Silymarin Cream Versus Combined Silymarin Cream and Microneedling in Treatment of Melasma

NCT ID: NCT05099601

Last Updated: 2021-10-29

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

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-05-31

Study Completion Date

2022-12-31

Brief Summary

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Melasma is an acquired pigmentary disorder, occurring most commonly on the face. It is more prevalent in females and darker skin types. Melasma is mainly a clinical diagnosis consisting of symmetric reticulated hypermelanosis in three predominant facial patterns: centrofacial, malar, and mandibular. Melasma, though benign, can be extremely psychologically distressing and has been shown to have a significant impact on quality of life, social and emotional wellbeing. Multiple factors are implicated in the pathogenesis of melasma; however, the definite underlying mechanisms are not yet completely established. Ultraviolet exposure is one of the leading etiological factors, besides genetic and hormonal factors.

Detailed Description

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Many studies examined multiple treatment options for melasma, but none of them is completely satisfactory with recurrence in most cases.

Silymarin (SM) is a standardized extract from Silybum marianum seeds, is traditionally used as a hepatoprotective agent for its potent regenerative properties. Lately, SM is utilized in dermatological and cosmetic preparations for its antioxidant effect, anti-inflammatory and immunomodulatory properties.

Silibinin, the main component of silymarin, has been found to have antioxidant properties. It decreases the hazardous effects of solar ultraviolet radiation and significantly prevents melanin production in a dose-dependent manner without effect on cell viability.

Skin microneedling, or percutaneous collagen induction by needles, is a minimally invasive procedure that uses short fine needles to puncture the skin and stimulates fibroblast proliferation, release of growth factors and collagen production.

Long-term improvement of melasma after microneedling was reported , however, the exact mechanism that promotes skin lightening is not known.

Conditions

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Melasma

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Each side of the patients' face will be randomly allocated to either topical silymarin 0.7% and microneedling or topical silymarin 0.7% alone.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Silymarin alone versus silymarin and microneedling

There will be one group of patients. Each side of the patients' face will be randomly allocated to either topical silymarin 0.7% and microneedling or topical silymarin 0.7% alone.

Group Type EXPERIMENTAL

Silymarin

Intervention Type COMBINATION_PRODUCT

The patients will use topical silymarin 0.7% cream on the face twice daily(home use).

Microneedling

Intervention Type PROCEDURE

Patients will be subjected to microneedling sessions on one side of the face. Three consecutive sessions, 4 weeks apart (0, 4, 8 weeks), will be performed by dermapen. Sessions will be done by well trained physician.

Interventions

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Silymarin

The patients will use topical silymarin 0.7% cream on the face twice daily(home use).

Intervention Type COMBINATION_PRODUCT

Microneedling

Patients will be subjected to microneedling sessions on one side of the face. Three consecutive sessions, 4 weeks apart (0, 4, 8 weeks), will be performed by dermapen. Sessions will be done by well trained physician.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age: 18-50 years old.
* Pattern of melasma: Bilateral symmetrical facial melasma of any pattern.
* Fitzpatrick skin phototypes: Types III, IV and V

Exclusion Criteria

* Pregnancy and lactation.
* Patients taking oral contraceptive pills, hormonal replacement therapy or treatment for chronic illness at the time of the study or during the past 6 months.
* Coexistance of diseases associated with hyperpigmentation such as Addison disease.
* Scarring and keloid tendency, active skin infections as active HSV.
* Previous history of post inflammatory hyperpigmentation.
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Assiut University

OTHER

Sponsor Role lead

Responsible Party

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Dina Abd El-nasser Attay

principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Central Contacts

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Sahar A Ismail, Professor

Role: CONTACT

Phone: +201008899446

Email: [email protected]

Rofaida R Shehata, PHD

Role: CONTACT

Phone: +201006897580

Email: [email protected]

References

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Balkrishnan R, McMichael AJ, Camacho FT, Saltzberg F, Housman TS, Grummer S, Feldman SR, Chren MM. Development and validation of a health-related quality of life instrument for women with melasma. Br J Dermatol. 2003 Sep;149(3):572-7. doi: 10.1046/j.1365-2133.2003.05419.x.

