tretinoin and hydroquinone

Postinflammatory hyperpigmentation (PIH) has posed a substantial challenge for patients with higher Fitzpatrick skin types, specifically types III to VI. Treatment modalities pose a number of limitations due to the number of treatments required, potential side effects, and overall efficacy. Fortunately, multiple therapies have been delineated that can be moderately to highly efficacious in treating PIH in patients with skin of color. This article will review some of these modalities and procedures for this common patient concern.

Topics: Chemexfoliation; Dermatitis; Dermatologic Agents; Dicarboxylic Acids; Drug Combinations; Ethanol; Glycolates; Humans; Hydroquinones; Hyperpigmentation; Inflammation; Keratolytic Agents; Lactic Acid; Pyrones; Resorcinols; Salicylates; Salicylic Acid; Skin Pigmentation; Tretinoin

Abnormal pigmentation, particularly hyperpigmentation, is major issue of concern for people with colored skin. Several hypopigmenting agents, which exert their action by inhibiting tyrosinase activity and/or transcription, have been used for treatment. However, results have been discouraging. To manage abnormal pigmentation properly, the mechanisms of melanogenesis should be understood. Endogenous and exogenous factors affect melanogenesis via intracellular machineries. cAMP and PKC are critical factors of important transduction pathways and cross-talk between them could amplify the melanogenic effect. Here, factors involved in melanogenesis regulation via cAMP and/or PKC pathways are reviewed with their action mechanisms.

Topics: Animals; Antioxidants; Cyclic AMP; Epidermal Cells; Epidermis; Humans; Hydroquinones; Melanins; Melanocytes; Protein Kinase C; Radiation-Protective Agents; Signal Transduction; Tretinoin; Ultraviolet Rays

Melasma is a common, acquired facial skin disorder, mostly involving sun-exposed areas like cheeks, forehead and upper lip. Melasma occurs in both sexes, although almost 90 percent of the affected are women. It is more common in darker skin types (Fitzpatrick skin types IV to VI) especially Hispanics/Latinos, Asians and African-Americans. The onset of the melasma is at puberty or later, with exception of darker skin types, who tend to develop this problem in the first decade of life. The etiology is still unknown, although there are a number of triggering factors related to the onset of melasma. The most important are sun-exposure and genetic factors in both sexes, while hormonal activity has more important role in females. In addition, stress and some cosmetic products and drugs containing phototoxic agents can cause outbreaks of this condition. Melasma should be treated using monotherapies or combination of therapy, mainly fixed triple or dual combinations containing hydroquinone, tretinoin, corticosteroids or azelaic acid. Modified Kligman's formula is also very effective. Above mentioned therapy regimens in combination with UVA and UVB blocking sunscreens are mostly effective in epidermal melasma. Discontinuation of the use of birth control pills, scented cosmetic products, and phototoxic drugs coupled with UV protection are also benefitial in clearing of melasma. Alternative treatment including chemical peels and glicolic acid, seem to have the best result as a second line treatment after bleaching creams. Laser treatments show limited efficacy and should rarely be used in the treatment of melasma. Combining topical agents like hydroquinone, tretinoin and a corticosteroid in addition to sun avoidance, regular use of sunscreen throughout the year and patient education is the best treatment in this difficult to treat condition.

Topics: Adrenal Cortex Hormones; Female; Humans; Hydroquinones; Keratolytic Agents; Male; Melanosis; Photochemotherapy; Radiation-Protective Agents; Tretinoin

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

Since the term "cosmeceutical" was coined over 2 decades ago, the number of products in this category that claim to combat dermal aging has grown dramatically. Topical retinoids remain the mainstay for treating photoaging given their proven efficacy in both clinical and histologic outcomes. In addition to retinoids, many other cosmeceutical agents are now available. The proliferation of products can cause confusion among consumers, who often ask their dermatologist for advice as to which antiaging products they should choose. Ideally, the antiaging claims of cosmeceutical formulations and their components should be demonstrated in controlled clinical trials. In order to provide appropriate recommendations to their patients, dermatologists must become familiar with the available data on currently marketed products and gain experience with antiaging regimens. This review discusses the efficacy of a number of currently marketed drug products with proven photoaging benefits and cosmeceutical products that claim similar benefits. Among the agents discussed are single-entity and combination products containing hydroquinones, retinoids, topical antioxidants, and minerals.

Topics: Administration, Topical; Antioxidants; Benzoquinones; Cosmetics; Dermatologic Agents; Drug Combinations; Humans; Hydroquinones; Retinoids; Skin Aging; Tretinoin; Ubiquinone

In clinical practice, acquired hyperpigmentations represent the most common disorders of pigmentation the dermatologist has to treat. Despite the large number of depigmenting agents available, the treatment of hyperpigmentations is often unsuccessful and disappointing and is still a challenge for dermatologists. This article focuses on the chemical compounds reported to be in depigmenting or skin lightening agents, their proposed mechanism of action, and their clinical efficacy in the treatment of melasma and hypermelanoses, mainly based on randomized clinical trials. It also reviews chemical peels and their indications, together with the possible uses of laser and intense pulsed light.

Topics: Chemexfoliation; Dermatologic Agents; Drug Combinations; Flavonoids; Glucocorticoids; Humans; Hydroquinones; Hydroxybenzoates; Hyperpigmentation; Laser Therapy; Lasers; Melanosis; Retinoids; Tretinoin

Melasma is a common disorder of hyperpigmentation and generally involves areas of the face and neck. Hyperpigmentation is especially prevalent in darker complected patients and is often difficult to treat. Hydroquinone, tretinoin, and topical corticosteroids are well established monotherapeutic agents for treating melasma and hyperpigmentation; however, a stable, once-daily formulation triple combination cream containing 0.05% tretinoin, 4.0% hydroquinone, and 0.01% fluocinolone acetonide (Tri-Luma) represents the only commercially available combination of all three agents. This product is approved by the US FDA for the treatment of facial melasma. A number of publications have described the safety and efficacy of triple combination cream in over 2000 patients with melasma, some of whom were treated for >12 months. In the initial 8-week study, 29% of patients experienced complete clearing of melasma by week 8, and 77% were clear or almost clear by week 8. Similarly, good results were seen in the two long-term studies, with the clear/mild rate ranging from 78% to 84% of patients at month 6 and from 81% to 94% of patients at month 12. Adverse events were almost always mild in severity and typically occurred only at the application site. The primary concern for most physicians using corticosteroid-containing products on the face is skin atrophy. However, only two cases of skin atrophy were reported across the three published studies. Overall, the results of these extensive studies indicate that triple combination cream is efficacious in treating melasma and exhibits a safe profile with low potential for adverse events.

Topics: Administration, Cutaneous; Fluocinolone Acetonide; Glucocorticoids; Humans; Hydroquinones; Keratolytic Agents; Melanosis; Time Factors; Tretinoin

Melasma is an irregular brown or grayish-brown facial hypermelanosis, often affecting women, especially those living in areas of intense UV radiation. The precise cause of melasma remains unknown; however, there are many possible contributing factors. Because of its dermal component and tendency to relapse, melasma is often difficult to treat. The use of broad-spectrum (UVA + UVB) sunscreen is important, as is topical hydroquinone, the most common treatment for melasma. Other lightening agents include retinoic acid (tretinoin) and azelaic acid. Combination therapies such as hydroquinone, tretinoin, and corticosteroids have been used in the treatment of melasma, and are thought to increase efficacy as compared with monotherapy. Kojic acid, isopropylcatechol, N-acetyl-4-cysteaminylphenol, and flavonoid extracts are other compounds that have been investigated for their ability to produce hypopigmentation, but their efficacy, safety, or trial design indicates that the interventions would need further study before they could be recommended. Chemical peels, laser treatments, and intense pulsed light therapy are additional therapeutic modalities that have been used to treat melasma.

