Occurring more frequently in women of reproductive age, the common dermatologic condition melasma is estimated to affect between 15% and 50% of pregnant women. According to data from the American Academy of Dermatology, 90% of melasma patients are women. While for some individuals the condition can disappear on its own, many patients find melasma to be difficult to remedy, requiring months of treatment to see improvement and often recurring once treatment is ceased.
Currently available therapies include hydroquinone – commonly the first line of treatment for melasma – tretinoin and corticosteroids, topical prescription medications, chemical peels, microdermabrasion, and laser or light-based procedures. However, these treatments have varying success rates and are often associated with complications. Common side effects patients report include skin irritation, further hyperpigmentation, or worsening of the condition. In an attempt to provide an efficacious alternative therapeutic modality, recent research efforts have begun investigating the impact of platelet-rich plasma injections on melasma symptoms.
Pilot Study of PRP Treatment for Melasma
In the first-ever randomized placebo-controlled study of PRP for melasma treatment, a team of researchers in Thailand aimed to assess the efficacy of the therapy in a group of female melasma patients. A cohort of 10 women (mean age of 46.2 years) with bilateral mixed-type melasma were enrolled in the split-face, single-blinded prospective trial. The researchers injected platelet-rich plasma intradermally into one side of the face every 2 weeks for a total of four treatment sessions, while also injecting saline into the other (control) side. Outcomes were measured using the modified Melasma Area and Severity Index (mMASI), Mexameter, and Antera 3D. Participant satisfaction was evaluated at baseline as well as at 2, 4, 6, and 10 weeks.
Improvements in Melasma
The results of the pilot study, published in the Journal of Cosmetic Dermatology, revealed that platelet-rich plasma injections were associated with improvements in melasma condition within 6 weeks of treatment. Both the mMASI score and Antera 3D-assessed melanin levels found significant improvement in the side of the face treated with PRP injections compared with the control side between baseline measurements and those obtained at week 6. The Antera 3D also found a reduction in mean wrinkle levels from baseline measurements to week 4. Additionally, reported patient satisfaction increased significantly over the duration of PRP treatment.
The study’s authors reported no difference between the PRP and control sides of the face in Mexameter-assessed erythema or melanin indices – however, there was a trend toward reduced pigmentation in the latter. Any side effects that occurred during treatment were mild in severity and resolved spontaneously.
The study’s authors acknowledge the limitations of their trial, including: the small size of the cohort, the participation of women only, as well as the short follow-up period of only one month post-treatment.
Not only did the latest research show significant improvement in melasma symptoms and patient satisfaction associated with regular platelet-rich plasma injections, the study also revealed the additional benefit of wrinkle reduction beginning at week 4. This was “likely attributable to the rejuvenating effect of PRP that has been demonstrated in many studies, whereby fibroblast and collagen proliferation are stimulated and hyaluronic acid synthesis is enhanced,” the study’s authors noted.
As the first randomized, placebo-controlled trial of PRP treatment for melasma, the study and its findings set the stage for future research, bringing the method a step closer to the practice setting. The great potential benefit of intradermal PRP injections as an alternative or adjuvant treatment for melasma implicates the need for further investigation to assess its long-term safety and efficacy.