Search

Background: Q‐switched (QS) Nd: YAG laser is one of the treatment options for solar lentigines (SLs). However, the incidence of post‐inflammatory hyperpigmentation (PIH) is a common complication, especially in dark‐complexioned skin. Isobutylamido thiazolyl resorcinol (ITR) has been reported as a preventive modality for ultraviolet B (UVB)‐induced hyperpigmentation. Aims: This study aims to evaluate the efficacy and safety of ITR for the prevention of laser‐induced PIH. Patients/Methods: A randomized, evaluator‐blinded study including 24 subjects with SLs was conducted. Three SLs of each patient were randomized into three groups, which were to apply ITR twice daily, once daily, and no application for 2 weeks. Thereafter, 532‐nm QS Nd: YAG laser was performed. Incidence of laser‐induced PIH, relative melanin index (RMI), mean luminance score (L*), hyperpigmentation score, and adverse events were recorded for 2 months post‐laser. Results: The incidence of PIH at the 4th week after laser treatment was significantly lower in the ITR twice‐daily group compared to the no‐application group (20.83% vs. 50%, p = 0.028). There was no statistically significant difference in RMI, mean L*, and hyperpigmentation score between treatments at all visits. No serious adverse events were reported regarding ITR application and laser treatment. Conclusion: Two‐week application of ITR prior to QS: Nd YAG laser treatment may potentially reduce the incidence of PIH. A longer duration of application, including after the laser procedure, may be more beneficial for the prevention of laser‐induced PIH. [ABSTRACT FROM AUTHOR]

Background: The recent removal of hydroquinone from the over‐the‐counter market has created a need for modern skin lightening formulations. An effective pigment lightening formulation must be non‐irritating to prevent skin darkening from post‐inflammatory hyperpigmentation, penetration enhanced to reach the epidermal/dermal junction, contain anti‐inflammatory ingredients, and address multiple mechanisms of pigment production. Objective: The objective of this research was to demonstrate the efficacy of a topical multimodal pigment lightening preparation containing tranexamic acid, niacinamide, and licorice. Methods: Fifty female subjects 18+ years of all Fitzpatrick skin types with mild to moderate facial dyspigmentation were enrolled. Subjects were provided with the study product for twice daily use on the entire face and an SPF50 sunscreen with evaluations occurring at Week 4, Week 8, Week 12, and Week 16. The investigator used a face map to identify a pigmented target site on the face for dermaspectrophotometer (DSP) measurement. The dermatologist investigator completed a baseline facial efficacy and tolerability assessment. The subjects completed a tolerability assessment. Results: 48/50 subjects completed the study without tolerability issues. The DSP readings demonstrated a statistically significant reduction in target spot pigmentation at Week 16. The investigator assessed a 37% decrease in pigment intensity, a 31% decrease in pigment extent, a 30% decrease in pigment homogeneity, a 45% improvement in brightness, a 42% improvement in clarity, and a 32% improvement in overall facial skin dyspigmentation at Week 16. Conclusion: The combination of penetration enhanced tranexamic acid, niacinamide, and licorice was effective in inducing facial pigment lightening. [ABSTRACT FROM AUTHOR]

Introduction: Melasma is an acquired pigmentary disorder which currently has no definitive treatment. Although topical drugs containing hydroquinone are the basis of treatments, they are usually associated with recurrence. We aimed to evaluate the effectiveness and safety of monotherapy with topical methimazole 5% versus combination of Q‐Switched Nd: YAG Laser and topical methimazole 5% in patients with refractory melasma. Methods: A total of 27 women with refractory melasma were included. We applied topical methimazole 5% (once a day) with three passes of QSNd: YAG laser (Wavelength: 1064 nm, pulse energy: 750 mJ, fluence: 1.50 J/cm2, spot size: 4 × 4 mm, hand piece: fractional, JEISYS company) for six sessions on the right half of the face, and topical methimazole 5% (once a day) on the left half of the face, for each patient. The treatment course was 12 weeks. Evaluation of effectiveness was done with the Physician Global Assessment (PGA), Patient Global Assessment (PtGA), Physician satisfaction (PS), Patients satisfaction (PtS), and mMASI score. Results: PGA, PtGA, and PtS were not significantly different between the two groups at any time (p > 0.05). PS in the laser plus methimazole group was significantly better than methimazole group at 4th, 8th, and 12th weeks (p < 0.05). The rate of PGA improvement in the combination group was significantly better than the monotherapy over time (p < 0.001). The changes of mMASI score between the two groups did not significantly differ at any time (p > 0.05). There was no significant difference in the adverse events between the two groups. Conclusion: Combination therapy with topical methimazole 5% and QSNY laser can be considered as an effective way to treat refractory melasma. [ABSTRACT FROM AUTHOR]

Background: Various topical agents have been used to treat melasma; however, a large‐scale evaluation among the currently available treatment is lacking. Objectives: The aim of this study was to evaluate the efficacy and safety of topical agents for melasma. Methods: The MEDLINE, Embase, Web of Science, Cochrane, and Alt‐Healthwatch databases were searched in November 2021. Original studies that reported pre‐ and post‐treatment Melasma Area Severity Index (MASI)/modified Melasma Area Severity Index (mMASI) scores and/or adverse effects (AEs) were eligible for inclusion. The main outcome was the efficacy analyzed by the changes in the pre‐ and post‐treatment with standardized mean difference (SMD) of MASI/mMASI scores; the AEs were calculated with incidence proportion by the reported percentage of skin irritations. Results: A total of 45 studies (2359 patients) and 55 studies (4539 patients) met the inclusion criteria for efficacy and AEs, respectively. Hydroquinone (HQ) monotherapy (SMD ‐1.3, 95% CI [−1.6 to −1.0]), HQ‐containing combination therapy (−1.4, [−1.7 to −1.1]), cysteamine (−1.6, [−2.0 to −1.2]), tranexamic acid (−1.5, [−2.0 to −1.1]), azelaic acid (−1.3, [−1.7 to −1.0]), and kojic acid (−0.9, [−1.3 to −0.5]) demonstrated comparable efficacy, while zinc sulfate did not exhibit statistically significant improvement (−1.2, [−2.7 to 0.4]). HQ‐containing combination therapy (50.9%) and cysteamine (42.2%) demonstrated the highest incidence of irritation, while azelaic acid (18.7%), kojic acid (5.3%), and tranexamic acid (0.8%) revealed a lower risk. Conclusions: In this meta‐analysis, non‐HQ agents except zinc sulfate may be considered as an alternative to HQ‐containing agents. However, treatment should be guided by patient's tolerance, availability, and physicians' experience. [ABSTRACT FROM AUTHOR]

Hyperpigmentation is the most common complaint in the age group 40–45 years, seeking consultation for skin disorders. Hydroquinone is a commonly used depigmenting agent in clinical practice for treating hyperpigmentation. Prolonged use of hydroquinone has been associated with cancer risk and exogenous ochronosis. The CARES (The Coronavirus Aid, Relief, and Economic Security Act) Act of 2020 has instituted significant changes to hydroquinone containing OTC (over the counter) products, and consequently, many hydroquinone‐based OTC products had to be withdrawn from the market. Henceforth, products containing hydroquinone would need US Food and Drug Administration approval via new drug application pathways for commercialization. Alternative treatment options to hydroquinone in clinical practice are reviewed in this paper with regard to their safety and efficacy vis a vis hydroquinone. Also, new potential treatment options such as thiamidol, Polypodium leucotomos, and glutathione are discussed. The review shows that these alternative depigmenting agents can be rationally combined to achieve desired treatment goals in the management of hyperpigmentation. [ABSTRACT FROM AUTHOR]

