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Clinical Study
Skin Needling to Enhance Depigmenting Serum Penetration in
the Treatment of Melasma
Copyright © 2011 G. Fabbrocini et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Melasma is a common hypermelanotic disorder affecting the facial area which has a considerable psychological impact on the
patient. Managing melasma is a difficult challenge that requires long-term treatment with a number of topical agents, such as
rucinol and sophora-alpha. Aims. We aim to compare the combined treatment of skin needling and depigmenting serum with that
using depigmenting serum alone in the treatment of melasma, in order to evaluate the use of microneedles as a means to enhance
the drug’s transdermal penetration. Methods. Twenty patients were treated with combined skin needling and depigmenting serum
on one side of the face and with depigmenting serum alone on the other side. The outcome was evaluated periodically for up to
two months using the Melasma Area Severity Index score and the Spectrocolorimeter X-Rite 968. Results. The side with combined
treatment (skin needling + depigmenting serum) presented a statistically significant reduction in MASI score and luminosity
index (L) levels compared to the side treated with depigmenting serum alone, and clinical symptoms were significantly improved.
Conclusions. Our study suggests the potential use of combining skin needling with rucinol and sophora-alpha compounds to
achieve better results in melasma treatment compared to rucinol and sophora-alpha alone.
were summated to obtain the total MASI score: forehead 0.3 The first treatment, performed by a different dermatol-
(D+H)A + right malar 0.3 (D+H)A + left malar 0.3 (D+H)A ogist, was preceded by the disinfection and the application
+ Chin 0.1 (D+H)A. of a topical anaesthetic for 60 minutes on melasma right
In order to carry out a comparative analysis, digital hemifacial areas. A topical anaesthetic was also applied on
photographs were collected for each patient and gathered melasma left hemi-facial areas for the same time period, so
in a database: two right hemi-face and two left hemi- as not to introduce bias, as the PH of the topical anaesthetic
face photographs were captured by using both standard should act as a factor against or favouring the penetration of
light and UV light; ultraviolet reflectance photography is the depigmenting agents used. This was carried out by rolling
a valuable tool to accentuate pigmentation (Figures 1 and a special device over melasma areas, (Figure 4; Dermaroller-
2), but patients must wash and degrease the face before Model CIT 8) which consists of a 12 cm plastic handle
photography to prevent reflection from the skin surface, attached to a cylinder, like a small paintroller, 20 mm in
which obscures pigmentation assessment. A colorimetric diameter and 20 mm in length. The surface of the cylinder
evaluation of melasma areas (right hemi-face, left hemi-face) houses 24 circular arrays of 8 needles each (total 192 needles),
was performed using X-Rite (Figure 3; Spectrocolorimeter with a needle length of 0.5 mm and a diameter of 0.02 mm.
X-rite 968). Colorimetric evaluation can objectively detect Needles and disks are firmly bound together with a special
changes in the degree of skin pigmentation as the colorimeter medically approved adhesive. The tool was rolled in different
records color in a designated three-dimensional space: L∗ , directions: horizontally, vertically and diagonally, and right
a∗ , b∗ . The first value, luminance (L∗ ), expresses the and left. This ensured an even pricking pattern, resulting
brightness of the variations in color from total black to total in about 250–300 pricks/cm2 . As expected, the skin bled
white. The value a∗ is a tone of color ranging from red for a short time after treatment. When bleeding stopped,
(+) to green (−). When the rash appears on the skin, the a serous ooze formed and was removed from the surface
value becomes positive. The third value represented by b∗ of the skin using sterile saline solution. After rolling, the
is a tone of colour ranging from blue (−) to yellow (+). If depigmenting serum was applied on the treated areas. On the
hyperpigmentation appears, the value becomes positive. melasma left hemi-facial areas, depigmenting serum alone
4 Plastic Surgery International
Table 2
Depigmenting Serum + Skin needling Depigmenting serum alone
Pz. L∗ before treatment L∗ after treatment L∗ before treatment L∗ after treatment
1 51.70 59.89 54.80 59.94
2 55.82 65.49 55.36 60.88
3 58.45 68.22 56.77 64.89
4 54.27 64.17 56.67 63.74
5 48.85 59.63 53.15 59.55
6 59.78 70.92 61.18 62.18
7 55.09 66.30 53.92 60.97
8 52.10 63.70 51.20 57.66
9 56.73 69.27 58.18 65.52
10 56.34 67.18 59.48 65.02
11 51.45 62.02 54.54 60.55
12 60.15 70.38 59.76 66.61
13 52.60 63.70 54.39 60.03
14 56.25 64.22 56.10 59.00
15 55.91 66.10 56.83 62.03
16 50.26 65.35 55.92 59.62
17 52.73 59.73 52.13 60.79
18 50.35 64.71 51.17 59.22
19 52.72 62.71 54.73 62.14
20 55.31 65.73 52.04 61.98
Average 54.34 64.97 55.42 61.61
D STD 3.2665 3.1710 2.8177 2.425
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