USE THE SYSTEMIC METFORMIN IN MELASMA

NCT ID: NCT03475524

Last Updated: 2021-08-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-04-01

Study Completion Date

2021-08-31

Brief Summary

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Melasma is a chronic and relapsing acquired dyschromia due to an increased epidermal-melanin unit activity that affects sun-exposed areas mainly in women throughout the reproductive years. It is more common in women, accounting for 90% of all cases.The majority of patients are in third and fourth decades of their life. There are several risk factors that influence its appearance including genetic predisposition,exposure to heat and UV radiation, pregnancy, and exogenous hormones (such as oral contraceptives,thyroid hormones, and hormone replacement therapy). Other factors implicated are phototoxic drugs, anticonvulsant medications,and the use of certain cosmetics. Types of melasma are epidermal, dermal and mixed according to location of melanin.

Detailed Description

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Its pathogenesis is not fully understood, nevertheless there is evidence that melanogenesis in melasma differ from tanning and post-inflammatory hyperpigmentations as well as there is an involvement of the whole epidermal melanin unit in the process (not just hypertrophic melanocytes), mastocytes, fibroblast and endothelium derived cytokines, as well as there are upper dermal abnormalities different from other acquired pigmentary disorders. Patients with melasma have also been found to have higher markers of oxidative stress status.

Melasma has significant impact on patients physical health, interpersonal relationships ,social-well being and self- esteem as they refused to leave their house, felt inferior to others, and incessantly thought about their melasma being.

Melasma is often resistant to treatment and frustrating for both patients and clinician. In spite of presence of several methods for treatment of melasma exacted as, Topical compounds that include the Kligman's formula which is the triple combination of ( retinoid, hydroquinone, and steroid) and azelaic. Chemical peels (e.g., glycolic, β hydroxyl, and trichloroacetic acid )although these must be used cautiously in patients with darker skin. Laser and Light therapies represent potentially promising options for patients who are refractory to other modalities, but they also carry significant risk of worsening the disease.

Recently, some reports refer to the use of metformin in treatment of melasma. Metformin is antidiabetic drugs that was shown to exert its biological effect by decreasing cyclic adenosine phosphate , which is a well known modulator of melanin synthesis. Metformin decreased skin pigmentation in vivo with minimal side effects, suggesting a potential application of metformin in the treatment of hyperpigmentation disorders. Where the metformin was applied topically onto a mouse tail, whitening of the tail was observed. In addition, metformin decreased the epidermal level of melanin when metformin was applied to human skin punch biopsies and to reconstructed human epidermis. When melanocytes were treated with metformin, basal level of total melanin (eumelanin and pheomelanin) were reduced significantly. Also metformin blocked forskolin and alpha melanocyte-stimulating hormone which increase the levels of melanin. Metformin decrease levels of tyrosinase, tyrosinase-related protein-1 and tyrosinase-related protein-2.

Conditions

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Melasma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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study Metformin 1000 mg

Group Type EXPERIMENTAL

MetFORMIN 1000 Mg Oral Tablet

Intervention Type DRUG

oral tablet 1ooomg systemic metformin will be given to group

Trichloroacetic Acid Peeling

Intervention Type DRUG

Trichloroacetic acid peeling to the three groups

study Metformin 500 mg

Group Type EXPERIMENTAL

Trichloroacetic Acid Peeling

Intervention Type DRUG

Trichloroacetic acid peeling to the three groups

MetFORMIN 500 Mg Oral Tablet

Intervention Type DRUG

oral tablet 500 mg

control group

Group Type PLACEBO_COMPARATOR

Placebos

Intervention Type DRUG

oral placebos will be given to control beside trichloracetic acid peeling

Trichloroacetic Acid Peeling

Intervention Type DRUG

Trichloroacetic acid peeling to the three groups

Interventions

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MetFORMIN 1000 Mg Oral Tablet

oral tablet 1ooomg systemic metformin will be given to group

Intervention Type DRUG

Placebos

oral placebos will be given to control beside trichloracetic acid peeling

Intervention Type DRUG

Trichloroacetic Acid Peeling

Trichloroacetic acid peeling to the three groups

Intervention Type DRUG

MetFORMIN 500 Mg Oral Tablet

oral tablet 500 mg

Intervention Type DRUG

Other Intervention Names

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Glucophage Glucophage

Eligibility Criteria

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Inclusion Criteria

1. All patients above 18 years old with melasma.
2. With Fitzpatrick skin phototypes ranging from Type III-V will recruited.