Melasma is a common malady affecting all races with a higher incidence in Hispanics, Middle Eastern, Asians, and African origin females (Fitzpatrick skin phototypes III–V). Women are affected much more often than men. Melasma remains a significant cause of cosmetic morbidity and psychosocial embarrassment affecting quality of life necessitating effective and reliable treatment. Unfortunately, treatment remains unsatisfactory due to limited efficacy, adverse effects, and relapses after stopping treatment. Although chemical peels, laser and light therapies and dermabrasion may have utility, the evidence available for their efficacy is limited and they often cause post‐inflammatory hyperpigmentation, particularly in individuals with darker skin types. Medical therapies remain mainstay in the management of melasma. The triple combination, hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01% (Triluma, Galderma, Ft. Worth Texas, often modified incorporating different corticosteroids) remains the only US FDA‐approved treatment for melasma and is the gold standard due its demonstrated efficacy across ethnicities. Oral tranexamic acid alone or in combination with other modalities has also shown significant efficacy. Several cosmeceuticals and botanical extracts used as skin lightening agents have been demonstrated to be useful. Physical sunscreens containing zinc oxide, iron oxide, titanium dioxide, and silicones provide photoprotective and camouflage effect. We propose that a multimodality approach to the treatment of melasma is the most effective treatment approach. This review is focused on the medical therapies for melasma. [ABSTRACT FROM AUTHOR]

Background: Few safe and effective treatments are available for melasma. Cysteamine, a non‐melanocytotoxic molecule is a safer alternative to hydroquinone and usable for long‐term use. Aim: To evaluate the effect of cysteamine 5% cream in the treatment of melasma. Methods: Sixty‐five of 80 patients completed this single‐blind, randomized, controlled trial. The patients received cysteamine 5% or hydroquinone 4%/ascorbic acid 3% (HC) cream. The therapeutic response was evaluated by modified MASI (mMASI) and melanin index (SkinColorCatch) after 2 and 4 months of treatment. The effect of treatment on the quality of life was also assessed. Results: The decrease in mMASI score was from 6.69 ± 2.96 to 4.47 ± 2.16 in the cysteamine group and from 6.26 ± 3.25 to 3.87 ± 2.00 in the HC group after 4 months (p values < 0.001). The melanin index decreased from 37.72 ± 10.17 to 31.47 ± 11.90 in the cysteamine group and from 36.37 ± 10.80 to 23.16 ± 8.83 in the HC group after 4 months (p‐value = 0.003 and <0.001, respectively). The difference between mMASI score at baseline and month 4 was not significant between both groups (p‐value > 0.05). The difference between the melanin index at baseline and month 4 was significantly more pronounced in the HC group (p‐value = 0.002). Quality of life improved in both groups (p‐value < 0.05), but was not significantly different between groups (p‐value > 0.05). Conclusion: Cysteamine was confirmed to be an effective treatment for melasma, with equivalent results to HC in reducing mMASI score and improving quality of life, despite lesser melanin index reduction observed. Cysteamine and HC efficacy was confirmed in patients recalcitrant to previous treatments, by a significant reduction of mMASI and melanin index. [ABSTRACT FROM AUTHOR]

Background: Tranexamic acid (TA) can prevent melanocyte activation by various stimuli. Combining TA with either hydroquinone 4% or Q‐switched Nd:YAG laser may be associated with greater improvement of melasma. Objectives: We aimed to evaluate the efficacy and safety of oral TA alone and combined with either topical hydroquinone 4% or low‐fluence 1064 nm Q‐switched Nd:YAG laser in treatment of mixed melasma. Patients & Methods: Patients were randomly divided into three groups of 20 patients each. Group A were treated with oral TA 250 mg twice daily for three months; group B were treated with TA similarly combined with topical hydroquinone 4% cream; group C were treated with TA combined with two sessions of 1064 nm low‐fluence Q‐switched ND:YAG laser (850–1200 mJ/cm2, 4–5 Hz,spot size 4 mm) spaced 4 weeks apart. Patients were followed monthly for 9 months. Results: After cessation of therapy, the mean mMASI score was lowest in group B (2.34 ± 2.37) followed by groups A (6.38 ± 4.04) and C (7.24 ± 4.95).Mean percentage of mMASI score improvement was 35.91 ± 24.13, 77.47 ± 19.07, and 24.94 ± 27.79 in groups A, B, and C (p < 0.001). There was a significant reduction of telangiectasia in the three groups. Reported side effects were itching & irritation, post‐inflammatory hyperpigmentation, and gastritis. Conclusion: Oral TA is a tolerable effective treatment modality for melasma. Combining hydroquinone 4% with oral TA is associated with a relatively earlier and better cosmetic outcome. [ABSTRACT FROM AUTHOR]

Background: Melasma, also known as chloasma or mask of pregnancy, is a common, acquired, hyperpigmentary disorder usually affecting females. Tranexamic acid (TA), a derivative of amino acid lysine, has shown promising results over the past few years when used along with other therapies and when used as a stand‐alone therapy. Aim of the Work.: In this study, we aimed to evaluate and compare the effectiveness of topically applied tranexamic acid after microneedling versus topically applied hydroquinone (HQ) 4% alone in patients with melasma. Patients and Methods: Fifty selected patients were divided randomly according to the random number allocation method into two groups (25 patients each) of A (topical 4% hydroquinone, nightly application) and B (microneedling + topical 4% TA, every other week). Results: After eight weeks of treatment, the mean modified MASI score of the HQ treated side changed from 6.604 ± 4.02 to 3.032 ± 1.19 with a mean decrease percentage of 54.8% ± 19.4%. This reduction in modified MASI score was found to be statistically significant, (p < 0.001). MASI score of group B (TA +microneedling) changed from 6.348 ± 3.84 to 3.712 ± 1.19 with mean decrease percentage of 57.4% ± 23.4% which was also statistically significant, (p < 0.001). Conclusion: We demonstrated safety and efficacy of both used modalities and with minimal side effects. Topical HQ application achieved minimal non‐significant higher satisfactory results among raters and subjects. [ABSTRACT FROM AUTHOR]

Background: Hydroquinone, which is considered the gold standard skin depigmenting agent, has been associated with multiple side effects. Lately, deoxyarbutin has been suggested to be an alternative of hydroquinone with better safety profile. Objective: To compare the depigmenting effect of 2% deoxyarbutin and 4% hydroquinone sera. Methods: This double‐blind randomized controlled study was done on the right and left arms of healthy participants. Subjects were instructed to apply either 2% deoxyarbutin or 4% hydroquinone serum on each arm, which were randomly labeled as group A and B, every day for 12 weeks. Chromameter and mexameter analysis were done every 2 weeks to assess the color change. Paired and independent t‐tests were used to assess the color change within and between both groups, respectively. Results: A total of 59 females participated in this study. Both groups showed significant improvement in skin depigmentation as shown by the chromameter (increase in L* value) and mexameter (decrease in melanin index) analysis at the end of the study (p < 0.05). No significant difference in both parameters was observed between both groups (p > 0.05). No side effects were reported in either groups. Conclusion: 2% deoxyarbutin and 4% hydroquinone sera showed comparable depigmenting efficacy. [ABSTRACT FROM AUTHOR]

