title: A pilot study for triple combination therapy with a low-fluence 1064 nm Q-switched Nd:YAG laser, hydroquinone cream and oral tranexamic acid for recalcitrant Riehl's Melanosis.
abstract: BACKGROUND
  Riehl's melanosis presents as a diffuse gray-brown to black hyperpigmentation around face. The treatment of this disease is challenging and quite limited despite patients' excessive psychological stresses.
  
  
  OBJECTIVE
  In this prospective pilot study, we evaluated the efficacy and safety for a novel combination therapy based on low-fluence Q-switched 1064 nm Nd:YAG laser, hydroquinone cream and oral tranexamic acid for recalcitrant Riehl's melanosis.
  
  
  METHODS
  Totally eight patients with Riehl's melanosis who had failed improvements previously received multiple sessions (10-18 times) of combination treatment regimen. The primary endpoint was clinical score by the physician and the secondary endpoints were clinical score by the patients, instrumental analysis using melanin and erythema values, and histopathological score.
  
  
  RESULTS
  Among eight patients, three received "Almost clear" grade, the other five patients received "Marked improvement" grade at final visits. No serious adverse events and post-treatment downtime was observed. Mean Melanin and Erythema Indexes also showed significant decreases compared with baseline. Histopathologic examination confirmed a significantly greater reduction of melanin content in melanophages.
  
  
  CONCLUSIONS
  This combination method can be a viable option for Asian patients having Riehl's melanosis with high risk of post-inflammatory hyperpigmentation, maintaining low-dose laser irradiation.
authors.affiliation: a Department of Dermatology , Seoul National University College of Medicine , Seoul , Korea.
authors.forename: Hyuck Hoon
authors.initials: HH
authors.lastname: Kwon
authors.affiliation: a Department of Dermatology , Seoul National University College of Medicine , Seoul , Korea.
authors.forename: Jungyoon
authors.initials: J
authors.lastname: Ohn
authors.affiliation: a Department of Dermatology , Seoul National University College of Medicine , Seoul , Korea.
authors.forename: Dae Hun
authors.initials: DH
authors.lastname: Suh
authors.affiliation: b Oaro Dermatology Clinic , Seoul , Korea.
authors.forename: Hae Young
authors.initials: HY
authors.lastname: Park
authors.affiliation: b Oaro Dermatology Clinic , Seoul , Korea.
authors.forename: Sun Chul
authors.initials: SC
authors.lastname: Choi
authors.affiliation: b Oaro Dermatology Clinic , Seoul , Korea.
authors.forename: Jae Yoon
authors.initials: JY
authors.lastname: Jung
authors.affiliation: c PHD Dermatology Clinic , Seoul , Korea.
authors.forename: In Ho
authors.initials: IH
authors.lastname: Kwon
authors.affiliation: d Department of Dermatology , Dongtan Sacred Heart Hospital, Hallym University College of Medicine , Hwaseong , Korea.
authors.forename: Gyeong-Hun
authors.initials: GH
authors.lastname: Park
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000328:Adult; D003131:Combined Modality Therapy; D004890:Erythema / Q000209:etiology; D005148:Facial Dermatoses / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D006873:Hydroquinones / Q000627:therapeutic use*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D028022:Low-Level Light Therapy / Q000379:methods*; D008543:Melanins / Q000032:analysis; D008548:Melanosis / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D006873:Hydroquinones; D008543:Melanins; D014148:Tranexamic Acid; C031927:hydroquinone
keywords: Riehl’s melanosis; combination therapy; laser treatment