Topics: Adrenal Cortex Hormones; Adult; Chemexfoliation; Clinical Trials as Topic; Combined Modality Therapy; Dermabrasion; Dicarboxylic Acids; Double-Blind Method; Drug Therapy, Combination; Female; Flavonoids; Gonadal Steroid Hormones; Humans; Hydroquinones; Laser Coagulation; Melanosis; Phototherapy; Plant Extracts; Pregnancy; Pregnancy Complications; Pyrones; Randomized Controlled Trials as Topic; Skin; Sunlight; Treatment Outcome; Tretinoin; Ultraviolet Rays

Pigmentary disorders are one of the most common skin disorders among people of color. Dyspigmentation in the form of either hyperpigmentation or hypopigmentation is often psychologically devastating to patients with darker skin. There is marked contrast between normally pigmented hyperpigmented, hypopigmented or depigmented skin in people of color. Despite being common, pigmentary disorders remain difficult to treat.

Topics: Administration, Cutaneous; Arbutin; Black People; Dicarboxylic Acids; Humans; Hydroquinones; Keratolytic Agents; Pigmentation Disorders; Pyrones; Tretinoin

Hyperpigmentation disorders of the skin are common. Three of the more common forms include melasma, lentigines, and post-inflammatory hyperpigmentation. Significant negative psychological consequences can result. Many therapeutic options exist, though treatment is often difficult, requiring lengthy therapy.

Topics: Chemexfoliation; Cryotherapy; Dermatologic Agents; Dicarboxylic Acids; Humans; Hydroquinones; Hyperpigmentation; Inflammation; Keratolytic Agents; Laser Therapy; Lentigo; Melanosis; Patient Education as Topic; Primary Prevention; Risk Factors; Self Care; Sunlight; Tretinoin

Exogenous ochronosis is clinically and histologically similar to its endogenous counterpart; however, it exhibits no systemic effects and is not an inherited disorder. It is characterized by an asymptomatic hyperpigmentation of the face, sides and back of the neck, back, and extensor surfaces of the extremities. The associated ochronotic discoloration most commonly results from use of products containing hydroquinone. It also occurs following use of antimalarials and products containing resorcinol, phenol, mercury or picric acid. The etiology of hydroquinone-induced hyperpigmentation in exogenous ochronosis remains speculative. The majority of patients with this condition are Black, but it has been reported to occur in Hispanics and Caucasians. Exogenous ochronosis is prevalent among South African Blacks, but is believed relatively uncommon within the US. The reasons for this phenomenon are not clear, but it could be a result of the use of skin care products containing resorcinol in combination with hydroquinone or the use of hydroquinone in a hydroalcoholic lotion. Treatment of this condition is difficult. The offending agent must be avoided, but improvement occurs only slowly. A number of topical agents have been studied as have dermabrasion and the use of lasers. Controlled studies in larger numbers of patients are require to determine the true efficacy of newer treatments.

Topics: Adrenal Cortex Hormones; Adult; Aged; Anti-Bacterial Agents; Caustics; Cosmetics; Cryotherapy; Dermabrasion; Dermatologic Agents; Female; Humans; Hydroquinones; Incidence; Keratolytic Agents; Laser Therapy; Middle Aged; Ochronosis; Resorcinols; Skin Care; South Africa; Sunscreening Agents; Tetracycline; Time Factors; Tretinoin; Trichloroacetic Acid

Melasma is a common acquired symmetric hypermelanosis characterized by irregular light- to gray-brown macules and patches involving sun-exposed areas of skin. Etiologic factors in the pathogenesis of melasma include genetic influences, exposure to UV radiation, pregnancy, hormonal therapies, cosmetics, phototoxic drugs, and antiseizure medications.. Melasma is often a therapeutically challenging disease, and current treatments include hypopigmenting agents, chemical peels, and lasers. Hypopigmenting agents include phenolic and nonphenolic derivatives. Phenolic agents include hydroquinone and hydroquinone combination preparations. Despite controversies regarding the issue of hydroquinone-induced ochronosis, hydroquinone remains the most effective topically applied bleaching agent approved by the Food and Drug Administration for the treatment of melasma. Nonphenolic bleaching agents include tretinoin and azelaic acid. Superficial, medium, and deep chemical peels are more often used in lighter-complexioned patients. Such peels should be used with caution in blacks. Although lasers have demonstrated significant efficacy in the treatment of a variety of hyperpigmentary disorders, their precise efficacy and place in the therapy of melasma have yet to be established.. In the hierarchy of therapies for melasma, the treating physician must consider the devastating psychosocial impact of pigmentary imperfections within the realm of the benefits and risks associated with each treatment.

Topics: Administration, Cutaneous; Chemexfoliation; Dermatologic Agents; Dicarboxylic Acids; Female; Humans; Hydroquinones; Keratolytic Agents; Laser Therapy; Male; Melanosis; Pregnancy; Tretinoin; United States; United States Food and Drug Administration

Recent evidence suggests melasma to be a photoaging disorder. Triple combination creams (TCC: fluocinolone acetonide 0.01%, hydroquinone 4% and tretinoin 0.05%) remain the gold standard treatment. Picosecond alexandrite laser treatment using a diffractive lens array (DLA) has been identified to be effective for improving photoaging conditions.. We aimed to compare the efficacy and tolerance of the picosecond alexandrite laser with those of DLA and TCC in female Asian patients with melasma.. Twenty-nine patients were randomly assigned to group A1 (3 laser sessions at 4-week intervals), A2 (5 laser sessions at 4-week intervals) or B (TCC daily for at least 8 weeks and then tapered until the final evaluation). The Melasma Area, Severity Index (MASI) score and VISIA were assessed at baseline, week 12 and week 20. By week 20, the follow-up periods for groups A1 and A2 were 3 months and 1 month, respectively.. Nine, 11 and 6 participants in groups A1, A2 and B completed the study, respectively. MASI scores were significantly improved in all 3 groups at weeks 12 and 20. In groups A1, A2 and B, the improvement rates at week 20 were 53%, 38% and 50%, respectively. VISIA. Picosecond alexandrite laser treatment using DLA showed comparable efficacy with TCC for the treatment of melasma. Improvements in texture, spots, wrinkles and pores were observed in the laser groups. Patients with melasma lesions that exhibit telangiectasia may benefit from additional laser treatment sessions.

Topics: Adult; Asian People; Combined Modality Therapy; Drug Combinations; Female; Fluocinolone Acetonide; Humans; Hydroquinones; Lasers, Solid-State; Melanosis; Middle Aged; Ointments; Prospective Studies; Single-Blind Method; Treatment Outcome; Tretinoin

Melasma is a common acquired pigmentary disorder characterized by symmetric hyperpigmented macules on the face. Triple combination cream (TCC) remains the gold standard treatment but its prolonged use often causes adverse effects. Recently, studies have shown that topical metformin has melanopenic action.. To evaluate the safety and efficacy of topical metformin in the treatment of melasma and to compare its efficacy with TCC (hydroquinone 2% + tretinoin 0.025% + fluocinolone acetonide 0.01%).. This was a randomized controlled study conducted on 40 patients with melasma aged more than 18 years. Patients in group 1 (n = 20) were treated with 30% metformin lotion, whereas group 2 patients (n = 20) were treated with TCC for 8 weeks. Pigmentation was assessed using Melasma Area and Severity Index (MASI) at baseline and after 8 weeks. Outcome measures included global improvement scale (grades 1-4) and patient satisfaction. Safety was assessed according to adverse events and patch testing.. All 40 patients completed the study. Out of 20 patients in group 1, 11 showed grade 1 improvement (1% to <25%) and grade 2 (25%-50%) and grade 3 (>50%-75%) improvements were seen in one patient each. In group 2, grades 1, 2, 3, and 4 improvements were seen in 14, 2, 1, and 1 patients, respectively. However, the difference was not statistically significant. Adverse events were noted in three patients in group 2 and none in group 1.. Topical metformin is a novel, safe, and almost as effective modality as TCC to treat melasma.

