Fern extract a potential adjunct therapy for melasma in Asians

Taking the oral extract product of the fern Polypodium leucotomos (PLE) on top of the standard topical hydroquinone cream and sunscreen reduces the severity of melasma to a greater extent compared with the standard treatment alone in Asian patients, a pilot study has shown.

The single-centre, prospective, double-blind study recruited 40 patients (mean age 51 years) diagnosed with melasma and were being treated with a standard topical treatment of 4% hydroquinone cream and sunscreen SPF 50+ at the National Skin Centre in Singapore. They were randomized 1:1 to oral PLE 480 mg twice daily or a placebo for 12 weeks, in addition to receiving standard topical treatment. [J Clin Aesthet Dermatol 2018;11:14-19]

As expected, both the PLE and the placebo arms significantly improved in mMASI* scores compared with baseline (54.9 percent; p≤0.01 and 44.4 percent; p≤0.01, respectively), as participants in both arms also received hydroquinone.

However, the reduction in mMASI score was greater in the PLE than the placebo groups, which became significantly different between groups starting from week 8 (percentage reduction, 49.4 percent vs 32.6 percent; p≤0.05).

“Subjects in the PLE group experienced significant improvement in mMASI scores from the first month of treatment, indicating that PLE accelerates the pigmentation clearance of melasma compared to those treated with topical 4% hydroquinone and sunscreen alone,” observed the researchers led by Dr Goh Chee-Leok from the National Skin Centre.

In addition, more patients in the PLE arm achieved ≥60 percent improvement in mMASI score than those in the placebo arm (40.0 percent vs 11.8 percent; p=0.066) after 2 months of treatment.

Both arms showed improvement in the erythema and the melanin indices compared with baseline, but the difference between the two groups were not statistically significant.

The melasma quality of life scores (MelasQoL) were also improved in both groups, although the between-group difference was not statistically significant until week 12 (improvement, 14.9 percent vs 11.7 percent; p≤0.05). The decrease in MelasQoL scores was fourfold greater in the PLE vs the placebo arms as early as week 4.

No major side effects were reported during the study. Mild itching and stinging with the use of hydroquinone cream were reported in two and three patients in the PLE and placebo arms, respectively.

“Our findings indicate that it is an effective co-adjuvant treatment for melasma in combination with topical 4% hydroquinone and sunscreen SPF 50,” said the researchers.

“It should be stressed that PLE should not be used in place of sun protection measures, including use of topical sunscreen and avoidance of sun exposure during the peak hours of the day,” they added, suggesting that further studies on a larger cohort or with a higher PLE dose might show significant effects.