MelOut: a conceptual treatment protocol for melasma based on PRP fraction enriched with DKK-1 and microneedling. Łukasz Malinowski, MD
ABSTRACT
Melasma is a chronic, recurrent pigmentary disorder in which currently used methods (topical agents, chemical peels, energy-based devices, systemic treatment) mainly provide symptomatic effects and are often associated with relapses. Increasing evidence suggests that sustained melanocyte hyperactivity may be influenced by Wnt/β-catenin signaling, whose physiological inhibitor is Dickkopf-1 (DKK-1). This article presents the concept of a potentially causative approach: the use of autologous platelet-rich plasma enriched with DKK-1 combined with a microneedling. The biological rationale is discussed (inhibition of the Wnt/β-catenin axis, reduction of the expression of key melanogenesis regulators and melanin transfer) and tissue remodeling through growth factors present in the plasma, as well as the practical assumptions of the authors’ MelOut protocol. Its application in clinical practice may promote more durable pigmentation control through simultaneous modulation of melanocyte activity and the skin microenvironment.