tretinoin and fluocinolone

To examine approaches to therapy for melasma in Latin Americans and to propose treatment algorithms for patients with mild, moderate and severe melasma.. Melasma is prevalent in up to 10% of the Latin American population. It is found in all racial groups and is more common in subjects with darker skin phototypes. A number of topical treatments and procedures have been used for melasma. Topical treatments containing hydroquinone are the most popular. Care must be taken when treating melasma to avoid inducing post-inflammatory hyperpigmentation and ochronosis. Determination of the severity of melasma (using the Melasma Area Severity Index and/or Physician's Global Assessment) and choice of the most effective and suitable treatment and/or procedure for individual patients is therefore essential. Sun protection is mandatory for all melasma patients.. Thirty-one clinical studies of topical treatments, chemical peels and laser and other therapies used for treating melasma were assessed for the level and quality of clinical evidence, by the Latin American Pigmentary Disorders Academy. The results of this analysis were combined with differential diagnosis guidelines and methods for assessing treatment success to establish algorithms for treating mild and moderate-to-severe melasma.. The most appropriate first-line treatment for mild melasma is hydroquinone 4%, triple combination cream containing hydroquinone 4%, tretinoin 0.05% and fluocinolone acetate 0.01%, double combination (e.g. 4% hydroquinone and 0.1% tretinoin) or non-phenolic therapy where there is an allergy to compounds. In moderate-to-severe melasma, triple combination cream is the recommended first-line treatment. Second-line treatment is double combination or hydroquinone 4% where triple therapy is not available or if allergic to compounds. Sun avoidance measures and broad spectrum sunscreens with high SPF are fundamental for the successful management of the disease.

Topics: Algorithms; Drug Therapy, Combination; Evidence-Based Medicine; Fluocinolone Acetonide; Humans; Hydroquinones; Latin America; Melanosis; Quality of Life; Tretinoin

Melasma is a pigmentary disorder affecting mainly face . Various treatment modalities available as topicals, superficial chemical peels and lasers but none till date gives promising results, until date quest for the best treatment modality is on.. To study the effect of oral and topical Tranexamic acid (TXA) and modified Kligman's regimen in treatment of melasma.. Patients having melasma were enrolled after consent for voluntary participation. A detailed history and clinical examination was done. Total 60 patients were enrolled and randomized in three groups, 20 received oral TXA 250 mg twice daily, 20 topical TXA and 20 received modified Kligman's regimen for 8 weeks along with sunscreen MASI(Melasma area severity index) was calculated at baseline, at end of 4 & 8 weeks. MASI score was compared with that at the end of the study. Based on reduction in mean MASI the therapeutic response was graded. Pre and post treatment photographs was also compared. Statistical analysis done by using student square T test , ANOVA And TUKEY test.. Reduction in MASI score was observed in all the groups but greater reduction in MASI score with modified Kligman's regimen by 30% followed with oral TXA by 25% reduction and least with topical TXA by 5%.. Although modified Kligman's regimen is comparatively more efficient but due to its side effects in long term usage oral tranexamic acid could be a promising therapeutic approach for melasma.

Topics: Administration, Cutaneous; Administration, Oral; Adolescent; Adult; Drug Combinations; Female; Fluocinolone Acetonide; Follow-Up Studies; Humans; Hydroquinones; Male; Melanosis; Middle Aged; Prospective Studies; Severity of Illness Index; Sunscreening Agents; Tranexamic Acid; Treatment Outcome; Tretinoin; Young Adult

A once-daily fixed combination of hydroquinone, tretinoin, and fluocinolone acetonide (Tri-luma) is a newly available treatment for melasma.. To assess cost-effectiveness of triple combination therapy (TCT) applied once daily and hydroquinone alone applied twice daily in the U.S., Argentina, Brazil, Chile, and Colombia from a payer's perspective.. Clinical data and utilization of key health resources (medication only) were assessed within an 8-week clinical trial conducted in Brazil. Total cost per primary success (complete clearing) was used to compare each treatment with not treating and incremental cost effectiveness ratios were used to compare between treatments.. TCT had a 30% better rate of complete clearing than hydroquinone with a lower cost in the U.S. and an incremental cost in other countries. In every country, cost per primary success was lower for TCT than for hydroquinone. Results were robust to varying assumptions of success rates and quantity used.

Topics: Administration, Topical; Cost-Benefit Analysis; Drug Combinations; Drug Costs; Fluocinolone Acetonide; Humans; Hydroquinones; Melanosis; Treatment Outcome; Tretinoin

A 42-year-old woman with phototype V, presented a 9-year history of refractory centrofacial melasma to topical bleaching agents and peelings, untreated for the last 90 days. One session of microneedling with 1.5 mm needles was performed with hydroquinone 4% sterile serum drug delivery; after 3 days, modified Kligman's formula (hydroquinone 4% + fluocinolone acetonide 0.01% + tretinoin 0.05%) and broad-spectrum sunscreen SPF 70 were introduced for daily use. After 30 days, a significant improvement was observed in the clinical outcome (Figure 1) and the quality of life of the patient. These parameters were measured using Melasma Area and Severity Index (MASI) scale, with an 82.5% decrease, and Melasma Quality of Life Scale - Brazilian Population (MELASQoL-BP), with a 60% decrease. Dermatoscopic analysis (polarized videodermatoscopy x20) of the glabellar region revealed lighting of the pseudoreticular pigment network, diffuse light to dark brown background, and reduction in vascularity and telangiectasias (Figure 2). At the 5-month follow-up, there had been no relapse. The patient continued to use a broad-spectrum sunscreen along with the topical regiment.