Background: Melasma is a common hyperpigmentation disorder with numerous, but often unsatisfactory treatment options. Aims: A pilot study to evaluate the efficacy and safety of a novel topical combination of 12% hydroquinone, 6% kojic acid, and 5% vitamin C cream for melasma. Patients and Methods: A pilot study of 6 women with melasma was conducted at an academic dermatology department and a private dermatology practice to evaluate the efficacy of a topical combination of 12% hydroquinone, 6% kojic acid, and 5% vitamin C cream, entitled the "Tam Formula." Two blinded evaluators calculated Melasma Area and Severity Index (MASI) Scores before and after treatment to evaluate change from baseline, and statistical analysis was performed. Results: Treatment with this combination topical cream resulted in an average 63.77 ± 22.10 percent reduction in MASI scores. Conclusions: While there is a need for further investigation, this pilot study indicates the Tam Formula may provide an alternative treatment option for melasma. [ABSTRACT FROM AUTHOR]

Background: Isobutylamido thiazolyl resorcinol (ITR, Thiamidol®) has been proposed as a potent tyrosinase inhibitor. A formulation containing ITR has recently shown promising efficacy for the treatment of some hyperpigmentary conditions. Objectives: This study aimed to evaluate the efficacy and safety of ITR in the prevention of ultraviolet (UV)‐induced hyperpigmentation in human skin. Materials and Methods: We performed a randomized, single‐blinded, pilot study in 30 healthy participants. One arm was randomly assigned to receive an ITR‐containing product for three weeks. Three hyperpigmented spots were induced by UVB irradiation on both arms after 3 weeks of ITR application. Outcome evaluations included measuring mean lightness index (*L) obtained by colorimeter, hyperpigmentation scores by visual analog scale (VAS), and adverse effects. Results: Both experimental sides showed no significant difference in terms of skin lightening after ITR application. However, the ITR‐treated sides showed a statistically significant lower mean lightness index compared to control after an induction with UVB. In addition, the ITR‐treated sides had an earlier improvement and resumed the normal skin color after 3 weeks post‐UVB induction. A clinical evaluation by a blinded nontreating physician and subjects was more favorable on the ITR‐treated side than the control side (P <.05). No significant side effect was noted. Conclusions: ITR is an effective agent in the prevention of pigmentary change from UVB irradiation and may serve as a promising agent for preventing other hyperpigmentary conditions. [ABSTRACT FROM AUTHOR]

Background: Robust evidence regarding the efficacy of topical tranexamic acid (TA) on melasma in Chinese population is lacking. Objective: To evaluate the efficacy and safety of 1.8% liposomal TA and microneedling with 5% TA solution on melasma. Methods: Sixty melasma patients were enrolled and randomized to receive 1.8% liposomal TA twice daily, microneedling with 5% TA solution weekly or 2% hydroquinone every night. Objective and subjective assessments were obtained at baseline, 4, 8, and 12 weeks. Results: 27.8% of patients of liposomal TA group, 33.3% of microneedling with TA solution group, and 30.0% of hydroquinone group were recognized as "more than 50% improvement." At the endpoint, the melanin index (MI) in all treatment groups was significantly decreased, while the improvement of MI in microneedling with TA solution group and hydroquinone group is higher than liposomal TA group. The erythema index (EI) was significantly diminished in liposomal TA group and microneedling with TA solution group. Dermatoscopy and reflectance confocal microscopy revealed decreased brown granules in all groups and reduced telangiectasia in liposomal TA group and microneedling with TA solution group. Conclusion: 1.8% liposomal TA and microneedling with 5% TA solution are both effective and safe on melasma. [ABSTRACT FROM AUTHOR]

Background: Many skin lightening preparations containing hydroquinone, kojic acid, arbutin, and deoxyarbutin are toxic to melanocytes. Objective: This research examined a new skin lightening agent from a family of gem difluorocompounds 2‐[2‐(2,4‐difluorophenyl)‐2‐propen‐1‐yl]‐1,3‐propanediol that also function as tyrosinase inhibitors. This ingredient does not exhibit melanocyte toxicity yet is capable of inducing skin lightening. This research compared the gem difluorocompound, TFC‐1067, to hydroquinone evaluating both tolerability and efficacy for lightening facial dyschromia. Method: 48 nonpregnant and non‐nursing healthy female subjects age 25‐70 years skin types I‐IV with mild‐to‐moderate facial dyschromia were randomized to receive either study product or 2% hydroquinone cream. Subject and investigator tolerability and efficacy assessments were made at baseline, week 4, week 8, and week 12. Dermaspectrophotometer readings from normal skin and a pigmented target area were obtained. All subjects underwent facial photography at each visit. Results: TFC‐1067 and 2% hydroquinone produced statistically significant skin lightening after 8 weeks of use, but only hydroquinone lightened the normal skin. This pattern continued into week 12 where both products significantly lightened dyschromic skin, but hydroquinone also lightened the normal skin, which is not always desirable. [ABSTRACT FROM AUTHOR]

Background: There are various treatment modalities for melasma, but none of them are effective on dermal component of melasma. Aims: In this study, we decided to evaluate the efficacy of microneedling plus tranexamic acid in comparison with 4% hydroquinone in the treatment of melasma. Methods: This is a single‐blind randomized clinical trial on 70 participants with 14% dropout, and therefore, 60 patients with melasma completed the study. Patients were randomized based on simple randomization in 2 groups of A (microneedling plus topical 4% tranexamic acid, monthly) and B (topical 4% hydroquinone, nightly). Evaluation of mean MASI score, patient and physician assessments was performed at 4th, 8th and12th weeks of the treatment. Statistical analysis was performed by paired t test, chi‐square test and Fisher's exact test, respectively. Results: Sixty women (30 patients in each group) were completed the study. Mean MASI score in group A was significantly lower at the end of the treatment (6.84 ± 4.31) than at the baseline (12.89 ± 5.16) (P <.01). Mean MASI score in group B was significantly lower at the end of the treatment (7.16 ± 4.38) than at the baseline (13.56 ± 4.88) (P <.01). There was no statistical difference between 2 groups regarding MASI score, physician and patient assessments during the treatment. Percentage of patient satisfaction was significantly higher than physician satisfaction in both treatment groups (P <.01). Conclusion: In our study, the combination of microneedling with tranexamic acid did not differ from 4% hydroquinone in the treatment of melasma. [ABSTRACT FROM AUTHOR]

