Abstract in English:

Abstract Background: Tranexamic Acid (TA) has demonstrated effectiveness on melasma treatment, and Ketotifen (KET) may inhibit mast cell-mediated melanogenesis. The histologic basis of their depigmenting effects remains unclear. Objectives: To evaluate histopathological changes from TA with KET over a 3-month treatment. Methods: In this randomized, double-blind trial, 50 women with facial melasma were assigned to KET 1 mg plus TA 250 mg (TA/KET group) or TA 250 mg (TA group), every 12 h for 3-months, with broad-spectrum sunscreen. Skin biopsies were performed at baseline and day-90. Pri-mary outcome was epidermal melanin density reduction; secondary outcomes included stratum corneum compaction, solar elastosis, basement membrane disruptions, and counts of mast cells, melanocytes (including pendulum melanocytes), and upper dermal VEGF density. Results: Groups were comparable at baseline. Both showed reduced epidermal melanin without intergroup difference, with unchanged VEGF expression, mast cell and melanocyte count, and stratum corneum parameters. The TA/KET-group presented an increase in epidermal thickness, reduction in solar elastosis, pendulum melanocytes counting, and basal membrane disruptions. Study limitations: The short treatment and follow-up may have limited detection of histologic progression. Toluidine blue, while effective in detecting abundant mast cell populations, may lack sensitivity for precise quantification. PAS staining of the basement membrane may occa-sionally produce artifactual discontinuities, even when the membrane is structurally intact. Ketotifen was not tested alone. Conclusion: Both interventions led to epidermal melanin reduction. The combination TA/KET induced greater dermal and epidermal remodeling changes that surpassed those with TA alone, showing features associated with photoaging reversal and skin homeostasis restoration.

Abstract in English:

Abstract Background: Thin melanoma (TM, ≤1.0 mm Breslow thickness) and Melanoma In Situ (MIS) constitute the majority of melanoma diagnoses worldwide and are responsible for melanoma-related deaths in these early-stage tumors. Despite their favorable prognosis, MIS and TM represent an opportunity for improving patient outcomes through early detection, accurate risk stratification, and long-term surveillance for metastasis and new skin neoplasms. Objective: Provide an update of current evidence regarding epidemiology, risk factors, prog-nostic indicators, genetic background, and clinical management of MIS and TM. Methods: A comprehensive review of the literature and international guidelines was conducted, integrating epidemiologic data, clinical prognostic parameters, and molecular insights relevant to MIS and TM. Results: MIS and TM account for over 80% of all melanomas, with increasing incidence and relatively stable mortality rates. Prognosis is primarily determined by Breslow depth and ulcer-ation, while factors such as mitotic rate, anatomic site, and age further refine risk assessment. Genetic alterations contribute to tumorigenesis but are not yet integrated into routine mana-gement. Long-term dermatological surveillance is needed, as new neoplasms, recurrence, and metastasis can develop during follow-up. Conclusions: MIS and TM are increasingly diagnosed, and dermatologists need to be a part of early detection, multidisciplinary management, and lifelong surveillance, which remain the cornerstone of reducing melanoma-related mortality. Study limitations: The substantial heterogeneity among the included studies limits direct comparison and quantitative synthesis of the available data.

Abstract in English:

Abstract Background: Psoriasis is a chronic immune-mediated inflammatory disease linked to sys-temic comorbidities such as obesity, diabetes, cardiovascular disease, and inflammatory bowel disease. Non-pharmacological interventions, such as dietary modifications, nutritional sup-plementation, exercise, and psychological interventions, have emerged as complementary therapies in the management of psoriasis. Objectives: Review the current and recent evidence and the role of trace elements, vitamins, diet, exercise, and psychological interventions as complementary approaches in the manage-ment of patients with psoriasis. Materials and methods: A narrative review was conducted, analyzing clinical trials, meta-analyses, and cohort studies from major databases. Results: Trace elements such as zinc, copper, and selenium, and vitamins including D, E, B-complex, and A, play roles in oxidative stress modulation, immune regulation, and keratinocyte biology. However, the clinical efficacy of micronutrient supplementation remains uncertain due to inconsistent and conflicting findings. Dietary interventions, particularly Mediterranean diet adherence and weight loss through caloric restriction or bariatric surgery, have been associated with reductions in psoriasis severity, although clear clinical protocols are lacking. Aerobic exer-cise appears beneficial but is underutilized, partially due to psychological and disease-related barriers. Furthermore, psoriasis is associated with a high prevalence of psychological disorders, with the necessity to integrate psychological interventions to optimize disease management. Study limitations: The available evidence is limited and with heterogeneity in study design, with small sample sizes, observational methodologies, and inconsistent intervention protocols, restricting causal inference and generalizability. Conclusion: While non-pharmacological strategies show promise as complementary interven-tions in psoriasis management, they cannot replace conventional therapy. Further studies are required to confirm their clinical impact. These approaches should be considered as comple-mentary strategies, with individualized patient assessments and continuous follow-up being essential.