探討臉部黃褐斑多元治療模式之成效：範域文獻回顧

Efficacy of Multimodal Therapies for Facial Melasma: A Scoping Review

黃褐斑是一種常見且複雜的後天性色素沉著性皮膚疾病，特別在亞裔與拉丁美洲族群中盛行率高，對患者生活品質造成顯著影響。其發病機制涉及紫外線、荷爾蒙、遺傳、發炎及血管生成等多重因素，使治療極具挑戰性。本文以範域文獻回顧研究法，針對臉部黃褐斑統整多元整合治療策略，以提升療效並降低復發率。經搜索PubMed、Embase、Cochrane Library、Scopus與Web of Science等五大資料庫，檢索期限至2025年8月。納入條件為以臉部黃褐斑患者為研究對象，且介入措施包含多元治療模式包含藥物組合、雷射、光療、化學換膚或注射等之臨床研究，最終共納入14篇文獻進行分析與歸納。結果顯示，多元整合治療普遍優於單一療法，常見高效組合包括：傳明酸注射合併外用藥物能顯著改善黃褐斑嚴重度指數並提升患者滿意度；能量設備與藥物聯合應用，如低能量釹雅克雷射或非汽化式飛梭雷射搭配壬二酸或傳明酸，可加速色素淡化；新興藥物與注射策略，如肉毒桿菌素合併三合一美白藥膏在頑固型黃褐斑中具持久且安全的臨床效果。然而，目前研究存在樣本數少、追蹤期短及結果異質性高等限制，且部分能量治療仍有復發與發炎後色素沉著風險。結論指出，多元整合治療為黃褐斑管理的主要趨勢，能針對多重病理機制進行多靶點介入。未來研究應致力於建立標準化臨床流程、進行高品質長期隨機對照試驗，並優化美白成分與新興能量設備的遞送與安全性評估，以提供臨床決策與後續系統性回顧研究之依據。

Melasma is a common and complex acquired hyperpigmentary skin disorder, particularly prevalent among Asian and Latin American populations, and has a significant impact on patients’quality of life. Its pathogenesis involves multiple factors, including ultraviolet radiation, hormonal influences, genetic predisposition, inflammation, and angiogenesis, making treatment highly challenging. This study conducted a scoping review to summarize current multimodal combination therapy strategies for facial melasma aimed at enhancing efficacy and reducing recurrence. A comprehensive search was performed across five major databases PubMed, Embase, Cochrane Library, Scopus, and Web of Science up to August 2025. Eligible studies included clinical trials involving facial melasma patients treated with combination therapies, such as drug combinations, laser or light-based therapies, chemical peels, or injectable agents. A total of 14 studies met the inclusion criteria and were analyzed. Findings indicated that multimodal combination therapies generally achieved superior outcomes compared to monotherapy. Highly effective approaches included: tranexamic acid (TXA) injection combined with topical agents, which significantly improved melasma severity scores and patient satisfaction; energy-based devices combined with topical agents e.g., low-fluence Q-switched Nd:YAG laser or non-ablative fractional laser with azelaic acid or TXA, which accelerated pigment reduction; and novel combinations, such as botulinum toxin type A with triple combination cream, demonstrating durable and safe results in refractory melasma cases. However, current evidence is limited by small sample sizes, short follow-up durations, and high heterogeneity, while some energy-based treatments still carry a risk of recurrence and post-inflammatory hyperpigmentation. In conclusion, multimodal combination therapy represents a major trend in melasma management, offering multi-targeted intervention across diverse pathogenic pathways. Future research should focus on establishing standardized treatment protocols, conducting large-scale, long-term randomized controlled trials, and optimizing delivery systems and safety assessments of novel agents and energy-based technologies to strengthen clinical decision-making and guide future systematic reviews.