陈子龙,马文宇

黄褐斑多为双侧面部对称发生的淡褐色至深褐色斑片，其有慢性病程、复发倾向、损容倾向以及治疗困难的特征。近年来，由于黄褐斑的发病率持续升高，它导致患者容貌、心理健康及工作社交受到极大的影响，尽管如此，目前尚无一种完全满意的治疗方案。通过对全球范围的黄褐斑研究和治疗技术的综述，我们希望能够为临床医生提供有价值的指导。

黄褐斑；氨甲环酸；黑素；给药方式；治疗

[1] Cohen P R.Melasma treatment:A novel approach using a topical agent that contains an anti-estrogen and a vascular endothelial growth factor inhibitor[J].Medical Hypotheses,2017,101:1-5. [2] Rathore S P,Gupta S,Gupta V.Pattern and prevalence of physiological cutaneous changes in pregnancy:A study of 2000 antenatal women[J].Indian Journal of Dermatology,Venereology and Leprology,2011,77:402. [3] Tamega A A,Miot L D B,Bonfietti C,et al.Clinical patterns and epidemiological characteristics of facial melasma in Brazilian women[J].Journal of the European Academy of Dermatology and Venereology,2013,27(2):151-156. [4] Sarkar R,Ailawadi P,Garg S.Melasma in men:A review of clinical,etiological,and management issues[J].The Journal of clinical and aesthetic dermatology,2018,11(2):53. [5] Kim E H,Kim Y C,Lee E S,et al.The vascular characteristics of melasma[J].Journal of dermatological science,2007,46(2):111-116. [6] Handel A C,Lima P B,Tonolli V M,et al.Risk factors for facial melasma in women:a case–control study[J].British Journal of Dermatology,2014,171(3):588-594. [7] Passeron T,Picardo M.Melasma,a photoaging disorder[J].Pigment cell&melanoma research,2018,31(4):461-465. [8] Hexsel D,Arellano I,Rendon M.Ethnic considerations in the treatment of Hispanic and Latin‐American patients with hyperpigmentation[J].British Journal of Dermatology,2006,156(s1):7-12. [9] Mahmoud B H,Ruvolo E,Hexsel C L,et al.Impact of long-wavelength UVA and visible light on melanocompetent skin[J].Journal of investigative dermatology,2010,130(8):2092-2097. [10] KrupaShankar D S R,Somani V K,Kohli M,et al.A cross-sectional,multicentric clinico-epidemiological study of melasma in India[J].Dermatology and therapy,2014,4:71-81. [11] 中国中西医结合学会皮肤性病专业委员会色素病学组,中华医学会皮肤性病学分会白癜风研究中心,中国医师协会皮肤科医师分会色素病工作组.中国黄褐斑诊疗专家共识(2021版)[J].中华皮肤科杂志,2021,54(2):6. [12] Noh T K,Choi S J,Chung B Y,et al.Inflammatory features of melasma lesions in Asian skin[J].The Journal of Dermatology,2014,41(9):788-794. [13] Rodríguez-Arámbula A,Torres-Álvarez B,Cortés-García D,et al.CD4,IL-17,and COX-2 are associated with subclinical inflammation in malar melasma[J].The American Journal of Dermatopathology,2015,37(10):761-766. [14] Lee D J,Lee J,Ha J,et al.Defective barrier function in melasma skin[J].Journal of the European Academy of Dermatology and Venereology,2012,26(12):1533-1537. [15] Li Y,Yang C Y,Man M Q,et al.Disruption of epidermal permeability barrier enhances UV‐induced hyperpigmentation[J].Photodermatology,Photoimmunology&Photomedicine,2020,36(2). [16] Sarkar R,Jagadeesan S,Basavapura Madegowda S,et al.Clinical and epidemiologic features of melasma:a multicentric cross‐sectional study from India[J].International Journal of Dermatology,2019,58(11):1305-1310. [17] 何黎,刘玮,李利.舒敏保湿类护肤品在敏感性皮肤中的应用指南[J].中国皮肤性病学杂志,2019,33(11):1229-1231. [18] 涂颖,顾华,李娜,等.青刺果油对神经酰胺合成及神经酰胺酶表达的影响[J].