The Journal of dermatological treatment · 2026
Exploring the mechanism of differential responses to combination therapy in melasma: pigmentary versus mixed pigmentary-vascular types-a clinical study based on interaction analysis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Li Xiaoyan, Nie Lei, Guo Wei, Li Chen, Sun Bo, Chen Dong, He Yajie, Zhang Xiaotian, Zhang Yinping
Аннотация
BACKGROUND: Melasma shows clinical heterogeneity, but the role of vascular components in treatment resistance remains unclear.
METHODS: This retrospective cohort study included 75 melasma patients stratified by severity (mild/moderate/severe, n = 25 each) and classified into pure pigmentary (M-type, n = 42) and mixed pigmentary-vascular (M + V-type, n = 33). All received low-fluence Q-switched 1064 nm laser plus oral tranexamic acid. Primary outcome was modified Melasma Area and Severity Index (mMASI) reduction. Multiple regression and interactionanalyses were performed.
RESULTS: M-type showed significantly higher mMASI reduction than M + V-type (p < 0.001). Treatment resistance rate was markedly higher in M + V-type (p < 0.001). M + V-type, diseaseduration ≥5 years, and severe disease were independent negative predictors. A significantclinical type × severity interaction was detected (p = 0.018), with the M + V effect most pronounced in severe patients.
CONCLUSION: Mixed pigmentary-vascular type is independently associated with poor response, aggravated by severe disease. For severe M + V-type, adjunctive anti-vascular or anti-inflammatory strategies may be warranted.
METHODS: This retrospective cohort study included 75 melasma patients stratified by severity (mild/moderate/severe, n = 25 each) and classified into pure pigmentary (M-type, n = 42) and mixed pigmentary-vascular (M + V-type, n = 33). All received low-fluence Q-switched 1064 nm laser plus oral tranexamic acid. Primary outcome was modified Melasma Area and Severity Index (mMASI) reduction. Multiple regression and interactionanalyses were performed.
RESULTS: M-type showed significantly higher mMASI reduction than M + V-type (p < 0.001). Treatment resistance rate was markedly higher in M + V-type (p < 0.001). M + V-type, diseaseduration ≥5 years, and severe disease were independent negative predictors. A significantclinical type × severity interaction was detected (p = 0.018), with the M + V effect most pronounced in severe patients.
CONCLUSION: Mixed pigmentary-vascular type is independently associated with poor response, aggravated by severe disease. For severe M + V-type, adjunctive anti-vascular or anti-inflammatory strategies may be warranted.