Topics: Adult; Aged; Aged, 80 and over; Drug Combinations; Female; Fluocinolone Acetonide; Humans; Hydroquinones; Male; Melanosis; Metformin; Middle Aged; Ointments; Patient Satisfaction; Prospective Studies; Severity of Illness Index; Skin Lightening Preparations; Skin Pigmentation; Treatment Outcome; Tretinoin; Young Adult

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

Facial postinflammatory hyperpigmentation (PIH) is challenging to manage in patients with skin of color because of the risk of subsequent treatment-related hyperpigmentation.. To evaluate the safety and efficacy of combining glycolic acid (GA) peels with a modified Kligman formula (MKF) containing hydroquinone 2%, tretinoin 0.05%, and hydrocortisone 1% for the treatment of facial PIH in Indian patients.. Thirty Indian patients (Fitzpatrick skin Types III-V) with facial PIH were randomly assigned to 2 groups of 15 each. One group received serial GA peels combined with an intervening topical regimen containing MKF. The other group received MKF alone. Results were evaluated by a clinical investigator at baseline and at the end of 21 weeks (3 weeks after treatment completion) using an objective scoring system, the Hyperpigmentation Area and Severity Index (HASI) score, and clinical photography.. The baseline mean HASI scores of the 2 groups were comparable. There was a statistically significant difference in the mean HASI score of the peels group compared with the MKF alone group at 12 weeks (p = .004) and 21 weeks (p < .001). Side effects were observed in both groups and were managed with liberal application of emollients. No patient dropped out of the study as a result of the side effects.. This study demonstrates that serial GA peels in combination with a MKF are efficacious and safe in the treatment of facial PIH in dark-skinned patients.

Topics: Administration, Cutaneous; Adult; Anti-Inflammatory Agents; Chemexfoliation; Drug Combinations; Facial Dermatoses; Female; Glycolates; Humans; Hydrocortisone; Hydroquinones; Hyperpigmentation; India; Inflammation; Keratolytic Agents; Male; Severity of Illness Index; Tretinoin; Young Adult

Melasma is an abnormal acquired hyperpigmentation of the face of unknown origin, it is considered a single disease and very little has been found regarding its pathogenesis. It is usually assumed that melasma is due to excessive melanin production, but previous work using Raman spectroscopy showed degraded molecules of melanin in some melasma subjects, which may help to explain the success or failure of the standard therapy.. We perform Raman spectroscopy measurements on in vivo skin from melasma patients before treatment to identify the molecular structure of melanin within every melasma lesion. The Raman spectra were grouped according to the treatment response from patient, and the Raman spectra were analyzed.. Raman spectroscopy measurements showed a different molecular structure of the patients who did not respond to treatment, those patients shows atypical Raman skin spectrum with peaks associated with melanin not well defined, which is consistent with molecular degradation and protein breakdown.. Our results are consistent with our previous work in the sense that melasma patients who do not respond to treatment have an abnormal melanin. We believe it will eventually help to decide the treatment of melasma in clinical dermatology.

Topics: Administration, Cutaneous; Adrenal Cortex Hormones; Adult; Anti-Inflammatory Agents; Dermatologic Agents; Drug Combinations; Female; Humans; Hydroquinones; Keratolytic Agents; Male; Melanins; Melanosis; Middle Aged; Skin; Spectrum Analysis, Raman; Treatment Outcome; Tretinoin; Young Adult

Melasma is a common acquired skin disorder. While different treatments are currently being used, in many cases it is refractory to treatment. According to the effects of topical steroids in decreasing skin pigmentation, we studied the efficacy of this new method for treatment of melasma. A total of 42 women with facial melasma, admitted to the department of dermatology of Hamadan, were enrolled in the study. They were divided randomly into two groups (A and B), group A (case) received subepidermal triamcinolone injections with a dose of 4 mg per cc and 5 mm intervals until complete blanching of melasma lesions, and group B (control) received Kligman's formula (hydroquinone 5%, tretinoin 0.1%, and dexamethasone 0.1%). At the first visit, we completed the MASI score papers, and we repeated that at weeks 4 and 8 of the study. We followed them for two months, every two weeks. At each visit, side effects and clinical response to treatment were noted. A decrease in MASI was observed in both group (11.57 ± 4.33 vs 9.31 ± 3.75 at 4th week and vs 8.01 ± 3.1 at 8th week, P-value < 0.001 in group A, and 10.46 ± 5.61 vs 9.76 ± 5.21 at 4th week and vs 8.96 ± 4.96 at 8th week, P-value< 0.001 in group B). In comparison between 2 groups, response to treatment was much better in group A than group B (P-value<0.001). In comparison to topical treatments, based on these findings, triamcinolone microinjection is a new, safe and strong therapeutic method for treatment of melasma.

Topics: Administration, Topical; Adult; Dexamethasone; Female; Humans; Hydroquinones; Melanosis; Middle Aged; Skin Pigmentation; Treatment Outcome; Tretinoin; Triamcinolone

Melasma is acquired symmetric hypermelanosis characterized by light-to-deep brown pigmentation over cheeks, forehead, upper lip, and nose. Treatment of this condition is difficult and associated with high recurrence rates. Chemical peels have become a popular modality in the treatment of melasma.. To compare the therapeutic efficacy and tolerability of glycolic acid (35%) versus salicylic-mandelic (SM) acid (20% salicylic/10% mandelic acid) versus phytic combination peels in Indian patients with melasma.. Ninety patients diagnosed with melasma were randomly assigned into 3 groups of 30 patients each. Group A received glycolic acid (GA-35%) peel, Group B received SM acid, and Group C received phytic combination peels. Each group was primed with 4% hydroquinone and 0.05% tretinoin cream for 4 weeks before treatment. Chemical peeling was done after every 14 days in all groups until 12 weeks. Clinical evaluation using melasma area and severity index (MASI) score and photography was recorded at every visit and follow-up was done until 20 weeks.. There was a decrease in MASI score in all 3 groups but it was statistically significantly lower in Group A than Group C (p = .00), and it was also statistically significantly lower in Group B than Group C (p = .00) but there was no statistically significant difference between Groups A and B (p = .876). Objective response to treatment evaluated by reduction in MASI scoring after 12 weeks was 62.36% reduction in GA group, 60.98% reduction in SM group, and 44.71% in phytic acid group.. It is concluded that GA (35%) and SM acid peels are both equally efficacious and a safe treatment modality for melasma in Indian skin, and are more effective than phytic acid peels. Salicylic-mandelic peels are better tolerated and more suitable for Indian skin.

Topics: Adult; Antioxidants; Chemexfoliation; Drug Combinations; Female; Follow-Up Studies; Glycolates; Humans; Hydroquinones; India; Keratolytic Agents; Male; Mandelic Acids; Melanosis; Middle Aged; Phytic Acid; Prospective Studies; Salicylic Acid; Severity of Illness Index; Treatment Outcome; Tretinoin; Young Adult

Quality-switched (QS) laser therapy is a safe and well-established treatment option for removing solar lentigines. Triple combination therapy (TCT) with the active pharmaceutical ingredients hydroquinone 5%, tretinoin 0.03%, and dexamethasone 0.03% is often used for skin-lightening.. This prospective, open-label trial compares the efficacy and safety of a QS Ruby laser (QSRL) and a TCT in the treatment of solar lentigines.. In total, 15 patients with symmetrically distributed solar lentigines on the back of both hands were included. The lesions on the back of the right hand were treated in one or 2 sessions with a QSRL, the ones on the back of the left hand with a TCT for 7 weeks accompanied by UV protection. Clinical results were evaluated 4 weeks, 8 weeks, and 20 weeks after baseline.. Treatment with QSRL provided significant lightening (p = .01) compared with TCT. Both procedures were generally well-tolerated. Comparing the side effects, the laser produced significantly more crusting and hyperpigmentation than the TCT.. Both QSRL and TCT were capable in reducing solar lentigines in Fitzpatrick skin Type I to IV with an acceptable side effect profile. The QSRL provides faster, superior, and long lasting lightening compared with TCT.

