conditions that can be successfully treated with phototherapy.
He also states that phototherapy has few risks of side effects and a low frequency of interactions with other medications, and therefore it should be safe to combine phototherapy with other treatment modalities for itching. Compared with other treatments for chronic pruritus, phototherapy has the advantage of being safe for all patients, from childhood to old age, and including pregnant or breastfeeding women, and therefore should be considered early on in treatment.