Background: The increase in the pigmentation of skin grafts during the healing process is a cosmetic problem. There are a variety of medical and surgical treatment options for skin graft darkening. Aims: The aim of this study was to investigate the effects of topical hydroquinone, tretinoin, and betamethasone application on hyperpigmentation of skin grafts. Methods: A skin defect was created on the backs of 17 Long‐Evans rats, and a 2 × 2 cm split‐thickness skin graft was sutured. After 15 days, eight rats in the treatment group were treated with application of hydroquinone, tretinoin, and betamethasone cream, while nine rats in the control group were not treated. Visual evaluation was performed on days 45 and 75 using the Melasma Severity Scale (MSS), and histological evaluation was performed on day 75 using S100 and Masson Fontana (MF) staining. The Mann‐Whitney U test was used for statistical analysis. Results: Mean MSS values of the treatment group on days 45 were significantly lower compared to the control group (P =.036). On day 75, the mean MSS score of the treatment group was also lower; however, the difference was not statistically significant (P =.302). Histological evaluation of S100 and MF staining scores of the treatment group showed fewer melanocytes and fewer pigments in epidermis (P =.009 and P =.002, respectively). Conclusions: This study showed that topical application of hydroquinone, tretinoin, and betamethasone reduced the hyperpigmentation, number of melanocytes, and melanin pigment intensity that developed on the rat skin graft models. Clinical studies are needed to assess whether a similar effect could be observed with human skin grafts. [ABSTRACT FROM AUTHOR]

Background: Melasma is an acquired disorder of facial pigmentation which is a treatment challenge. Aims: The aim of this article is to critically appraise the clinical trial evidence for different treatment modalities for melasma, published in peer‐reviewed journals in the past 10 years. Patients/Methods: The literature review was conducted using PubMed and MEDLINE. The search was performed in July 2019, and search parameters were limited to all English language articles published in the past 10 years only. Results: Eighty‐nine clinical trials were found. Four clinical trials investigated topical hydroquinone, supporting its safety and efficacy as first‐line treatment. Twelve studies showed tranexamic acid as very promising. Nineteen studies assessed various novel oral, injectable, and topical treatments and highlight some new potential future treatments. Forty‐two studies investigated laser and light treatment in melasma: LFQS laser is still one of the best options, especially in darker skin types. However, the picosecond laser has shown excellent results. Finally, 11 studies looked at peels. Overall, peels have not been shown to be superior to the use of topical therapy alone. Conclusion: Topical therapy with a HQ and retinoid‐based product should be first line for a minimum of 3 months with the addition of oral tranexamic acid at 250 mg BD if no contraindication. Second‐line treatment with lasers includes the LFQS Nd:YAG, picosecond laser, and the pulsed dye laser in lighter skin types. Third‐line therapy would be the addition of chemical peels to the above treatments, with GA or TCA peels having the most evidence for effectiveness. [ABSTRACT FROM AUTHOR]

Background: The management of melasma is still challenging, and new treatment modalities with favorable side effect profile are required. Methimazole, a peroxidase inhibitor, seems to have a beneficial effect in the management of melasma but there is a paucity of studies for evaluation of its efficacy. This double‐blinded trial was aimed to evaluate the efficacy and safety of methimazole vs hydroquinone 4% which is the gold standard treatment in the management of melasma. Methods: Fifty patients with melasma were enrolled and randomly divided into two groups to receive 4% hydroquinone or 5% methimazole once daily for 8 weeks. Forty patients completed the study. The clinical response was assessed at 4th, 8th, and 12th weeks after treatment by MASI score, patient satisfaction, and physician scores. Results: Both groups showed a reduction in the MASI score at the 8th week which was more significant in hydroquinone group but higher relapse rate was also observed in this group after discontinuing the drug. The side effects were similar between groups. Also, patient and physician satisfaction scores were also more in favor of hydroquinone 4%. Conclusion: Methimazole could be an alternative treatment of melasma alone or in combination with other depigmenting drugs. Although not as effective as hydroquinone, the noncytotoxic and nonmutagenic aspects of methimazole may make it a promising alternative for the treatment of melasma. [ABSTRACT FROM AUTHOR]

Summary: Exogenous ochronosis is a cutaneous condition characterized by blue‐black pigmentation resulting as a complication of long‐term application of skin‐lightening creams containing hydroquinone and other substances such as quinine, phenol and mercury derivatives. We report a case of a 55‐year‐old woman who developed exogenous ochronosis as a result of prolonged use of topical hydroquinone for 5 years, characterized by greyish hyperpigmented patches on the nose and cheeks. The diagnosis was confirmed histologically. Treatment with picosecond laser resulted in marked clinical improvement together with improvement in overall texture and quality of the skin. [ABSTRACT FROM AUTHOR]

Background: Melasma is a common acquired hyperpigmentation disorder observed mainly in young women. Hydroquinone is the basic treatment that its effect alone and in combination with other medications has been proven. Liposomes are microscopic vesicles in which water and lipid‐soluble medications can be introduced to enhance their efficacy and specificity. The aim of this study was to compare therapeutic effects of topical liposomal hydroquinone with its conventional form on melasma. Methods: This double‐blind randomized clinical trial study was conducted on 20 women. Participants were asked to apply a certain amount of topical liposomal hydroquinone on one side of the face and conventional hydroquinone on the other side for three months. Skin pigmentation severity was measured using Melasma Area and Severity Index (MASI) at each visit, separately for each side of the face every month until one month after the last treatment, the data were recorded in a questionnaire and were analyzed by SPSS 16 software, paired sample t test, and repeated measurement ANOVA. Results: MASI score in both case and control groups significantly reduced (P < 0.001) but no significant difference between the case and control groups was observed at any time interval (P > 0.05). Conclusion: This study shows that liposomal hydroquinone has a significant therapeutic effect on melasma, but we did not observe any superiority in comparison with the conventional method. Therefore, it can be considered in the treatment protocol of this disease. [ABSTRACT FROM AUTHOR]

Summary: Background: Melasma is a highly prevalent hyperpigmentation disorder with a high relapsing rate and a negative impact on the psychological state of the affected patients. The exact pathogenesis of melasma is not completely elucidated; however, ultraviolet induced oxidative stress has an important role in its pathogenesis. Silymarin, antioxidant drug, reduces the harmful effects of solar ultraviolet radiation such as inflammation, immune responses, DNA damage, and pigmentation. Objectives: To assess the efficacy and safety of topical silymarin with different concentrations (0.7% and 1.4%) versus hydroquinone 4% in the treatment of melasma. Methods: Forty‐two adult female patients with melasma were assigned to three equal groups each containing 14 patients; group1 was treated by silymarin 0.7% cream, group 2 was treated by silymarin 1.4% cream and group 3 was treated by hydroquinone 4% cream. The duration of treatment was 3 months. Results: MASI score was significantly reduced in all groups at the end of third month; however, there were no significant differences in the therapeutic response between the three studied groups. No side effects were recorded with silymarin, while hydroquinone was associated with significant adverse effects. Conclusions: Silymarin cream might serve as an effective and safe treatment modality for melasma. [ABSTRACT FROM AUTHOR]