Topics: Aged; Dexamethasone; Drug Combinations; Erythema; Female; Hand Dermatoses; Humans; Hydroquinones; Lasers, Solid-State; Lentigo; Male; Middle Aged; Pain; Prospective Studies; Skin Cream; Skin Lightening Preparations; Tretinoin

Post-inflammatory hyperpigmentation is a frequent concern when treating solar lentigines.. To assess the safety and efficacy of a triple combination cream with fluocinolone acetonide 0.01%, hydroquinone 4% and tretinoin 0.05% as adjuvant to cryotherapy in the treatment of solar lentigines in hands dorsum, and in the prevention of post-inflammatory hyperpigmentation after cryotherapy.. This prospective, randomized, controlled, investigator-blinded, single-centre study enrolled 50 patients. Twenty-five patients received a 2-week daily triple combination cream plus sunscreen pre-treatment and 25 received sunscreen alone. After that, cryotherapy was performed in all patients followed by a 3-week recovery period. After this period, patients received the same initial treatment and were followed up for 8 weeks. Melanin and erythema levels of a target and a control lentigo were objectively measured using a narrowband reflectance spectrophotometer. Lentigines count, colour homogeneity and global improvement were also assessed.. The number of solar lentigines reduced in the first 2 weeks only in patients who used the triple combination 25 ± 7 vs. 22 ± 8 (P < 0.0001), and reduced at the end of the study for both groups (P < 0.0001). The melanin levels also reduced in the first 2 weeks only in patients who used the triple combination 297 ± 69 vs. 273 ± 66 (P < 0.0001) and reduced at the end of the study for both groups (P < 0.0001). Erythema and residual blisters from cryotherapy were the reported adverse reactions.. Triple combination cream can be used to enhance the resolution of solar lentigines, and to significantly reduce melanin levels and lentigines count, improving treatment results. It was well-tolerated and did not increase the occurrence of neither erythema nor other side-effects after the cryotherapy.

Topics: Anti-Inflammatory Agents; Antineoplastic Agents; Antioxidants; Chemotherapy, Adjuvant; Cryotherapy; Drug Combinations; Erythema; Female; Fluocinolone Acetonide; Hand Dermatoses; Humans; Hydroquinones; Lentigo; Male; Melanins; Middle Aged; Prospective Studies; Single-Blind Method; Skin Cream; Sunlight; Tretinoin

Topics: Adult; Bromides; Copper; Dexamethasone; Drug Combinations; Female; Humans; Hydroquinones; Laser Therapy; Male; Melanosis; Middle Aged; Prospective Studies; Severity of Illness Index; Single-Blind Method; Skin Cream; Treatment Outcome; Tretinoin

Facial dyspigmentation treatment is an unmet need in dermatology with increasing challenges due to the questionable safety of hydroquinone. This research examined a new OTC formulation containing hydroxyphenoxy propionic acid, ellagic acid, yeast extract, and salicylic acid on subjects who previously completed 12 weeks of treatment with 4% hydroquinone and 0.025% retinoic acid. The goal of this study was to evaluate the skin lightening and tolerability profile of a 20-week maintanence therapy with a cosmeceutical formulation during the summer months. 33 healthy subjects ages 25-60 years with moderate facial dyspigmentation defined as a score of 3 on a 5-point scale were enrolled. There was statistically significant improvement at week 20 in terms of even skin tone (P<0.001), spot intensity (P<0.001), spot size (P<0.05) and overall hyperpigmentation (P>=0.002).

Topics: Adult; Cosmeceuticals; Double-Blind Method; Female; Humans; Hydroquinones; Hyperpigmentation; Keratolytic Agents; Male; Middle Aged; Pigmentation Disorders; Skin; Treatment Outcome; Tretinoin

This study aimed to determine the efficacy and safety of fluocinolone acetonide, hydroquinone, and tretinoin (FAHT) cream for the treatment of moderate and severe facial melasma. The primary objective was assessment of clinical efficacy, instrumental measured efficacy, and integral therapeutic efficacy at the end of weeks 4 and 8.. A total of 233 subjects were randomly allocated (1:1 ratio) to receive topically administered FAHT cream (n = 117) or placebo (n = 116) once nightly for 8 weeks. Observed side effects were documented throughout.. In the per protocol set (PPS; those subjects who met all requirements of the protocol), the integral therapeutic efficacy rate of FAHT cream on moderate and severe melasma was 68.57% (vs. placebo, 0.94%), the clinical effective rate of FAHT cream was 74.29 % (vs. placebo, 0.94%), and the instrumental measure efficacy of FAHT cream was 71.43% (vs. placebo, 6.60%). The difference in efficacy between the two groups was statistically significant (p < 0.001). In the full analysis set (FAS; the PPS and those subjects who were lost to follow-up but received at least one study treatment), the integral therapeutic efficacy rate of FAHT cream was 64.60% (vs. placebo, 0.88%), the clinical effective rate of FAHT cream was 69.91% (vs. placebo, 0.88%), and the instrumental measure efficacy of FAHT cream was 69.03 % (vs. placebo, 7.08%). The difference in efficacy between the two groups was statistically significant (p < 0.001). Of 113 subjects in the FAHT group, 34 (30.1%) reported adverse effects. Most of the pathological adverse effects were mild and resolved with either continuous treatment or discontinuation. Of 113 subjects in the placebo group, three (2.6%) reported mild adverse effects. No severe adverse effects or other abnormal clinical results were associated with the study treatment.. FAHT cream is efficacious, well tolerated, and has a high margin of safety for the treatment of moderate and severe melasma in the Chinese population.

Topics: Adolescent; Adult; Asian People; Double-Blind Method; Female; Fluocinolone Acetonide; Humans; Hydroquinones; Male; Melanosis; Middle Aged; Tretinoin; Young Adult

Melasma has a negative impact on quality of life since it typically occurs on the face.. To evaluate the erythema and pigmentation of melasma lesions and the surrounding areas in patients receiving triple combination (TC: hydroquinone, tretinoin, and fluocinolone acetonide) regimens.. Patients first received an 8-week daily TC treatment and were then randomized to twice weekly or tapering regimen with TC. Melanin and erythema levels of lesions and surrounding areas were objectively measured using a narrowband reflectance spectrophotometer.. Progressive reduction in the mean melanin levels was observed in the treatment phase. Following both maintenance regimens, there was no difference between melanin levels in the melasma lesions. Adverse effects were rare in both phases of the study and there was borderline reduction in erythema with regimen II.. Both maintenance regimens were effective in maintaining results obtained during the initial treatment phase, and were safe and well-tolerated. Erythema was less intense with the tapering regimen.

Topics: Adolescent; Adult; Anti-Inflammatory Agents; Antioxidants; Drug Therapy, Combination; Erythema; Fluocinolone Acetonide; Humans; Hydroquinones; Keratolytic Agents; Long-Term Care; Maintenance Chemotherapy; Melanins; Melanosis; Prospective Studies; Single-Blind Method; Skin; Skin Pigmentation; Tretinoin; Young Adult

Melasma is a common melanosis often difficult to treat.. The aim of this paper was to report on the safety and efficacy of non-ablative fractional photothermolysis combined with the use of triple-combination cream (TCC) on a large population with melasma resistant (i.e., with no complete/near-complete clearing) to TCC alone.. Seventy-six patients with resistant melasma underwent a combined treatment protocol. The protocol consisted of a TCC (hydroquinone 4%, retinoic acid 0.03%, hydrocortisone butyrate 0.1%) applied daily for 10 days followed by four laser treatments performed in 3-week intervals with a fractional 1540-nm erbium-glass laser. During these intervals, and for 3 months after the last laser session, TCC was also applied daily following a "pulse-therapy" scheme. Improvement was assessed by the melasma-area-and-severity-index (MASI) score.. At 1 month, marked (>75%) and moderate (51-75%) clearing of melasma were observed in 46 of 76 (67.1%) and 12 of 76 (21%) cases, respectively. At 6 months, we noticed a marked improvement in 16 of 76 (21.1%) and no improvement in 33 of 76 (43.4%) patients.. Our study proposes the combination of NFP/TCC as a useful therapy for patients with melasma resistant to TCC alone, but it shows that its long-term efficacy is limited.

Topics: Adult; Combined Modality Therapy; Dermatologic Agents; Female; Humans; Hydrocortisone; Hydroquinones; Lasers, Solid-State; Low-Level Light Therapy; Melanosis; Middle Aged; Treatment Failure; Treatment Outcome; Tretinoin; Young Adult

We sought to evaluate the efficacy and tolerability of treating melasma using a 4% hydroquinone skin care system, including a proprietary cleanser, toner, 4% hydroquinone, exfoliation enhancer, and sunscreen, plus tretinoin cream 0.025%. Together these products offer not only treatment of melasma but also a complete skin care regimen. Twenty participants with mild or moderate epidermal melasma with Fitzpatrick skin types III to VI were instructed to use the hydroquinone skin care system and tretinoin cream for 12 weeks. Melasma severity, melasma pigmentation intensity, and melasma area and severity index (MASI) score were significantly reduced from week 4 onward relative to baseline (P < or = .01). The proportion of participants who felt embarrassed or self-conscious about their skin very much or a lot declined from 80% (16/20) to 20% (4/20) between baseline and week 12. Similarly, the proportion of those who made very much or a lot of effort to hide their skin discoloration declined from 90% (18/20) to 37% (7/19). In total, 85% (17/20) of participants were satisfied with the overall effectiveness of the study treatment. Three participants had adverse events probably related to treatment (dryness, erythema, peeling, and stinging sensation). The 4% hydroquinone skin care system plus tretinoin cream 0.025% is effective and well-tolerated in the treatment of melasma.

