Combination Therapy of RFM and Cysteamine Effective in Treating Melasma

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New data revealed the high efficacy and safety of combining radiofrequency microneedling (RFM) with Cysteamine cream to treat refractory melasma.¹ Previous clinical trials have confirmed Cysteamine’s power to diminish melasma within 8 to 16 weeks.² However, this is the first study to assess the combined approach of RFM and cysteamine.

The vehicle-controlled, split-face, randomized trial recruited patients at Linkou Chang Gung Memorial Hospital between December 1, 2022, and November 30, 2023. The study included 30 female participants over the age of 20 with Fitzpatrick skin types III (n = 6) and IV (n = 24) and a clinical diagnosis of melasma for over a year. More than half of patients had a dry skin type. While some patients previously utilized treatments such as laser therapy, tranexamic acid, and Cysteamine cream, 40% had not received any listed treatments.

The microneedling therapy was delivered over 4 sessions at a monthly interval with supplemental evaluations at the fifth and sixth visits. One side of the face was treated with RFM and Cysteamine serum as a combination therapy while the other was treated with RFM and placebo saline. Additionally, half of the patients received a topical cysteamine cream to use at home as a part of their daily skincare routine post-treatment. This was to be applied in the evening and left on the skin for 15 minutes before being washed off.

Patients were assessed at baseline (day 0) as well as on days 30, 60, 90, 120, and 180. The modified Melasma Area and Severity Index (m-MASI) was used to determine treatment efficacy. Skin changes, such as the appearance of wrinkles, texture, pore sizes, and pigment spots, were analyzed via the VISIA system. Self-reported patient questionnaires were also used at each visit.

All cohorts saw improvement in Hemi m-MASI scores but the group with RFM and Cysteamine both in-office and at-home had the most improvement scores by session 6 (t = 3.662, p = 0.003). This demonstrated a meaningful change in melasma severity and skin texture, compared to the groups who were not treated with Cysteamine at home or in-office.

This group also saw significant wrinkle reduction at the fourth (t = −2.389, p = 0.033) and fifth (t = −2.357, p = 0.035) sessions, according to the VISIA Score. Additionally, texture improvements were observed at the fourth (t = 2.389, p = 0.033), fifth (t = 2.157, p = 0.05), and sixth (t = 2.19, p = 0.049) sessions. UV spots decreased significantly by the fifth and sixth sessions (t = −2.739, p = 0.017 and t = −2.176, p = 0.05, respectively). Despite this, red areas did increase at the sixth session (t = 2.772, p = 0.017).

Erythema was seen in 26.7% of the group. In terms of other adverse effects, 1 patient experienced scaling while another had an allergic reaction. Patients in other groups reported pain, dryness, itching, and acne but all adverse events were not severe.

The researchers noted several limitations including the restricted number of participants, the possible lack of patient compliance for at-home Cysteamine treatment, and the changing levels of UV exposure based on the seasons. Additional investigations regarding optimal treatment protocols and patient adherence can further the potential of this synergistic approach.

“The findings from this study significantly enhance the current understanding of melasma treatments, emphasizing the effects of combining RFM with topical cysteamine,” the authors wrote. “The observed differences in treatment outcomes highlight the effectiveness of these approaches, both separately and in combination, providing valuable insights for clinical application.”

References 

1. Tsai YW, Lin CH, Lai YJ, et al. Efficacy and Safety of Combination Therapy of Microneedling Radiofrequency, In-Office and Home-Based Topical Cysteamine in Refractory Melasma: A Split Face, Vehicle-Control, Randomized Control Trial. J Cosmet Dermatol. Published online November 22, 2024. doi:10.1111/jocd.16661

2. Mansouri P, Farshi S, Hashemi Z, Kasraee B. Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial. Br J Dermatol. 2015;173(1):209-217. doi:10.1111/bjd.13424