الفهرس 
Clinical Presentation and DistributionOnly 14 pages are availabe for public view
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Abstract
Melasma, also known as chloasma is a common condition that is usually seen in women in their childbearing period. 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.
GA has become the gold standard of chemical peeling agents. The depth of a GA peel depends on concentration, volume, and duration of application. Glycolic acid concentrations range from 20 up to 70%. Being a weak acid, it has to be neutralized by plain water or a weak buffer as sodium bicarbonate. It is stable, not light sensitive, inexpensive, safe, easy to administer, with generally little or no downtime.
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.
Liposomes are commonly used in dermal applications. The use of the liposomal drug-delivery system for cosmetics is frequently used in several hundred commercials in various forms like gels, creams, and moisturizers. Liposomal vesicles form an occlusive layer adhering to the skin surface. This occlusion promotes the penetration of encapsulated active ingredients into the skin and protects the cells from external stressors, such as sunlight and sweat. This facilitates delivery of the active ingredients to the outermost/deeper skin layers as desired for cosmetic products.
In our comparative study, the right side treated with nano vit C cream showed marked clinical improvement in the melasma lesions by 69.03% reduction in hemi MASI score that was statistically significant compared with the left side treated with GA 70% that showed moderate improvement by 59.97% reduction in hemi MASI score and was statistically significant.There were no side effects reported by nano vit C compared to GA 70% chemical peel, besides the rapid response obtained after 3 sessions by nano vit C compared with GA 70%.
Evaluation by the Antera camera reveals 8.82% decrease in the the Antera average on the right side while there was a 7.25% decrease in the the Antera average of the left side after the treatment and was highly statistically significant. Evaluation by the Antera camera reveals 16.67% decrease in the the Antera variation on the right side while there was a 9.46% decrease in the the Antera variation of the left side after the treatment and was also highly statistically significant.
All that makes nano vit C cream is an easy, safe and effective method in the treatment of both epidermal and mixed melasma with convenient, painless way of drug delivery, compared with GA 70% peel which is also effective in the treatment of superficial melasma.