Topics: Administration, Cutaneous; Antioxidants; Drug Therapy, Combination; Female; Humans; Hydroquinones; Keratolytic Agents; Melanosis; Middle Aged; Patient Satisfaction; Severity of Illness Index; Skin Care; Skin Pigmentation; Sunscreening Agents; Time Factors; Treatment Outcome; Tretinoin

The safety and efficacy of a novel skin-lightening cream (SLC) with 4% hydroquinone (HQ), which additionally contains 4 skin-brightening actives, was compared with a triple combination cream (TCC) with 4% HQ, 0.05% tretinoin, and 0.01% fluocinolone acetonide for the treatment of melasma under measures of sun protection. The study was a randomized, investigator-blinded, split-face study including 20 Caucasian females with at least mild epidermal or mixed melasma. Evaluations were made before treatment, after 4 and 8 weeks, and after 12 weeks at the end of the once-daily treatment period with the creams. The evaluations included the investigator's tolerability assessments, the Investigator's Global Assessment, the Melasma Area and Severity Index (MASI), and a participant questionnaire. Under the conditions of the present study, the SLC was comparable in both efficacy and tolerability with the well-established TCC treatment for facial melasma. The MASI reduction became significant for both creams after 4 weeks and reached -77% for SLC and -79% for TCC cream after 12 weeks of once-daily use under measures of sun protection. None of the subjects discontinued treatment because of an intolerability or adverse event. About one-third of the subjects experienced at least one local intolerability (eg, erythema, dryness, or peeling) with both creams over the entire study period, while the remaining subjects did not experience any intolerabilities.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Dermatologic Agents; Drug Combinations; Female; Fluocinolone Acetonide; Follow-Up Studies; Humans; Hydroquinones; Melanosis; Middle Aged; Severity of Illness Index; Single-Blind Method; Surveys and Questionnaires; Treatment Outcome; Tretinoin; Young Adult

Various treatment modalities are available for management of melasma, ranging from topical and oral to chemical peeling, but none is promising alone. Very few studies are available regarding efficacy of combination of topical treatment with chemical peeling. Combination of chemical peeling and topical regimen can be a good treatment modality in the management of this recalcitrant disorder.. To assess the efficacy of combination of topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling in the treatment of melasma in Indian patients.. Forty Indian patients of moderate to severe epidermal variety melasma were divided into two groups of 20 each. One Group i.e. peel group received topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling and other group i.e. control group received topical regimen (2% hydroquinone, 1% hydrocortisone, 0.05% tretinoin).. There was an overall decrease in MASI from baseline in 24 weeks of therapy in both the groups (P value < 0.05). The group receiving the glycolic acid peel with topical regimen showed early and greater improvement than the group which was receiving topical regimen only.. This study concluded that combining topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling significantly enhances the therapeutic efficacy of glycolic acid peeling. The combination of glycolic acid peeling with the topical regimen is a highly effective, safe and promising therapeutic option in treatment of melasma.

Topics: Adult; Anti-Inflammatory Agents; Antioxidants; Chemexfoliation; Female; Glycolates; Humans; Hydrocortisone; Hydroquinones; Hyperpigmentation; Hypertrichosis; Irritants; Keratolytic Agents; Male; Melanosis; Treatment Outcome; Tretinoin; Young Adult

Even facial pigmentation is considered a universal sign of youth and beauty in all cultures and at all ages in both men and women. The recent FDA concern about the safety of topical hydroquinone has provided the impetus for research into new pigment lightening alternatives in the cosmetic OTC market.. This research examined a novel hydroxyphenoxy propionic acid, ellagic acid, yeast extract, and salicylic acid formulation applied twice daily compared to the standard prescription combination of 4% hydroquinone cream and 0.025% tretinoin cream applied nightly.. This single-center investigator-blinded 12 week study enrolled 82 subjects (7 male, 75 female) ages 25-60 years divided into 2 balanced groups of 41 subjects each with one group using a novel hydroxyphenoxy propionic acid, ellagic acid, yeast extract, and salicylic acid formulation applied twice daily compared to the standard prescription combination of 4% hydroquinone cream and 0.025% tretinoin cream applied nightly.. Significant tolerability issues arose with the prescription combinations that were not seen with the cosmetic formulation. In terms of ability to even skin tone, decrease spot intensity, decrease spot size, and improve overall pigmentation, both products demonstrated parity.. This research demonstrated the value of cosmetic formulations as part of a treatment regimen for pigmentation issues.

Topics: Administration, Cutaneous; Adult; Double-Blind Method; Drug Combinations; Ellagic Acid; Face; Female; Humans; Hydroquinones; Male; Middle Aged; Patient Satisfaction; Pigmentation Disorders; Salicylic Acid; Skin Lightening Preparations; Treatment Outcome; Tretinoin; Yeasts

The relapsing nature of melasma emphasizes the need to maintain efficacy achieved after acute treatment.. To compare clinical efficacy and safety of two 6-month Triple Combination (TC; containing fluocinolone acetonide, hydroquinone and tretinoin) maintenance regimens in subjects with moderate to severe melasma, after daily treatment up to 8 weeks.. This randomized, investigator-blinded, controlled study had a maintenance phase of 6 months. Sixteen centres in Brazil and Mexico enrolled 242 subjects 18 years or older attaining no or mild melasma after 8 weeks of daily TC applications. Subjects were randomized to receive TC in a twice weekly or tapering regimen [3/week (1st month), 2/week (2nd month), 1/week (4th month)]. Efficacy and safety measurements included median time to relapse and relapse-free rate, Global Severity Score, Melasma Area and Severity Index score (MASI), subject's assessment, quality of life questionnaire (MelasQol), and adverse events.. The majority (78.8%) had no or mild melasma (GSS ≤ 1) at week 8 and entered maintenance phase. After 6 months, 53% of patients remained relapse-free with improved quality of life, and time to relapse was similar between groups (about 190 days). Melasma severity at study entry, not maintenance baseline, influenced relapse rate. The twice weekly regimen tended to show better effectiveness in postponing relapse in severe melasma. Both regimens were safe.. After resolution of melasma with TC, maintenance therapy over 6 months was successful in preventing relapse in over half of the patients who entered maintenance phase. Prescribing medicines should be adapted to patients based on melasma severity.

Topics: Dermatologic Agents; Drug Therapy, Combination; Fluocinolone Acetonide; Humans; Hydroquinones; Melanosis; Quality of Life; Recurrence; Severity of Illness Index; Surveys and Questionnaires; Tretinoin

A common, disfiguring problem in women, melasma is often refractory to treatment, and long-term remissions are difficult to achieve. This study assessed the safety and effectiveness of a procedure combining microdermabrasion, a topical regimen, and low fluence Q-switched Nd:YAG laser treatment.. In this observational study of 27 female subjects, phototypes II-V, referred for treatment of mixed-type melasma refractory to previous therapies, low-fluence QS Nd:YAG laser treatment of 1.6-2 J/cm(2) with 5 or 6 mm spot was administered immediately following microdermabrasion. Daily application of a broad-spectrum sunscreen began immediately; subjects used a topical skin care regimen of hydroquinone with tretinoin or vitamin C. Treatments were repeated at 4-week intervals. Follow-up assessment was done 3-12 months after the last treatment. Adverse effects were recorded at each visit. Standardized digital photographs obtained before each treatment session and at follow-up visits were objectively assessed by blinded comparison using a quartile grading system.. Treatment was successful in all skin types, deemed painless by all subjects, and required no anesthesia. Average number of treatments was 2.6. Twenty-two subjects (81%) had >75% clearance of melasma; 11 subjects (40%) achieved >95% clearance. Most subjects showed >50% clearance of their melasma 1 month after the first treatment. Side effects were limited to mild post-treatment erythema, which developed after the microdermabrasion and lasted approximately 30-60 minutes. Four subjects noted temporary exacerbation of melasma after inadvertent sun exposure, but this resolved within several weeks of resuming the topical skin care regime. Remission lasted at least 6 months.. Microdermabrasion plus low-fluence QS Nd:YAG laser treatment is a simple, non-invasive procedure with minimal risk, no recovery time, and long-lasting remission. Treatment works on all skin phototypes in just two to three treatment sessions. Subject compliance with skin care was excellent, probably due to the dramatic improvement observed within 4 weeks.