Background: Postinflammatory hyperpigmentation (PIH) occurs as a result of different inflammatory dermatoses and exogenous factors in individuals with darker skin types. With current skin lightening treatments, there are concerns about irritation leading to worsening of their underlying inflammatory skin condition or worsening of PIH. Case: A 20‐year‐old woman with Fitzpatrick skin type (FST) V presented with facial hyperpigmented patches since childhood following an intermittent erythematous, pruritic facial rash. Skin biopsy confirmed PIH secondary to possible burnt‐out morphea. Treatment with topical adapalene 0.1% gel and triple combination cream (containing hydroquinone, topical corticosteroids, and retinoids) proved unsuccessful. Treatment with cysteamine 5% cream over 4 months resulted in significant improvement with a reduction in the melanin index. Discussion: The current recommendation for first‐line treatment in PIH is hydroquinone or triple combination cream containing hydroquinone, which can be associated with significant short‐ and long‐term side effects. Cysteamine 5% cream is one of the latest cosmetic skin lightening products. It is hypothesized that cysteamine reduces melanin production by inhibiting key melanogenic enzymes required in melanogenesis. Its efficacy and tolerability have been demonstrated in two randomized controlled trials against placebo in patients with melasma. This report demonstrates a successful use of cysteamine 5% cream in a patient with chronic severe PIH. [ABSTRACT FROM AUTHOR]

Background Melasma's high prevalence and profound psychological impact on patients necessitate efficacious, economical, and safe therapeutic interventions. Adjunctive therapies such as tranexamic acid ( TA) can enhance the therapeutic effect of standard treatments like hydroquinone 4% cream ( HQ). Objective To conduct an assessor- and analyst-blinded, parallel, superiority, randomized controlled trial to compare the clinical efficacy and safety of oral TA plus HQ vs. HQ alone in melasma treatment. Materials and Methods A total of 100 eligible patients with symmetric facial melasma were assigned to the intervention (250 mg thrice daily oral TA plus HQ 4% cream nightly) or the control group ( HQ 4% cream only). Following 3 months of treatment, MASI (melasma area and severity index) score reduction was calculated as the primary outcome measure. After a 3-month follow-up, relapse was also assessed. Results A total of 88 patients completed the study. At the end of the 6-month period, the overall mean of the MASI score in the intervention group was 1.8 points lower than in the controls (95% confidence interval, 0.36-3.24, P = 0.015) but the relapse rate was not significantly different (30% vs. 26% in the treatment vs. control group, respectively). Side effect occurrence was also similar, but treatment satisfaction was higher in the intervention group than the controls, with 82.2% vs. 34.95 of patients reporting moderate-to-complete satisfaction, respectively ( P < 0.001). Conclusions Oral TA can enhance the efficacy of hydroquinone 4% cream in melasma treatment, but the high incidence of relapse suggests that treatment effects may be temporary, warranting more investigation. [ABSTRACT FROM AUTHOR]

Summary: L‐Cysteamine is a biological antioxidant produced during the coenzyme A metabolism cycle and is naturally present in all mammalian cells. The efficacy of topical cysteamine for the treatment of melasma has been recently shown in two double‐blind, randomized, and placebo‐controlled clinical trials. Herein, we report a 44‐year‐old patient with melasma resistant to Kligman's formula (Pigmanorm cream), who was successfully treated with topical cysteamine as a new depigmenting agent. Skin colorimetric measurements, MASI score determination, and standard photographies after 2 and 4 months of once daily application of cysteamine cream showed a marked improvement of the hyperpigmented lesions. Telangiectasia and perilesional hypopigmentation improved rapidly after the discontinuation of Kligman's formula and starting the treatment with topical cysteamine. After 4 months, the therapeutic results were maintained through a biweekly application regimen of cysteamine cream. The use of cysteamine cream was well tolerated and did not induce any side effects during the 3‐year follow‐up of the patient. Cysteamine is a natural molecule with an excellent safety profile and known antimutagenic, antimelanoma, and anticarcinogenic effects. Considering the high efficacy of cysteamine cream, it is possible that it could replace mutagenic and carcinogenic depigmenting agents such as hydroquinone in near future. [ABSTRACT FROM AUTHOR]

With dermatologists continuing medical education and patient education, including web-based materials, as well as counseling during office visits, these formulations can be used safely, with limited fear of EO. Therefore, 4% hydroquinone prescriptions may not be affordable to some patients and now cannot be purchased OTC at cheaper prices compared with other OTC hyperpigmentation therapies. Since topical hydroquinone is not available OTC, more patients will likely seek skin-lightening treatments, including 4% hydroquinone, from dermatologists. [Extracted from the article]

Background Treatment of melasma remains a challenge and involves multistep approach. Diacetyl boldine ( DAB) stabilizes tyrosinase in its inactive form while TGF- β1 biomimetic oligopeptide-68 inhibits tyrosinase activity. Aims (1) to study the efficacy and safety of the combination use of two formulae containing two principal ingredients: DAB and TGF- β1 biomimetic oligopeptide-68 on facial melasma, and (2) to compare their efficacy with 2% and 4% hydroquinone cream ( HQ) on sun-protected normal skin. Methods A randomized, double-blind, 12-week comparative study of pre-/post-treatment was conducted in 40 females. Melasma was evaluated by manual MASI score and MASI score with instrumentally graded darkness at baseline, 6th week, and 12th week. The author also compared their effect with HQ on the arms, assessed their safety profile throughout the study. Results Thirty-eight subjects have completed the study. Their melasma showed improvement at the 6th week and 12th week as compared with baseline ( P < 0.05). None developed severe reaction. Most subjects had temporary, mild skin reaction. About 2.6% of subjects graded themselves markedly improved, 76.3% moderately improved, and 21.1% slightly improved. Each formula showed either more efficacy or exerted faster action on pigment reduction than HQ. Conclusion Combination of DAB serum at night and DAB/ TGF- β1 biomimetic oligopeptide-68/sunscreen cream in the morning and at noon was effective and safe for facial melasma. They were superior to HQ in pigment reduction. [ABSTRACT FROM AUTHOR]

Background Melasma is one of the most common cosmetic disorders with skin darkening. Although several treatment modalities are available, none is satisfactorily used in management of this condition. Tranexamic acid ( TA), a plasmin inhibitor, is reported to improve melasma when injected locally or used as oral and topical forms. Aim The aim of this study was to compare therapeutic effects of liposomal tranexamic acid and conventional hydroquinone on melasma. Methods Thirty women with bilateral melasma were enrolled in a split-face trial lasting 12 weeks. Patients blindly applied 5% topical liposomal TA and 4% hydroquinone cream, to the designated sides of the face twice daily in addition to the assigned sunscreen in the morning. Skin pigmentation was measured using MASI (Melasma Area and Severity Index) at each visit separately for each side at the base line and every month until one month after treatment course. Data were obtained from patients file and were analyzed statistically using SPSS software, paired samples t-test, and repeated measured ANOVA. Results Twenty-three patients completed the study. The mean MASI scores significantly reduced in both treated sides ( P < P = 0.001) after 12 week. A greater decrease was observed with 5% liposomal TA, although this difference was not statistically significant. Irritation occurred in three patients with hydroquinone, while no serious adverse events occurred with TA. Conclusion On the basis of these results, topical liposomal TA can be used as a new, effective, safe, and promising therapeutic agent in melasma. [ABSTRACT FROM AUTHOR]

