口服疗法治疗黄褐斑的研究进展

Research Advances in Oral Therapies for Melasma

摘要: 黄褐斑是一种常见的获得性色素沉着性疾病，具有复发率高的特点，治疗难度大。发病机制涉及氧化应激、炎症反应、血管增生及黑素合成异常等多条通路。近年来，口服药物及膳食补充剂因其方便、安全及系统调节优势成为研究热点。本文综述了口服药物与膳食补充剂治疗黄褐斑的作用机制、临床疗效及安全性。氨甲环酸是目前证据等级最高的一线口服药物，通过抑制纤溶酶系统、抗炎、抗血管生成及竞争性抑制酪氨酸酶等多靶点发挥作用。谷胱甘肽、褪黑素等抗氧化剂通过清除自由基改善色素沉着，但证据等级较低。酮替芬、非那雄胺等其他口服药物疗效有限或存在争议，多作为辅助用药。松树皮提取物、番茄提取物等膳食补充剂主要通过抗氧化及光保护作用辅助治疗，临床证据尚不充分。

Abstract: Melasma is a common acquired hyperpigmentation disorder characterized by high recurrence rates and therapeutic challenges. Its pathogenesis involves multiple pathways including oxidative stress, inflammatory response, angiogenesis, and abnormal melanin synthesis. In recent years, oral medications and dietary supplements have become research hotspots due to their convenience, safety, and systemic regulatory advantages. This review summarizes the mechanisms, clinical efficacy, and safety of oral medications and dietary supplements for melasma treatment. Tranexamic acid represents the first-line oral agent with the highest level of evidence, exerting therapeutic effects through inhibition of the plasminogen system, anti-inflammatory activity, anti-angiogenesis, and competitive inhibition of tyrosinase. Antioxidants including glutathione and melatonin improve hyperpigmentation by scavenging free radicals, though with lower evidence levels. Other oral agents such as ketotifen and finasteride show limited efficacy or remain controversial, serving primarily as adjunctive therapies. Dietary supplements including pine bark extract and tomato extract exert auxiliary effects mainly through antioxidant and photoprotective mechanisms, with insufficient clinical evidence to support their routine use.