The application of platelet-rich plasma in melasma:a system review and single-arm meta-analysis
Objective To systematically evaluate the efficacy and safety of platelet-rich plasma(PRP)in melasma treatment.Methods The relevant studies up to January 2023 were collected from multiple databases,including CNKI,WanFang,SinoMed,PubMed,Embase,Web of Science,Cochrane library,Chinese Clinical Trial Registry Platform,and ClinicalTrials.gov.The study quality was evaluated using the MINORS software and the single-arm meta-analysis was performed using the Stata 14.0.Results A total of 19 studies were included in the meta-analysis,comprising pre-and post-treatment data from 550 patients with melasma.The random-effect model of meta-analysis showed that PRP significantly improved melasma,resulting in the decrease of melasma area and scoring index(MASI)scores[-6.82,(95％CI:-9.77,-3.87)]and the modified-MASI scores(mMASI)[-5.62,(95％CI:-7.79,-3.45)].In addition,the remission rate(improved score ≥ 50％),response rate(improved score 25％),and patient satisfaction rate were 55.3％(95％CI:42.2％,68.1％),88.8％(95％CI:77.7％,96.7％),and 93.0％(95％CI:79.0％,100％),respectively.In terms of remission rate,meta-regression revealed that combined treatment outperformed single treatment of PRP(72.7％vs.41.7％,P=0.011),that the microneedle or water light injections(a kind of mesotherapy)of PRP outperformed superficial microinjection(70.7％vs.39.0％,P=0.011),and that longer treatment or longer follow-up periods outperformed short-term studies(71.9％vs.38.2％,P=0.01).Conclusion PRP has promising efficacy in treating melasma,with mild adverse effects and rare profound adverse events.The improvement of melasma may be more significant using these therapeutic approaches associated with PRP,such as combined treatment,microneedle or water light injections and longer periods of treatment.
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