Reference Type BACKGROUND
PMID: 14510991 (View on PubMed)

Choo SJ, Ryoo IJ, Kim YH, Xu GH, Kim WG, Kim KH, Moon SJ, Son ED, Bae K, Yoo ID. Silymarin inhibits melanin synthesis in melanocyte cells. J Pharm Pharmacol. 2009 May;61(5):663-7. doi: 10.1211/jpp/61.05.0016.

Reference Type BACKGROUND
PMID: 19406006 (View on PubMed)

Cohen BE, Elbuluk N. Microneedling in skin of color: A review of uses and efficacy. J Am Acad Dermatol. 2016 Feb;74(2):348-55. doi: 10.1016/j.jaad.2015.09.024.

Reference Type BACKGROUND
PMID: 26549251 (View on PubMed)

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 BACKGROUND
PMID: 25184917 (View on PubMed)

Hou A, Cohen B, Haimovic A, Elbuluk N. Microneedling: A Comprehensive Review. Dermatol Surg. 2017 Mar;43(3):321-339. doi: 10.1097/DSS.0000000000000924.

Reference Type BACKGROUND
PMID: 27755171 (View on PubMed)

Kimbrough-Green CK, Griffiths CE, Finkel LJ, Hamilton TA, Bulengo-Ransby SM, Ellis CN, Voorhees JJ. Topical retinoic acid (tretinoin) for melasma in black patients. A vehicle-controlled clinical trial. Arch Dermatol. 1994 Jun;130(6):727-33.

Reference Type BACKGROUND
PMID: 8002642 (View on PubMed)

Kren V, Walterova D. Silybin and silymarin--new effects and applications. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2005 Jun;149(1):29-41. doi: 10.5507/bp.2005.002.

Reference Type BACKGROUND
PMID: 16170386 (View on PubMed)

Nofal A, Ibrahim AM, Nofal E, Gamal N, Osman S. Topical silymarin versus hydroquinone in the treatment of melasma: A comparative study. J Cosmet Dermatol. 2019 Feb;18(1):263-270. doi: 10.1111/jocd.12769. Epub 2018 Aug 26.

Reference Type BACKGROUND
PMID: 30146802 (View on PubMed)

Pandya AG, Hynan LS, Bhore R, Riley FC, Guevara IL, Grimes P, Nordlund JJ, Rendon M, Taylor S, Gottschalk RW, Agim NG, Ortonne JP. Reliability assessment and validation of the Melasma Area and Severity Index (MASI) and a new modified MASI scoring method. J Am Acad Dermatol. 2011 Jan;64(1):78-83, 83.e1-2. doi: 10.1016/j.jaad.2009.10.051. Epub 2010 Apr 15.

Reference Type BACKGROUND
PMID: 20398960 (View on PubMed)

Rigopoulos D, Gregoriou S, Katsambas A. Hyperpigmentation and melasma. J Cosmet Dermatol. 2007 Sep;6(3):195-202. doi: 10.1111/j.1473-2165.2007.00321.x.

Reference Type BACKGROUND
PMID: 17760699 (View on PubMed)

Tamega Ade A, Miot LD, Bonfietti C, Gige TC, Marques ME, Miot HA. Clinical patterns and epidemiological characteristics of facial melasma in Brazilian women. J Eur Acad Dermatol Venereol. 2013 Feb;27(2):151-6. doi: 10.1111/j.1468-3083.2011.04430.x. Epub 2012 Jan 3.

Reference Type BACKGROUND
PMID: 22212073 (View on PubMed)

Tran JM, Chan AW (2012) Quick diagnosis: melasma. University of Toronto Med J 89: 143-145.

Reference Type BACKGROUND

Vaid M, Katiyar SK. Molecular mechanisms of inhibition of photocarcinogenesis by silymarin, a phytochemical from milk thistle (Silybum marianum L. Gaertn.) (Review). Int J Oncol. 2010 May;36(5):1053-60. doi: 10.3892/ijo_00000586.

Reference Type BACKGROUND
PMID: 20372777 (View on PubMed)

Wu DC, Fitzpatrick RE, Goldman MP. Confetti-like Sparing: A Diagnostic Clinical Feature of Melasma. J Clin Aesthet Dermatol. 2016 Feb;9(2):48-57.

Reference Type BACKGROUND
PMID: 27047632 (View on PubMed)

Other Identifiers

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MSM

Identifier Type: -

Identifier Source: org_study_id