Development Of Adipose-Derived Mesenchymal Stem Cells Secretome (ADMSCS) Based Products From Stem Cell Conditioned Medium For Melasma Therapy

Melasma is a pigmentation disorder in the form of brownish macules with irregular edges caused by dysfunctional melanogenesis. Melasma is more common in women with Fitzpatrick skin types IV-VI, namely those of Asian, Hispanic, and African descent, especially on sun-exposed areas of the face. Various epidemiological studies report that melasma can occur in all ethnicities, but the prevalence of melasma tends to be higher in East Asian (Japanese, Korean, and Chinese), Indian, Pakistani, Middle Eastern, and Mediterranean-African populations. In a 2014 study, melasma patients in Asia tended to be aged 21-64 years. The prevalence of melasma varies from place to place depending on race, skin phototype, and intensity of sun exposure. 4 Based on the distribution of lesions, melasma is clinically divided into 3 types: centrofacial (65%), malar (20%), and mandibular (15%).

Melasma is a disorder with multifactorial causes. Several trigger factors for melasma include genetic predisposition, exposure to ultraviolet (UV) light, hormonal influences, pregnancy, cosmetic use, consumption of photosensitizing medications, stress, and oxidative stress. One of the main triggering factors that can worsen melasma lesions is UV light.

Melasma impacts a person's appearance, causing psychosocial and emotional disturbances and a decreased quality of life. Generally, melasma patients often complain of embarrassment, low self-confidence, dissatisfaction, and a lack of desire to travel.According to the WHO, quality of life is an individual's perception of their position in life, both in the context of culture, value systems, goals, expectations, standards, and concerns. In 2003, Balkhrisnan et al. developed a Melasma Quality of Life Scale (MELASQoL) questionnaire consisting of 10 questions to assess the effects of melasma on emotional aspects, social relationships, and daily activities.12 The MELASQoL questionnaire contains questions covering 3 domains, namely emotional conditions (questions 1-4), social life (questions 5-7, and 10), and recreation (questions 8-9). A study by Aditya et al. has validated and assessed the reliability of the MELASQoL questionnaire prepared in Indonesian, namely MELASQoL-INA. The higher the MELASQoL score, the lower the person's quality of life.

Various treatment modalities are available for melasma, but none are satisfactory, and relapses often occur after therapy is discontinued.15,16 The mainstay of melasma therapy is sun avoidance and the use of broad-spectrum sunscreen. Other primary treatments for melasma include eliminating causative factors and using bleaching agents, such as hydroquinone (HQ). Hydroquinone at a concentration of 2-5% as a single therapy or in combination with tretinoin and topical corticosteroids (triple combination cream) is the gold standard for melasma therapy. However, this therapy has side effects if used long-term and without proper monitoring. Therefore, a more effective treatment modality is needed for melasma treatment.

Technological advances have resulted in the development of cosmeceutical products derived from natural and synthetic ingredients, some of which have been clinically and empirically tested and successfully commercialized. In Indonesia, the cosmetics industry market is growing relatively rapidly, with total cosmetic product sales in 2017 (Rp9.76 trillion) increasing by 12.9% compared to 2016 (Rp8 trillion), and cosmetic exports increasing by 20% with a transaction value of US$406 million. This indicates that researchers and developers in the cosmetics industry are continuously innovating to find new compound combinations or other modalities to support the growth of the cosmetics market.