Tranexamic Acid in Melasma

Melasma

Melasma occurs as symmetrical and irRegular tan-brown macules on the face. It is predominantly seen on the malar areas of cheek, forehead and chin. Ultraviolet (UV) radiation exposure, genetic susceptibility, and hormonal imbalance are considered to be most important aetiological factors. Melasma is more common in women and is a common cosmetic concern among indian population.

Topical medications have some efficacy in treating the epidermal-type melasma, but not in the dermal or mixed types. Prolonged application duration, slow response, limited efficacy, and undesirable recurrence are the major disadvantages of topical therapies causing patients to stop treatment. Topical bleaching agents may irritate the skin and cause PIH or result in exogenous ochronosis. The most effective and safe treatment for melasma is yet to be determined.

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There is increased evidence showing interaction between keratinocytes and melanocytes in the process of melanogenesis through the PA (plasminogen) activation system.  Thus rationale to adding TA (tranexamic acid) , a PA inhibitor, as an adjuvant in the treatment of melasma to increase the efficacy of previous treatments and reduce the chances of recurrence. TRANEXAMIC ACID is used as an antifibrinolytic agent, and is found to inhibit plasminogen-keratinocyte interaction by decreasing the tyrosinase activity, causing decreased melanin synthesis from the melanocytes. Its use in melasma is a novel concept. The patients should be screened for contraindications and risk factors prior to the commencement of oral therapy.

Intralesional tranexamic acid is a safe and effective treatment option of melasma with no risk of PIH, thrombotic or bleeding tendency; 6-12 MONTHLY SESSIONS ARE RECOMMEDNDED. The inclusion of maintenance topical therapy and strcit sun protection is strongly recommended to improve efficacy and decrease the recurrence of melasma.

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Botulinum Toxin For Palmo Planter Hyperhidrosis

PALMO PLANTER HYPERHIDROSIS

Primary Focal Hyperhidrosis is a disorder that results in considerable functional and psychosocial impairment. Patients experience symptoms for years before presenting to their dermatologists.

Multiple treatment modalities exist. Their efficacy depends on the body area affected and  severity of the sweating, and  patient’s tolerance and response to previous treatments. Healthcare professionals should be aware of the risks, benefits, cost, and reasonable expectations associated with the available treatment modalities. Conservative measures

are attempted before invasive and irreversible options, even in patients with severe hyperhidrosis.

BTX-A provides excellent efficacy in achieving anhidrosis and improves patients’ quality of life for a relatively long duration. Along with DIGITAL IONTOPHORESISIS, BOTOX

may be considered a first-line therapy for moderate-to-severe PALMO-PLANTER  HYPERHIDROSIS

Treatment options should be tailoredto each patient individually, taking risks, benefits, cost, and convenience into account.

Palmar Hyperhidrosis

Efficacy of BTX-A on palmar Hyperhidrosis both quantitatively and subjectively  is around 80–90%.. The duration of anhidrosis is approximately 6 months, and ranges from 4 to 12 months.

Adverse Events

Transient weakness of the intrinsic hand muscles is the most noteworthy adverse event when using BTX for palmar HH.The weakness usually begins after 1–3 days and resolves within 10–14 days.   handgrip strength is generally normal in most patients, yet finger pinch strength is often reduced i.e poor fine motor control.

Pain and soreness during thprocedure and for up to 1–2 days due to the multiple injections into the palm.Proper anesthesia ensures patient compliance.  Mild numbness and paresthesias, are transient in treated patients.

Dosing

The dose required to effectively treat palmar symptoms ranges from 100 to 240 U of Botox. Doses should be tailored , with injections of approximately 2–3 U of Botox_ spaced every 1–2 cm.

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