Comparative study between the effect of topical nanosome vitamin-C and TCA chemical peeling on facial hyperpigmentation

Abstract

Melasma, also known as chloasma or “mask of pregnancy,” is a common condition that is usually seen in women of childbearing age. Melasma is a common acquired hypermelanosis characterized by irregular brownish macules and patches involving the sun-exposed areas of the skin. The disease affects all racial groups but is most prevalent in darker skin individuals (skin type IV–VI).Many etiological factors have been included in the etiology and pathogenesis of melasma, including pregnancy, oral contraceptives, sun exposure, genetic factors, cosmetics, phototoxic drugs, antiseizure medications, and thyroid dysfunction. However, one third of cases in women and most cases of men are idiopathic. TCA has become the gold standard of chemical peeling agents. It has been well studied and is known in its ability to create superficial, medium-depth, and deep peels. It is stable, inexpensive, with no systemic toxicity. It is easy to perform, as the peel depth correlates with the intensity of skin frost, and there is no need to neutralize a TCA peel. Vitamin C (Ascorbic acid) is one of the potent water soluble antioxidants that can be used as a lightening agent because it interferes with melanogenesis by inhibiting the activity of tyrosinase enzyme, the rate limiting step in melanogenesis thus reducing melanin synthesis. Also, it has a photoprotective effect, preventing the absorption of UVA and UVB rays . It is retained in the epidermis, which is an advantage over sunscreens that are easily removed. It has an antioxidant effect, preventing the production of free radicals that trigger melanogenesis. It also minimizes oxidized melanin, changing the pigmentation from black to tan. Consequently, ascorbic acid has an important effect on treatment of melasma and in order to increase permeability of vit C into skin deep layers nano liposomal vit C was used due to the small size of the nanoparticles with an average size of 117.6 nm. Since vitamin C is easily oxidized and decomposes in an aqueous solution, which make its passage through the skin is difficult. Here comes the rule of iontophoresis that’s used to enhance drug penetration through the skin by applying electric current through the tissues with iontocare device. It has been regarded as a very promising treatment modality because it offers the possibility of controlled delivery of drugs and is potentially effective for any charged molecule. Also the structural changes caused by the electrical current, such as micropore formation in the stratum corneum, may assist the transport of charged drugs across the stratum corneum. In our comparative study, the right side treated with nano vit C showed marked clinical improvement in the melasma lesions by 47.36% reduction in hemi MASI score that was statistically significant compared with the left side treated with TCA 15% that showed mild improvement by 36.16% reduction in hemi MASI score and was statistically significant. There were no side effects reported by nano vit C compared to TCA 15% chemical peel, besides the rapid response obtained after 3 sessions by nano vit C compared with TCA15%. Subjective evaluation reveals 13 out of 20 patients with good to excellent improvement by nano vit C treated side, while 11 out of 20 patients with good to excellent improvement by TCA 15% treated side. All that makes nano vit C aided by iontophoresis is an easy, safe and effective method in the treatment of melasma with convenient, painless way of drug delivery, compared with TCA 15% peel which is also effective in the treatment of melasma .