Topics: Adult; Antioxidants; Ascorbic Acid; Combined Modality Therapy; Dermabrasion; Female; Follow-Up Studies; Humans; Hydroquinones; Keratolytic Agents; Lasers; Lasers, Solid-State; Melanosis; Middle Aged; Single-Blind Method; Sunscreening Agents; Treatment Outcome; Tretinoin

There are numerous common skin disorders involving hyperpigmentation, including solar lentigines, postinflammatory hyperpigmentation, melasma, freckles, and dyschromia from photoaging. While these conditions are of an aesthetic nature, there is great interest in newer, safer, and more effective treatment modalities. Topical hydroquinone (HQ) has been the gold standard of skin lighteners for many years. However, regulatory authorities around the world are now questioning its safety. A randomized, double-blind, half-face study was conducted in females having moderate to severe facial hyperpigmentation to assess the efficacy and tolerability of 3 new skin brightener formulations containing SMA-432, a prostaglandin E2 inhibitor, compared with 4% HQ. Each subject was assigned 2 of the 4 test materials and was instructed to apply the product on the assigned side of the face twice daily for 12 weeks. Evaluation visits were conducted at baseline and at 4, 8, and 12 weeks. At each visit, subjects were evaluated by a blinded investigator for clinical efficacy and tolerability using grading scales. Standardized digital photography and Chroma Meter assessments were also taken. Self-assessment questionnaires were completed at weeks 4, 8, and 12. Sixty-eight Caucasian subjects (136 half faces) completed the study. All test materials significantly reduced overall hyperpigmentation and improved the Investigator's Global Hyperpigmentation Improvement rating at weeks 4, 8, and 12 compared with baseline. SMA-432 exhibited a dose-dependent improvement in hyperpigmentation. There were no major tolerability issues with any of the test materials. Self-assessments were generally favorable for all test materials. At the completion of the trial, subjects rated one of the tested multimodality brightener compositions as the most favorable product and 4% HQ as the least favorable. This study demonstrated that the new non-HQ-containing skin brightener formulations were as effective and equally well tolerated as the gold standard, 4% HQ, in females with facial hyperpigmentation.

Topics: Adult; Aged; Antioxidants; Chemistry, Pharmaceutical; Color; Dermatologic Agents; Dinoprostone; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Hydroquinones; Hyperpigmentation; Middle Aged; Prostaglandin Antagonists; Surveys and Questionnaires; Treatment Outcome; Tretinoin

Various treatments are currently available for melasma. However, results are often disappointing.. We sought to assess the efficacy and safety of nonablative 1550-nm fractional laser therapy and compare results with those obtained with triple topical therapy (the gold standard).. Twenty female patients with moderate to severe melasma and Fitzpatrick skin types II to V were treated either with nonablative fractional laser therapy or triple topical therapy (hydroquinone 5%, tretinoin 0.05%, and triamcinolone acetonide 0.1% cream) once daily for 8 weeks in a randomized controlled observer-blinded study. Laser treatment was performed every 2 weeks for a total of 4 times. Physician Global Assessment was assessed at 3 weeks, 3 months, and 6 months after the last treatment.. Physician Global Assessment improved (P < .001) in both groups at 3 weeks. There was no difference in Physician Global Assessment between the two groups. Mean treatment satisfaction and recommendation were significantly higher in the laser group at 3 weeks (P < .05). However, melasma recurred in 5 patients in both groups after 6 months. Side effects in the laser group were erythema, burning sensation, facial edema, and pain; in the triple group side effects were erythema, burning, and scaling.. Limitations were: small number of patients; only one set of laser parameters; and a possible difference in motivation between groups.. Nonablative fractional laser therapy is safe and comparable in efficacy and recurrence rate with triple topical therapy. It may be a useful alternative treatment option for melasma when topical bleaching is ineffective or not tolerated. Different laser settings and long-term maintenance treatment should be tested in future studies.

Topics: Administration, Topical; Adult; Female; Humans; Hydroquinones; Laser Therapy; Melanosis; Middle Aged; Pilot Projects; Recurrence; Treatment Outcome; Tretinoin; Triamcinolone Acetonide

Melasma is common among females. At present, its most reliable topical treatment is the Kligman-Willis formula.. To evaluate objectively the pattern of pigmentation improvement and recurrence.. Thirty-four Thai females with melasma showing similar lesions on both cheeks were randomly assigned to 8-week daily treatment with either one of two different versions of the formula together with strict sun protection. They were objectively evaluated instrumentally with a Mexameter® every 2 weeks, and were followed up for the subsequent 40 weeks.. Thirty of 34 subjects who completed their 8-week treatment displayed a similar improvement pattern with either formulae. All expressed satisfaction with the results of the treatment. Instrumental evaluation detected that the pigmentation reached a nadir after 6 weeks, regardless of the formulae. Twenty-one subjects, who were further followed up, exhibited mild relapse within 2 months after finishing the treatment. Yet, their pigmentation levels remained significantly lower than those before treatment. Both formulae increased transepidermal water loss and skin surface hydration during the treatment period.. Melasma in Thai females responded well to the Kligman-Willis formula. A relapse that was detected with the instrumental measurement after treatment discontinuation suggests the necessity to continue even intermittent treatment after attaining therapeutic success.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Asian People; Chemistry, Pharmaceutical; Drug Combinations; Female; Humans; Hydroquinones; Keratolytic Agents; Melanosis; Radiation-Protective Agents; Recurrence; Sunscreening Agents; Thailand; Treatment Outcome; Tretinoin

Triple combination (TC) cream is a stable combination of fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05% and is currently the only hydroquinone-containing drug approved by the Food and Drug Administration for the treatment of melasma.. To evaluate the safety and efficacy of TC cream when used sequentially with intense pulsed light (IPL) treatments in patients with moderate to severe melasma.. This was a 10-week, split-face study in which 56 patients with symmetrical melasma lesions were treated with TC cream on one side of the face and an inactive control cream on the other side of the face. Patients also had two IPL treatments at weeks 2 and 6. (Topical treatment was suspended during IPL treatments ± 1 day.). Melasma severity was significantly less with TC cream and IPL than with inactive cream and IPL at weeks 6 (p=.007) and 10 (p=.002). Improvement in melasma was greater with TC cream and IPL than with inactive cream and IPL according to investigator and patient evaluations at weeks 6 and 10 (p<.001 for both time points). Treatment with TC cream and IPL was well tolerated.. The results of this study suggest that TC cream and IPL treatment is an effective and safe treatment option for patients with melasma.

Topics: Adult; Aged; Anti-Inflammatory Agents; Combined Modality Therapy; Female; Fluocinolone Acetonide; Humans; Hydroquinones; Keratolytic Agents; Low-Level Light Therapy; Male; Melanosis; Middle Aged; Radiation-Protective Agents; Tretinoin

A hydroquinone (HQ) skin care system has been designed for use in conjunction with nonsurgical procedures.. The authors evaluate the efficacy of this system plus tretinoin for improving facial appearance in comparison to a standard skin care regimen in users of botulinum toxin Type A (BoNT-A).. In this multicenter, randomized, investigator-masked, parallel-group study, 61 patients who received upper facial treatment with BoNT-A at a plastic surgery or dermatology clinic were randomly assigned to apply either the HQ system (cleanser, toner, proprietary 4% hydroquinone, exfoliant, and sunscreen) plus 0.05% tretinoin cream or a standard skin care regimen (cleanser, moisturizer, and sunscreen) for 120 days. Outcomes were assessed by the investigators and through a patient questionnaire.. Compared with standard skin care, the HQ system plus tretinoin resulted in significantly milder fine lines/wrinkles and hyperpigmentation at Days 30, 90, and 120 (p ≤ .05) and significantly superior overall ratings for each of nine patient assessments at Days 90 and 120 (p ≤ .05). A relatively greater proportion of patients using the HQ system plus tretinoin believed that their study treatment had further enhanced the improvements attained with BoNT-A (86% vs 8%). Both regimens were generally well tolerated.. Adjunctive use of the HQ system plus tretinoin can further enhance the improvements in facial appearance attained with BoNT-A. Applying the HQ system plus tretinoin offers multiple clinical benefits over standard skin care, including significantly greater improvements in fine lines/wrinkles and hyperpigmentation.