Topics: Adult; Combined Modality Therapy; Cosmetic Techniques; Dermatologic Agents; Drug Delivery Systems; Female; Fluocinolone Acetonide; Follow-Up Studies; Humans; Hydroquinones; Melanosis; Needles; Quality of Life; Sunscreening Agents; Treatment Outcome; Tretinoin

Melasma is an acquired, facial hyperpigmentation without a specific origin. It is regularly associated with multiple etiologic factors such as pregnancy, genetic, racial, and from estrogen administration. Among the methods to treat skin hyperpigmentation a series of skin bleaching agents have been used. At present, the most commonly used agent is known as hydroquinone. Nowadays, it is known that hydroquinone can cause cancer in animals with unknown relevance to humans.. In this work, Raman spectroscopy was used to observe the presence of hydroquinone in the skin of 18 patients who have been under treatment for melasma.. A significant increase in the Raman signal was observed in the six bands associated with hydroquinone after melasma treatment.. The authors believe that monitoring the presence of hydroquinone may be useful for an optimal personalized treatment of melasma and to provide the specialist a support tool to control the administration of this type of bleaching agents.

Topics: Adult; Drug Monitoring; Drug Therapy, Combination; Female; Fluocinolone Acetonide; Humans; Hydroquinones; Male; Melanosis; Middle Aged; Precision Medicine; Skin; Skin Lightening Preparations; Spectrum Analysis, Raman; Treatment Outcome; Tretinoin; Young Adult

Latin-Americans have a heterogeneous ancestry that is defined by their place of domicile, while Hispanics are defined as those persons of Spanish descent. These two groups have a diverse range of skin phototypes and pigmentation and are prone to an increased incidence of melasma and post-inflammatory hyperpigmentation. Little research has been conducted to evaluate the frequency, course, effects, tolerability and treatment response of skin diseases in Hispanic and Latin-American populations. From the limited data that are available it is considered that the treatment of melasma in these two groups does not differ from the general population. First-line therapy of melasma should consist of effective topical therapies, mainly a fixed triple combination of hydroquinone, retinoic acid and fluocinolone acetonide. Where patients have either sensitivity or triple combination therapy is unavailable, other compounds with dual ingredients may be considered as an alternative. Options for second-line therapy include peels either alone or in combination with topical therapy. Lasers should rarely be used in the treatment of melasma and then only as third-line therapy in cases of melasma which is resistant to all other therapies. If applied, skin type must be taken into account. Irritation and sensitivity can be a concern in darker-skinned Hispanic patients and for this reason, the risk of post-inflammatory hyperpigmentation (PIH) following treatment should be considered.

Topics: Administration, Topical; Drug Therapy, Combination; Facial Dermatoses; Fluocinolone Acetonide; Glucocorticoids; Hispanic or Latino; Humans; Hydroquinones; Hyperpigmentation; Keratolytic Agents; Latin America; Salicylic Acid; Skin Pigmentation; Tretinoin

Retinoic acid is one of the most promising drugs for chemotherapy and chemoprevention of cancer. Either blocking activator protein-1 (AP-1) activity or activating retinoic acid response element (RARE) have been proposed to be responsible for its antitumor activity. However, evidence for this hypothesis is lacking in vivo studies. To address this issue, we used an AP-1-luciferase transgenic mouse as a carcinogenesis model and new synthetic retinoids that are either selective inhibitors of AP-1 activation or selective activators of the RARE. The results showed that the SR11302, an AP-1 inhibition-specific retinoid, and other AP-1 inhibitors such as trans-retinoic acid and fluocinolone acetonide, markedly inhibit both 12-O-tetradecanoylphorbol-13-acetate-induced papilloma formation and AP-1 activation in 7,12-dimethyl benz(a)anthracene-initiated mouse skin (P < 0.05). In contrast, repeated applications of SR11235, a retinoid with RARE transactivating activity, but devoid of AP-1 inhibiting effect, did not cause significant inhibition of papilloma formation and AP-1 activation (P > 0.05). These results provide the first in vivo evidence that the antitumor effect of retinoids is mediated by blocking AP-1 activity, but not by activation of RARE.

Topics: 9,10-Dimethyl-1,2-benzanthracene; Animals; Anticarcinogenic Agents; Carcinogens; Female; Fluocinolone Acetonide; Luciferases; Male; Mice; Mice, Transgenic; Papilloma; Recombinant Fusion Proteins; Regulatory Sequences, Nucleic Acid; Retinoids; Skin Neoplasms; Tetradecanoylphorbol Acetate; Transcription Factor AP-1; Transcriptional Activation; Tretinoin