Background Various treatments are currently available for melasma. However, results are often disappointing. Objectives 1 To assess the efficacy and safety of combinations of hydroquinone, glycolic acid, and hyaluronic acid in the treatment of melasma after topical application. 2 To evaluate the dermoscopy as a tool in diagnosis and follow-up of melasma treatment. Patients and Methods One hundred patients with mild, moderate-to-severe melasma were divided into five groups. Group I (twenty patients were treated with cream formula containing 4% hydroquinone), group II (twenty patients were treated with cream formula containing 4% hydroquinone + 10% glycolic acid), group III (twenty patients were treated with cream formula containing 4% hydroquinone + 0.01% hyaluronic acid), group IV (twenty patients were treated with cream formula containing 4% hydroquinone + 10% glycolic acid + 0.01% hyaluronic acid), and group V (twenty patients were treated with placebo cream). All patients were subjected to dermoscopic examination and digital photographs before and after treatment. The response and side effects were evaluated. Results Groups I, III, and IV showed highly significant changes in modified Melasma Area and Severity Index ( mMASI) score after using the treatment. Group II showed significant change in mMASI score after using the treatment. The side effects were more reported in group II, followed by group IV, followed by group I, followed by group III. There was highly significant difference between the dermoscopic color findings before and after treatment. Vascularization was another dermoscopic finding. Conclusion A cream formula containing 4% hydroquinone + 10% glycolic acid + 0.01% hyaluronic acid was very effective in treatment of melasma with tolerable side effects. Dermoscope is a valuable noninvasive tool in the diagnosis and follow-up of melasma treatment. [ABSTRACT FROM AUTHOR]

Background Melasma is a dermatosis with significant repercussions on patients' quality of life, and there is currently no standard treatment. Hydroquinone is deemed the treatment of choice, but its safety has been questioned in certain cases. Aims To determine the efficacy and safety of a new combination of retinoids in the improvement of melasma. Patients/Methods Prospective, double-blind, vehicle-controlled, and randomized study in 30 patients with melasma. The product was applied on one side of the face and the vehicle on the other, twice daily during 3 months. Standardized photographs were taken using RBX technology on the three visits (basal, at one and a half months and at 3 months). The main variable to determine the efficacy was the improvement of the hemifacial Melasma Area Severity Index ( MASI). Other variables were determined such as improvement perceived by the investigator, improvement perceived by the patient, impact on quality of life or side effects. Results The MASI improvement at 3 months of treatment was significant on the treated side vs. the vehicle side, reaching an improvement of 70%, which is comparable to the percentage of improvement described with hydroquinone. No notable side effects were detected, in spite of a significant percentage of patients included in the study citing a history that could be compatible with sensitive skin. Conclusions This new combination of retinoids and depigmenting agents proved to be effective and safe in the treatment of melasma. [ABSTRACT FROM AUTHOR]

Background Hyperpigmentation and solar damage remains a difficult problem to treat with topical agents. Aims To evaluate a novel skin-lightening complex ( SLC) comprising four actives targeting melanin formation at multiple levels, namely disodium glycerophosphate, l-leucine, phenylethyl resorcinol, and undecylenoyl phenylalanine, in an oil-in-water emulsion cream. Patients ⁄Methods Skin-lightening complex was evaluated in 80 female subjects of skin types I-III with at least moderate mottled hyperpigmentation. After a wash-out period of 1 month with a sunscreen, the subjects added a cream containing the SLC for 12 weeks twice daily to entire face and continued the sunscreen use. Results Whereas there was no significant change during the wash-out period, the primary endpoint mottled hyperpigmentation decreased by 32% after the 12-week treatment period with the SLC cream. Secondary endpoints such as severity and number of lentigines, skin tone, and skin brightness also improved. In all, 57% of the subjects showed at least a moderate response, 17% did not improve, and 3% got worse after the treatment. Conclusions The SLC cream was well tolerated, in particular when comparing with exfoliating or peeling agent containing skin-lightening products. When used with a daily sunscreen, this study confirms that the SLC represents an alternative to hydroquinone, retinoids, and many other skin-lightening actives. [ABSTRACT FROM AUTHOR]

This article reviews an old drug tranexamic acid to its new use in the treatment of melasma. Its mechanism of preventing the activation of melanocyte from UV light, hormone and injured kerationcyte through the inhibition of the plasminogen activator system will be explored. The detail usage for such indication and its safety profile will also be thoroughly evaluated. [ABSTRACT FROM AUTHOR]

Melasma is an acquired hypermelanosis that results in localized hyperpigmentation, commonly found on the face. This condition is much more common in women than men. There are some features of melasma in men that seem to differ from those seen in women. However, there is a paucity of data on this topic. The aim of this article is to review the etiology, clinical presentation, and treatment of melasma in men. It is important for dermatologists to understand some unique aspects of melasma in this group to provide appropriate care for patients who suffer from this frustrating condition. [ABSTRACT FROM AUTHOR]

Summary Background Historically, the most effective treatments for skin lightening have contained hydroquinone. However, there is a need for an effective alternative. Aims The purpose of this study was to evaluate the skin-lightening efficacy and safety of lignin peroxidase (LIP) creams using a regimen of both day and night products compared with twice-daily application of 2% hydroquinone cream and placebo in Asian women. Patients/Methods This was a randomized, double-blind, placebo-controlled, split-face, single-center study of 51 patients. Patients were randomized to receive day and night LIP cream on one randomly selected side of their face and either 2% hydroquinone cream or placebo on the other. Results A statistically significant change from baseline in the melanin index was observed in LIP-treated skin, with a mean reduction of 7.6% ( P < 0.001) on Day 31. Conversely, hydroquinone and placebo did not provide a statistically significant lightening effect when instrumentally measured. Dermatologist scoring demonstrated a significant improvement in overall fairness as early as 8 days after treatment initiation in the LIP-treated group, which was not observed in the other groups. Overall, patients preferred the LIP creams. Conclusions The application of day/night LIP cream provided a significantly more rapid and observable skin-lightening effect than hydroquinone 2% cream or placebo. [ABSTRACT FROM AUTHOR]

Summary Background Melasma is an irregular brown or grayish-brown symmetric facial hypermelanosis, often affecting women, especially those living in areas with intense ultraviolet radiation. Objective Comparison of therapeutic effects of 20% azelaic acid and 4% hydroquinone cream in the treatment of melasma. Methods Twenty-nine women with melasma were recruited. Fifteen patients were treated with 4% hydroquinone cream and 14 patients were treated with azelaic acid cream for 2 months. The cream was applied twice daily. A broad-spectrum sunscreen was used concomitantly by both groups. The Melasma Area Severity Index (MASI) scores were determined prior to treatment and at each follow-up. Results The mean MASI score before treatment was 7.2 ± 3.2 in the hydroquinone group and 7.6 ± 3.5 in the azelaic acid group, with no significant difference between them ( t-test, CI 95% = −2.9 to 2.2). One month after treatment, the mean MASI score reached 6.7 ± 3.4 with hydroquinone and 6.3 ± 3.4 with azelaic acid with no significant difference between them ( t-test, CI 95% = −2.2 to 3). After 2 months' treatment, the MASI score was 6.2 ± 3.6 with hydroquinone and 3.8 ± 2.8 with azelaic acid, a significant statistical difference ( t-test, CI 95% = 0.03-4.9). Conclusions In conclusion, this study suggests that 20% azelaic acid cream applied twice daily may be more effective than hydroquinone 4% in reducing mild melasma. However, because this was an open trial, it is suggested that further studies involving large groups of patients be conducted to achieve a more conclusive result. [ABSTRACT FROM AUTHOR]