Topics: Administration, Cutaneous; Botulinum Toxins, Type A; Face; Female; Follow-Up Studies; Humans; Hydroquinones; Hyperpigmentation; Keratolytic Agents; Male; Middle Aged; Patient Satisfaction; Rejuvenation; Skin Aging; Skin Care; Surveys and Questionnaires; Time Factors; Tretinoin

Topics: Adult; Bleaching Agents; Dermatologic Agents; Drug Combinations; Female; Fluocinolone Acetonide; Glucocorticoids; Humans; Hydroquinones; Lasers, Dye; Melanosis; Middle Aged; Patient Satisfaction; Single-Blind Method; Tretinoin

There has been a proliferation of treatments for facial rejuvenation but, curiously, the use of such treatments on other areas of the body has not been widely investigated. The clinical effects of treating photodamaged skin of the neck and anterior chest area (décolletage) with a proprietary copper zinc malonate lotion and a proprietary 4% hydroquinone cream (twice daily), plus tretinoin cream (once daily), were evaluated in 42 females in a 24-week investigator-blind randomized study. Treatment was associated with early and significant (P< or =0.05) improvements in mean scores on an overall integrated assessment of photodamage (from week 4 onward) and for multiple signs of photodamage--tactile roughness (from week 2 onward); mottled hyperpigmentation, lentigines and fine wrinkling (from week 4 onward); laxity (from week 8 onward); and crepiness and coarse wrinkling (from week 12 onward). Treatment was generally well tolerated and 94% of subjects were satisfied or very satisfied with the overall improvement in their décolletage at week 24.

Topics: Adult; Copper; Dermatologic Agents; Drug Therapy, Combination; Female; Humans; Hydroquinones; Malonates; Middle Aged; Neck; Patient Satisfaction; Skin Aging; Tretinoin; Zinc

Topical triple combination (TC) treatment is considered the primary approach to melasma. Recently, collimated low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment has attracted attention as an alternative approach.. To compare the clinical efficacy and adverse effects of low-fluence Q-switched Nd:YAG laser when performed before and after treatment with topical TC using a split-face crossover design.. Thirteen patients with melasma received topical treatment with TC cream or 1,064-nm Q-switched Nd:YAG laser treatment on opposite sides of the face for 8 weeks, and then treatments were reversed for 8 weeks. Responses were evaluated using the Melasma Area and Severity Index scoring system, spectrophotometry measurements, and a subjective self-assessment method.. After 16 weeks, better results were seen in subjective assessments when laser treatment was used after 8 weeks of topical TC treatment than before usage of TC. There were no significant adverse effects with the laser treatments.. Laser treatment after topical TC cream was found to be safer and more effective than the post-treatment use of topical agents.

Topics: Administration, Topical; Adult; Antioxidants; Combined Modality Therapy; Cross-Over Studies; Drug Administration Schedule; Drug Combinations; Female; Fluocinolone Acetonide; Glucocorticoids; Humans; Hydroquinones; Keratolytic Agents; Lasers, Solid-State; Male; Melanosis; Middle Aged; Treatment Outcome; Tretinoin

A hydroquinone/tretinoin (HQ/tret) skin care system designed for use with non-surgical facial rejuvenation procedures has recently become available. In this observer-masked study, 36 patients with moderate-to-severe wrinkling of the skin around the eyes and lips were randomly assigned to use either the 4% hydroquinone/0.05% tretinoin skin care system or placebo products, each day for 90 days. In addition, all patients received intense pulsed light (IPL) treatment on days 30 and 60. At day 90, > or = 75% overall improvement was reported in 72% and 19% of patients in the HQ/tret + IPL group and the placebo + IPL group, respectively. HQ/tret + IPL was also associated with significantly lower mean hyperpigmentation scores at days 30, 60 and 90 (P < or = 0.05), and significantly lower mean laxity scores at day 90 (P< or =0.05) compared with placebo + IPL. Adjunctive use of the HQ/tret system enhances the improvements in facial skin achieved with IPL treatment.

Topics: Administration, Cutaneous; Adult; Female; Follow-Up Studies; Humans; Hydroquinones; Hyperpigmentation; Keratolytic Agents; Male; Middle Aged; Patient Satisfaction; Photochemotherapy; Rejuvenation; Single-Blind Method; Skin Aging; Tretinoin

Melasma is a common disorder affecting a significant percentage of the population, particularly those with skin of color. Therapy with hydroquinone, a depigmenting agent, as a single agent or in combination with other agents has been used with variable success. A triple-combination (TC) cream combining hydroquinone 4% with tretinoin 0.05% and fluocinolone acetonide 0.01% was developed for the treatment of melasma. We studied the use of TC cream for 24 weeks and had tissue samples for all time points in 62 patients with moderate to severe melasma. The atrophogenic potential of TC cream was evaluated through serial histopathologic examination of skin biopsies. No statistically significant histopathologic signs of atrophy of the epidermis or dermis were noted at any time point throughout the study. There was a marked reduction in epidermal melanin in treated subjects; however, we did not observe any significant difference in baseline and treated samples in the amount of perivascular inflammatory infiltrate, dermal mucin, keratinocyte and melanocyte atypia, or mast cells, consistent with findings of previous studies where topical retinoids were used. An increase in the mean number of blood vessels per square millimeter of tissue was observed in 2 study cohorts between baseline and week 24. These results suggest that the risk of skin atrophy with 24-week use of TC cream for the treatment of melasma is very low.

Topics: Administration, Cutaneous; Adult; Atrophy; Dermatologic Agents; Drug Combinations; Female; Fluocinolone Acetonide; Humans; Hydroquinones; Male; Melanosis; Middle Aged; Skin; Tretinoin

Melasma is an acquired, chronic hypermelanosis for which therapy remains a challenge.. To compare the efficacy and safety of a triple combination [TC: fluocinolone acetonide 0.01%, hydroquinone (HQ) 4%, tretinoin 0.05%] vs. HQ 4% after 8 weeks of treatment of moderate to severe facial melasma in Asian patients.. This was a multicentre, randomized, controlled, investigator-blinded, parallel comparison study. East and South-East Asian patients aged 18 years or older, with a clinical diagnosis of moderate to severe melasma, were enrolled in this study. Patients were enrolled at baseline and treated daily for 8 weeks with TC cream (one application at bedtime) or HQ cream (twice daily). There were four study visits: at baseline and weeks 2, 4 and 8. The primary efficacy variable was the melasma global severity score (GSS). Other outcome measures included Melasma Area and Severity Index, global improvement and patient satisfaction. Safety was assessed through the reporting of adverse events.. TC had superior efficacy to HQ for the primary variable: 77/120 patients (64.2%) on TC had GSS 'none' or 'mild' at week 8 vs. 48/122 patients (39.4%) on HQ (P < 0.001). The secondary efficacy variables confirmed these results. Patient satisfaction was in favour of TC (90/127, 70.8%, vs. 64/129, 49.6%; P = 0.005). More patients had related adverse events on TC (63/129, 48.8%) than on HQ (18/131, 13.7%) but most were mild and none was severe.. Efficacy in Asians and patient satisfaction were superior with the fixed TC than with HQ 4%.