中华皮肤科杂志,2012,45(10):718-722. [19] Boukari F,Jourdan E,Fontas E,et al.Prevention of melasma relapses with sunscreen combining protection against UV and short wavelengths of visible light:a prospective randomized comparative trial[J].Journal of the American Academy of Dermatology,2015,72(1):189-190.e1. [20] Grimes P E.Melasma:etiologic and therapeutic considerations[J].Archives of dermatology,1995,131(12):1453-1457. [21] SLOMINSKI A,MOELLMANN G,KUKLINSKA E.L‐tyrosine,L‐DOPA,and tyrosinase as positive regulators of the subcellular apparatus of melanogenesis in Bomirski Ab amelanotic melanoma cells[J].Pigment cell research,1989,2(2):109-116. [22] Slominski A,Zmijewski M A,Pawelek J.L‐tyrosine and L‐dihydroxyphenylalanine as hormone‐like regulators of melanocyte functions[J].Pigment cell&melanoma research,2012,25(1):14-27. [23] Palumbo A,Solano F,Misuraca G,et al.Comparative action of dopachrome tautomerase and metal ions on the rearrangement of dopachrome[J].Biochimica et Biophysica Acta(BBA)-General Subjects,1991,1115(1):1-5. [24] Bolognia J L,Pawelek J M.Biology of hypopigmentation[J].Journal of the American Academy of Dermatology,1988,19(2):217-255. [25] Wu S,Han J,Laden F,et al.Long-term ultraviolet flux,other potential risk factors,and skin cancer risk:a cohort study[J].Cancer epidemiology,biomarkers&prevention,2014,23(6):1080-1089. [26] Gupta A K,Gover M D,Nouri K,et al.The treatment of melasma:a review of clinical trials[J].Journal of the American Academy of Dermatology,2006,55(6):1048-1065. [27] Von Holstein C C,Eriksson S B,Källén R.Tranexamic acid as an aid to reducing blood transfusion requirements in gastric and duodenal bleeding[J].Br Med J(Clin Res Ed),1987,294(6563):7-10. [28] 二条貞子.ﾄﾗﾈｷｻﾑ酸による肝斑の治療[J].基礎と臨床,1979,13:3129-3130. [29] Sheu S L.Treatment of melasma using tranexamic acid:what's known and what's next[J].Cutis,2018,101(2):E7-E8. [30] 王雪,赵小峪,周泽荃,等.氨甲环酸在治疗黄褐斑领域中的应用进展[J].药学研究,2020,39(6):348-354. [31] Kim K M,Lim H W.The uses of tranexamic acid in dermatology:a review[J].International journal of dermatology,2023,62(5):589-598. [32] Na J I,Choi S Y,Yang S H,et al.Effect of tranexamic acid on melasma:a clinical trial with histological evaluation[J].Journal of the European Academy of Dermatology and Venereology,2013,27(8):1035-1039. [33] Tan A W M,Sen P,Chua S H,et al.Oral tranexamic acid lightens refractory melasma[J].Australasian Journal of Dermatology,2017,58(3):e105-e108. [34] Lee H C,Thng T G S,Goh C L.Oral tranexamic acid(TA)in the treatment of melasma:a retrospective analysis[J].Journal of the American Academy of Dermatology,2016,75(2):385-392. [35] El Hadidi H,Mosaad R,Ragab N.The efficacy of oral vs different dilutions of intradermal tranexamic acid microinjections in melasma—A randomized clinical trial[J].Dermatologic Therapy,2021,34(3):e14924. [36] Zhu C Y,Li Y,Sun Q N,et al.Analysis of the effect of different doses of oral tranexamic acid on melasma:a multicentre prospective study[J].European Journal of Dermatology,2019,29:55-58. [37] 邓梓丹,吴迪,栗丹,等.不同剂量及疗程的氨甲环酸治疗黄褐斑疗效比较[J].中国美容医学,2017,26(12):91-93.

点击下载PDF