Summary Background For treating irregular skin pigmentation, a hallmark of premature skin aging, safe and effective alternatives to hydroquinone and kojic acid are being researched. Aims Four skin-brightening actives targeting melanin formation at multiple levels, namely disodium glycerophosphate, L-leucine, phenylethyl resorcinol, and undecylenoyl phenylalanine, in an oil-in-water emulsion cream were evaluated. Patients/Methods Twenty female patients with mild-to-moderate epidermal melasma were included. After a washout period of 1 month with a sunscreen, they continued using the sunscreen and added the novel skin-brightening cream for 12 weeks twice daily to entire face. Results Whereas there was no significant change in skin pigmentation during the washout, signs for uneven skin tone including melasma area and severity and appearance of lentigines significantly decreased by up to 43% after the 12-week treatment period with the skin-brightening cream. The skin-brightening complex is well tolerated, which should allow its continued use over a prolonged period of time, in particular, when comparing skin-brightening approaches with exfoliating or peeling agents. Conclusions When used with a daily sunscreen, the skin-brightening complex represents a valuable alternative to hydroquinone products and can be used for maintenance or adjunct skin care with lightening therapies. [ABSTRACT FROM AUTHOR]

Acne scars are difficult to treat. Chemical reconstruction of skin scars (CROSS) is a technique using high strength trichloroacetic acid (TCA) focally on the atrophic acne scars to induce collagenization and cosmetic improvement. The aim of this study was to evaluate the efficacy and safety of CROSS technique using 100% TCA in ice pick scars in dark skin types IV and V. Thirty patients with ice pick acne scars were initially primed for 2 weeks before the procedure. The priming agents used were hydroquinone 4% applied in the morning and tretinoin 0.025% in the night. Sunscreens were advised to prevent postinflammatory hyperpigmentation. Subsequently, they underwent focal application of 100% TCA with a wooden toothpick in each individual scar, at 2 weekly intervals, for four sessions. Improvement was assessed by the physician, photographic assessment by an independent investigator, and patient feedback by visual analogue scale after the fourth treatment. Excellent improvement (more than 70%) was observed in the majority of patients (73.3%), while 20% patients showed good improvement (50-70%) and 6.7% patients had fair results (30-49%) at the end of four sessions. Transient hypopigmentation was observed in one patient and hyperpigmentation in two patients. However, no significant adverse effects such as prolonged pigmentary changes or scarring were noted. Treatment of ice pick acne scars with the CROSS technique using high strength 100% TCA is a safe, minimally invasive, efficacious, and cost-effective technique in darker skin. Adequate priming and continued use of hydroquinone and tretinoin reduces complications and promotes healing. [ABSTRACT FROM AUTHOR]

Exogenous ochronosis has been reported worldwide following long-term application of skin-lightening creams that contain hydroquinone, phenol or resorcinol. This report documents six patients presenting in Singapore with greatly differing facial dyschromias and discusses the diagnostic difficulties. [ABSTRACT FROM AUTHOR]

Skin hyperpigmentation, and the reactions that precipitate it, have been linked to free radicals by the fact that free radical scavengers or antioxidants can slow that hyperpigmentation. We have screened several hundred plant extracts for antioxidants and discovered one that is both a strong antioxidant and can reduce skin hyperpigmentation. Extracts of Dianella ensifolia contain 1-(2,4-dihydrophenyl)-3-(2,4-dimethoxy-3-methylphenyl) propane (DP), which was found to inhibit the free radical 1-1-diphenyl-2-picryl-hydrazyl (DPPH) with an EC50 value of 78 μm. DP was also found to inhibit Ultraviolet (UV)C-induced lipid oxidation with an EC50 of about 30 μm. We next investigated the effects of this antioxidant on skin hyperpigmentation. The reduction of discoloration by different topical treatments has been assessed in human volunteers using an in vivo assay for the rate of fading of UVB-induced tan. Two pharmaceutical formulas containing 4% hydroquinone (HQ) were used as positive controls, and we tested the ability of DP, a plant-derived amphoteric antioxidant, to increase performance of non-HQ cosmetic formulations. We found that the cosmetic formula containing DP produced an increase in the rate of fading compared to the two pharmaceutical treatments containing HQ. [ABSTRACT FROM AUTHOR]

Background Chemical peels and topical depigmenting agents have become a popular modality in the treatment of melasma. Aims To compare the clinical efficacy of trichloroacetic acid peel 20% vs. Jessner’s solution peel vs. the topical mixture of hydroquinone 2% and kojic acid. Patients and methods Forty five patients with melasma were randomly assigned into three groups of fifteen patients each. Group A received Jessner’s solution peel, group B received trichloroacetic acid peel 20%, and group C received topical hydroquinone 2% and kojic acid. All patients were seen in follow-up period after 16 weeks; clinical evaluation using Melasma Area and Severity Index (MASI) score and photography were recorded before and after treatment and after 16 weeks. Results There was a decrease in MASI score in all three groups after treatment and after follow-up period but after treatment MASI score was statistically significantly lower in group A than group C ( P = 0.01), and it was also statistically significantly lower in group B than group C ( P < 0.001) but there was no statistically significant difference between groups A and B. After the follow-up period, MASI score was statistically significantly lower in group A than group C ( P < 0.001), statistically significantly lower in group B than group C ( P < 0.001), and statistically significantly lower in group B than group A ( P = 0.035). The statistical analysis was done through one-wayanova followed by least significant difference (LSD). Conclusion Trichloroacetic acid 20% showed better results than Jessner’s solution as peeling agent and hydroquinone 2% with kojic acid as a topical agent in the treatment of melasma. [ABSTRACT FROM AUTHOR]

Arbutin, the β-d-glucopyranoside of hydroquinone, is a skin whitening cosmetic ingredient. Compared with arbutin, hydroquinone is a more potent skin lightening agent, but shows cytotoxicity, nephrotoxicity, and genotoxicity. To evaluate whether skin microflora can hydrolyze arbutin to hydroquinone, we measured the hydrolytic activity of the main skin microflora: Staphylococcus epidermidis and Staphylococcus aureus. All strains hydrolyzed arbutin, with activities of 0.16–4.51 nmol/min/mg. The hydrolyzed hydroquinone showed more potent 1,1-diphenyl-2-picrylhydrazyl radical scavenging activity and tyrosinase inhibition than arbutin. These findings suggest that normal skin microflora may increase the skin lightening effect of arbutin due to the antioxidant action of hydroquinone. [ABSTRACT FROM AUTHOR]

Background Long-term treatment with a high-strength hydroquinone (HQ) cream (usually 4% HQ) is the mainstay therapy for hyperpigmentation disorders. Instability and high potential for irritancy hinders patient compliance. A new 4% HQ preparation has been designed with an innovative antioxidant for stability and a biomimetic of an herbal extract for skin calming. Aims To investigate the activity, stability, and irritancy of a new HQ cream. Methods To evaluate the new HQ cream in comparison with commercial 4% HQ creams for stability by temperature stress test, for irritancy by repeated-insult patch test on human subjects, and for lightening effect using the MelanoDerm™ B skin equivalent model. Results The new HQ is more resistant to browning and shows less irritancy than three commercially available 4% HQ products. It has comparable bleaching effect with faster onset than a 4% HQ product containing 0.05% tretinoin and 0.01% fluocinolone acetonide. Conclusion Based on its improved stability, lower irritancy, and activity in skin lightening, the new approach to the formulation of 4% HQ may improve therapeutic outcomes by improving patient compliance to dosing. [ABSTRACT FROM AUTHOR]

