الفهرس 
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Abstract
Melasma is a common skin condition characterized by irregular light brown to dark brown patches on sun-exposed areas of the skin. It is more prevalent in women with darker skin types; however its incidence in men is considerable. Although its pathogenesis is not clearly defined, some etiological factors have been identified, including exposure to ultraviolet light, genetic influences, hormones associated with pregnancy, oral contraceptives, and photo toxic drugs. Melasma is a cosmetic condition; and patients with melasma report that their appearance affects their social life, emotional wellbeing and leisure activities.
Although multiple therapeutic modalities have previously been tried and advertised as being successful, truly efficacious treatment options for this condition have been few and quite elusive. Such treatment approaches include; numerous topical agents, chemical peels, dermabrasion, and a variety of lasers and light-based devices.
In this study we used micro needling alone or to deliver Platelet rich plasma (PRP) solution or Vit. C solution to evaluate the clinical, dermoscopic, histopathological and immunohistochemical changes in melasma patients treated with this technique.
Our study included twenty cases of melasma patients 10 patients received 6 sessions of micro needling with Vit C on Rt. side of the face versus 6 sessions of micro needling alone on Lt. Side. The other 10 patients received 6 sessions of micro needling with PRP on Rt. side of the face versus 6 sessions of micro needling alone on Lt. Side with 2 weeks interval between sessions.
Our study has demonstrated that there was clinical improvement after treatment. A 79.29 % decrease in MASI score after treatment when compared with that before treatment on Rt. side of group A and 49.13% on Lt. Side was reported. As regard group B the mean reduction percentage of MASI score from baseline to 2weeks after treatment revealed that it was reduced by 61.09% on Rt. side and by 40.01% on Lt. Side.
As regard histiopathological changes of treated patients, H&E microscopic examination of biopsies taken from melasma showed basal hyperpigmentation in all cases which showed significant decrease after treatment. Also by Masson-Fontana stained sections, we have demonstrated decrease of density of melanin in basal layer after treatment.
Immunohistochemical staining using MART-1 antibody revealed a significant quantitative decrease in the number of melanocytes after treatment.
Micro needling, PRP and Vit C are safe, easy, simple and effective methods for melasma treatment using the combined minimally invasive techniques employed in the present study. They showed good improvement in most cases with minimal downtime.
Meanwhile, combined techniques proved to be more beneficial and advisable over the application of single procedure.
Overall results were better with micro needling and vit C. PRP combined with micro needling also showed good improvement, however, the combined use of derma pen with vitamin C has superiority for patients of melasma over the use of derma pen with PRP, although both combinations were effective.
Combined treatment of microneedling and vit C or microneedling with PRP showed significant improvement when compared with microneedling alone.
In conclusion, on the basis of the findings, microneedling combined with topical Vit.C or PRP can be used as potentially a safe, effective, and promising therapeutic agent for treatment of melasma. The medication is easily available and affordable. Microneedling can significantly increase the effectiveness of topical therapeutic agents in treating melasma, and the combined therapy is safe and painless, without significant side effects and almost no downtime.