Exclusion Criteria

1. Pregnant or nursing women.
2. Current use of hormonal birth control medication or any hormonal therapy, Use of topical hydroquinone within 3 months of study, Use of topical steroids within 1 month of study, Regular use of tanning parlors and History of laser or dermabrasion to the face within 9 months of study.
3. Occupation involving primarily outdoor activities.
4. History of kidney dysfunction diabetic (excluded by history and laboratory), Significant cardiovascular or respiratory disease and any other systemic diseases(i.e,history of endocrine disorders).
5. patients with poor wound healing, recurrent herpes labialis and current skin infection (facial warts, molluscum contagiosum, history of hypertrophic scar/keloids, active dermatosis of atopic, seborrheic or other eczematous type).
6. Photosensitivity,
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Assiut University

OTHER

Sponsor Role lead

Responsible Party

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Karima Nageh

Principle investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Assuit University

Asyut, , Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Sahar Ismail, professor

Role: CONTACT

01007074449

Radwa Bakr, lecturer

Role: CONTACT

01119988115

Facility Contacts

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Radwa Bakr

Role: primary

01119988115

sahar Ismail

Role: backup

References

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Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014 Sep-Oct;89(5):771-82. doi: 10.1590/abd1806-4841.20143063.

Reference Type RESULT
PMID: 25184917 (View on PubMed)

Moubasher AE, Youssef EM, Abou-Taleb DA. Q-switched Nd: YAG laser versus trichloroacetic acid peeling in the treatment of melasma among Egyptian patients. Dermatol Surg. 2014 Aug;40(8):874-82. doi: 10.1097/DSS.0000000000000065.

Reference Type RESULT
PMID: 25068546 (View on PubMed)

Brianezi G, Handel AC, Schmitt JV, Miot LD, Miot HA. Changes in nuclear morphology and chromatin texture of basal keratinocytes in melasma. J Eur Acad Dermatol Venereol. 2015 Apr;29(4):809-12. doi: 10.1111/jdv.12453. Epub 2014 Mar 14.

Reference Type RESULT
PMID: 24629163 (View on PubMed)

Kong SH, Suh HS, Choi YS. Treatment of Melasma with Pulsed-Dye Laser and 1,064-nm Q-Switched Nd:YAG Laser: A Split-Face Study. Ann Dermatol. 2018 Feb;30(1):1-7. doi: 10.5021/ad.2018.30.1.1. Epub 2017 Dec 26.

Reference Type RESULT
PMID: 29386825 (View on PubMed)

Lehraiki A, Abbe P, Cerezo M, Rouaud F, Regazzetti C, Chignon-Sicard B, Passeron T, Bertolotto C, Ballotti R, Rocchi S. Inhibition of melanogenesis by the antidiabetic metformin. J Invest Dermatol. 2014 Oct;134(10):2589-2597. doi: 10.1038/jid.2014.202. Epub 2014 Apr 22.

Reference Type RESULT
PMID: 24756109 (View on PubMed)

Sarkar R, Arora P, Garg VK, Sonthalia S, Gokhale N. Melasma update. Indian Dermatol Online J. 2014 Oct;5(4):426-35. doi: 10.4103/2229-5178.142484.

Reference Type RESULT
PMID: 25396123 (View on PubMed)

Sheth VM, Pandya AG. Melasma: a comprehensive update: part I. J Am Acad Dermatol. 2011 Oct;65(4):689-697. doi: 10.1016/j.jaad.2010.12.046.

Reference Type RESULT
PMID: 21920241 (View on PubMed)

Sheth VM, Pandya AG. Melasma: a comprehensive update: part II. J Am Acad Dermatol. 2011 Oct;65(4):699-714. doi: 10.1016/j.jaad.2011.06.001.

Reference Type RESULT
PMID: 21920242 (View on PubMed)

Majid I, Haq I, Imran S, Keen A, Aziz K, Arif T. Proposing Melasma Severity Index: A New, More Practical, Office-based Scoring System for Assessing the Severity of Melasma. Indian J Dermatol. 2016 Jan-Feb;61(1):39-44. doi: 10.4103/0019-5154.174024.

Reference Type RESULT
PMID: 26955093 (View on PubMed)

Ismail SA, Mohamed GA, Mohamedeen KN, Sotohy RSA, Bakr RM. Does Systemic Metformin Have a Role in Treating Melasma? Dermatol Surg. 2024 Apr 1;50(4):366-371. doi: 10.1097/DSS.0000000000004092. Epub 2024 Feb 28.

Reference Type DERIVED
PMID: 38416809 (View on PubMed)

Other Identifiers

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MTM

Identifier Type: -

Identifier Source: org_study_id

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