Background Melasma is a common acquired hypermelanosis that is difficult to treat. Several chemical peeling agents were used in treatment of melasma. Topical vitamin C was also used with minimal side effects. Aim To compare the effect of 20% trichloroacetic acid (TCA) peel alone vs. 20% TCA peel combined with topical 5% ascorbic acid in cases of epidermal melasma. Patients and methods Thirty women with bilateral epidermal melasma (Fitzpatrick skin types III and IV) were divided into two groups (A and B, 15 patients each). Before therapy, digital photography and a melasma area and severity index (MASI) score were done for each patient. Groups A and B were primed for 2 weeks before TCA peel. Group B also applied 5% ascorbic acid topically once daily; 20% TCA peel was done for all patients weekly until clearance of melasma or for a maximum of six peels. Group B continued to use 5% ascorbic acid topically in between peels and during the 16-week follow-up period. Patients were assessed at the end of peeling sessions and at the end of follow-up by photography, MASI score, and a global evaluation by the patient. Results Group B compared with group A showed a significant decrease in MASI score at the end of TCA peels ( P < 0.001) and at the end of the 16-week follow-up period ( P < 0.003). Global evaluation showed that 13 patients (87%) in group B improved or maintained their improvement compared with only 10 patients (67%) in group A. Conclusion Topical ascorbic acid combined with 20% TCA peel in melasma improves the results and helps in maintaining the response to therapy. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the efficacy and safety of a triple combination (TC) cream and monotherapy with hydroquinone (HQ) cream in the treatment of moderate to severe facial melasma. A total of 120 patients applied TC cream once daily or HQ cream twice daily for 8 weeks. Evaluations included static global severity assessment of melasma, improvement of melasma over time, local tolerability, and adverse events. TC cream was significantly more effective than HQ cream from week 4 onwards: lesions were approximately equivalent to the surrounding skin in 35% of all TC-treated patients, compared to 5% of those who used HQ cream ( P = 0.0001). Improvement of more than 75% was achieved by 73% of TC cream patients and 49% of HQ cream patients ( P = 0.007). The incidence of adverse events (erythema, burning sensation, and desquamation) was similar in both groups. No patient dropped out of the study because of drug-related adverse events. TC cream was more effective than the HQ cream for the treatment of moderate to severe facial melasma. Both products had similar safety profiles. [ABSTRACT FROM AUTHOR]

Keywords: drug delivery; Erbium:YAG laser; laser; laser treatment; scar EN drug delivery Erbium:YAG laser laser laser treatment scar 3451 3452 2 12/01/20 20201201 NES 201201 INTRODUCTION The skin is an administration route with a low bioavailability; therefore, different methods to increase drugs permeation through the stratum corneum have been used. Drug delivery, Erbium:YAG laser, laser, laser treatment, scar. [Extracted from the article]

Hydroquinone (HQ) has been used since the 1950s in commercially available over-the-counter skin lightener products and since the 1960s as a commercially available medical product. It is also used in cosmetic products such as hair dyes and products for coating finger nails. Beginning in 2001, HQ is no longer authorized for use in cosmetic skin lightening formulations in European Union countries, although products containing arbutin, an analogue of HQ, and botanicals, including plants that naturally contain HQ and arbutin, continue to remain available in European countries. The potential toxicity of HQ is dependent on the route of exposure, and toxicity in rodents is highly sex-, species-, and strain-specific. Subchronic and chronic toxicity in experimental animals is primarily limited to nephrotoxicity in male F-344 rats. Dermal toxicity studies, even those conducted in the sensitive male F-344 rat, are essentially devoid of systemic toxicity. Developmental and reproductive toxicity studies with HQ in rats and rabbits have not demonstrated significant effects. Cancer bioassay data for HQ demonstrate limited effects and are not sufficient to classify HQ for human carcinogenicity. Epidemiology and occupational studies of workers with extensive exposure to HQ have not reported any evidence of adverse systemic health effects or carcinogenicity. A risk-benefit approach is recommended for assessing the available data for HQ, arbutin, and other materials in use as, or proposed for use as, skin lighteners to provide optimal therapeutic benefits to patients with pigmentary changes of the skin. [ABSTRACT FROM AUTHOR]

Background Melasma is an acquired hypermelanosis predominantly affecting the face of women. It is often recalcitrant to treatment with hypopigmenting agents. Objective To assess the efficacy of a nonhydroquinone cream (Amelan M®) vs. another (Mela-D®) as treatment for melasma. Methods Twenty-two French women with bilateral epidermal and/or mixed melasma were enrolled in a split-faced prospective trial lasting 4 months during summer season weeks. Twelve patients applied once-daily Amelan M® to one side of the face with sun-protective factor 60 UVA sunscreen each morning and Mela-D® once-daily to the other side of the face. Pigmentation was measured objectively using a mexameter and the melasma area and severity index (MASI) were measured subjectively. Results The mean decrease of pigmentation was statistically significant on the MASI with both cream and only with Amelan M with the mexameter. Some adverse side effects were observed. Conclusions Amelan M® is really more effective than Mela D® cream on melasma. Even though some side effects were observed patients preferred the Amelan M-treated side. [ABSTRACT FROM AUTHOR]

Hydroquinone has been used for decades as a skin lightening agent. Since January 1, 2001, its use in cosmetics has been banned. This ban is as a result of mid-term effects such as leukoderma-en-confetti/occupational vitiligo and exogenous ochronosis. However, a recent literature search on hydroquinone as a skin lightening agent suggests that possible long-term effects such as carcinogenesis may be expected as well. Metabolites of hydroquinone formed in the liver, e.g., p-benzoquinone and glutathione conjugates of hydroquinone, are mainly responsible for this. In the bone marrow, hydroquinone is oxidized into p-benzoquinone because of the high myeloperoxidase activity. Topically applied hydroquinone-containing creams may give rise to accumulation of these compounds, which can cause DNA damage and mutations. They also have the capability to disrupt protective mechanisms, whereby they facilitate further development of cancer. In the bone marrow, long-term effects such as aplastic anemia and acute myeloid leukemias may occur. Most of the evidence stems from research on benzene toxicity, which appears to arise via its metabolite hydroquinone. There is no report yet demonstrating carcinogenesis resulting from the application of hydroquinone-containing creams. However doctors should be aware of these potential health risks which were up until now disregarded. [ABSTRACT FROM AUTHOR]

A female Indian farmer with melasma developed progressive worsening of facial pigmentation while using topical hydroquinone. It manifested as bluish-black pigmentation, confirmed microscopically as ochronotic change, i.e. exogenous ochronosis (EO).Failure to follow adequate sun protective measures and usage of overly high concentrations of hydroquinone were the most likely causes of EO in this case.It is necessary to recognize this disorder at the earliest stage to avoid treatment disappointments. [ABSTRACT FROM AUTHOR]