Topics: Administration, Cutaneous; Adult; Analysis of Variance; Asian People; Double-Blind Method; Drug Combinations; Facial Dermatoses; Female; Fluocinolone Acetonide; Humans; Hydroquinones; Male; Melanosis; Middle Aged; Ointments; Patient Satisfaction; Treatment Outcome; Tretinoin

Triple-combination (TC) cream is a stable combination of fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%, and currently is the only US Food and Drug Administration-approved drug for the topical treatment of melasma. Furthermore, it is the only US Food and Drug Administration-approved product containing hydroquinone. Anecdotal evidence suggests that improvements in melasma can be achieved with a multifactor approach involving TC cream with a variety of procedures. A pilot study was designed to evaluate the efficacy and safety of sequential treatment with TC cream and a series of glycolic acid (GA) peels in participants with moderate to severe melasma. Participants were treated with TC cream for 2 weeks before the alternating sequential treatment cycles with TC cream and GA peels began. A total of six 2-week cycles of TC cream and 5 GA peels were used. Efficacy and safety evaluations were conducted at weeks 6 and 12. Investigator global assessment (IGA) ratings indicated that 1 of 20 participants (5%) had achieved treatment success (clear/almost clear) as early as week 6 and most participants had achieved treatment success by week 12 (65% [13/20]; P < .001 vs baseline). Objective absorption spectrometry measurements of the difference in melanin for involved versus uninvolved skin confirmed that hyperpigmentation was significantly reduced in participants at weeks 6 and 12 compared with baseline (P < .001 for both). Investigator and participant evaluations revealed that most participants (> or = 90%) showed improvement (excellent improvement, much improved, improved) by week 12 with alternating sequential treatment with TC cream and GA peels. Furthermore, the results of this study indicated that sequential treatment with TC cream and GA peels was well-tolerated.

Topics: Administration, Cutaneous; Adult; Chemexfoliation; Dermatologic Agents; Drug Combinations; Drug Therapy, Combination; Female; Fluocinolone Acetonide; Follow-Up Studies; Glycolates; Humans; Hydroquinones; Male; Melanosis; Middle Aged; Ointments; Pilot Projects; Severity of Illness Index; Treatment Outcome; Tretinoin

Chemical peels have become a popular modality in the treatment of melasma. The most disturbing side effect of this procedure is postinflammatory hyperpigmentation. This may be minimized with the help of priming agents. Because there is a paucity of such studies, this study was taken up to evaluate the beneficial effects of hydroquinone versus tretinoin as priming agents in treatment of melasma with glycolic acid peels.. Sixty patients of melasma were randomly assigned in three groups of 20 patients each in a single-blind study. Group I received only glycolic acid peels while Groups II and III were primed with 0.025% tretinoin and 2% hydroquinone, respectively, for 2 weeks before peeling. The patients received serial glycolic acid peels fortnightly for the first 3 months and then monthly for the next 3 months and were then followed up for the next 3 months when peeling was stopped. Clinical and photographic evaluation was done at 3, 6, and 9 months, and subjective improvement was noted.. There was an overall decrease in MASI from baseline to 6 months in all three groups but it was highly significant between Groups I and III (p<.001) at 6 and 9 months and significant between Groups II and III (p<.01) at 9 months.. Results are better with hydroquinone as priming agent compared to tretinoin in enhancing the results with glycolic acid peels in melasma and in decreasing postpeel postinflammatory hyperpigmentation.

Topics: Adolescent; Adult; Chemexfoliation; Female; Glycolates; Humans; Hydroquinones; Male; Melanosis; Middle Aged; Treatment Outcome; Tretinoin

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.

Topics: Administration, Topical; Adult; Drug Combinations; Emollients; Facial Dermatoses; Female; Fluocinolone Acetonide; Follow-Up Studies; Humans; Hydroquinones; Male; Melanosis; Middle Aged; Probability; Reference Values; Severity of Illness Index; Single-Blind Method; Treatment Outcome; Tretinoin

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

Melasma is a common hyperpigmentation disorder that is frequently recalcitrant to treatment. An 8-week, multicenter, open-label, community-based study evaluated a new therapeutic approach that combines tretinoin 0.05%, hydroquinone 4.0%, and fluocinolone acetonide 0.01% (RA+HQ+FA) in a hydrophilic cream formulation. The trial enrolled 1290 patients of diverse races/ethnicities with a full range of Fitzpatrick skin types (I through VI). The mean Melasma Area and Severity Index (MASI) decreased significantly at both weeks 4 and 8 compared with baseline in the overall study population and across all Fitzpatrick skin types and races/ethnicities (P<.0001). The mean MASI darkness and homogeneity scores likewise fell significantly at weeks 4 and 8 in all facial regions involved (forehead, right and left malar regions, and chin) and in all Fitzpatrick skin types (P<.0001). By week 8, investigators' global evaluations showed that 75% of patients had "moderate or marked improvement" or were "almost clear" or "clear." The study medication was found to be safe and well tolerated. The results of this study demonstrate that RA+HQ+FA produces significant rapid improvement of melasma across the range of patients seen in daily practice, including whites, Hispanics, blacks, Asians, American Indians, Alaskan natives, and Pacific Islanders.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Dermatologic Agents; Drug Combinations; Facial Dermatoses; Female; Fluocinolone Acetonide; Humans; Hydroquinones; Male; Melanosis; Middle Aged; Ointments; Prospective Studies; Treatment Outcome; Tretinoin; United States

This article describes a long-term, multicenter, open-label, 12-month study of once-daily fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05% (Tri-Luma Cream, hereinafter called TC [triple combination]) application in the treatment of melasma. A total of 228 patients with facial melasma were enrolled and treated; 173 patients (76%) completed the study. Most patients had 1 to 2 courses of treatment lasting approximately 6 months in total. TC cream showed a favorable safety profile. only 3 patients (1%) withdrew from the study due to treatment-related adverse events (AEs). A total of 129 patients (57%) experienced at least one treatment-related AE. Most AEs were expected application-site reactions that were mild and transient in nature and did not require remedial therapy. There were no cases of skin atrophy or skin thinning and only 6 cases of telangiectasia (5 mild and 1 moderate), most of which had improved by the end of the study. Results of the efficacy assessments were positive, with both the patient and the physician assessing melasma to be either completely or nearly cleared by the end of the study in more than 90% of cases. In this study, a once-daily application of TC cream over an extended period of 12 months showed no notable safety concerns and offered an effective treatment for melasma.

Topics: Antioxidants; Drug Combinations; Facial Dermatoses; Female; Fluocinolone Acetonide; Glucocorticoids; Humans; Hydroquinones; Keratolytic Agents; Male; Melanosis; Middle Aged; Ointments; Treatment Outcome; Tretinoin

Mild to moderately photodamaged skin is characterized by dyspigmentation, fine wrinkles, and tactile roughness. An optimal approach to the topical treatment of photoaging would simultaneously address all appearance issues.. This study was undertaken to evaluate the effect of 4% hydroquinone and 0.3% retinol in photoaging.. A 16-week study was designed to evaluate the efficacy and tolerance of a single cream containing prescription topical 4% hydroquinone for dyspigmentation and the cosmeceutical 0.3% retinol for fine wrinkles in an emollient vehicle for tactile roughness. This novel formulation was compared with 0.05% tretinoin emollient cream, the standard against which all other topical photoaging treatments are compared. Investigator assessments, subject assessments, and photography represented the evaluation end points.. The cosmeceutical emollient 4% hydroquinone/0.3% retinol cream more effectively diminished the collective signs of photodamage than 0.05% tretinoin emollient cream in terms of dyspigmentation, fine wrinkles, and tactile roughness in 16 weeks.. Combination therapy of hydroquinone and retinol may improve photoaging-associated hyperpigmentation.

Topics: Administration, Topical; Adult; Dermatologic Agents; Double-Blind Method; Drug Combinations; Emollients; Female; Humans; Hydroquinones; Hyperpigmentation; Middle Aged; Skin Aging; Treatment Outcome; Tretinoin; Vitamin A

In recent years, chemical peels have become increasingly popular in the treatment of melasma. However, postpeel hyperpigmentation is a frequently encountered side effect, especially in dark-skinned individuals. The role of priming agents in preventing this complication has not been adequately evaluated. Hence, we studied the effect of hydroquinone versus tretinoin as priming agents in minimizing the incidence of this side effect in a double-blind, randomized clinical trial of 50 patients with melasma.. Of a total of 50 patients, 25 patients each with a similar skin phototype, the nature and severity of melasma were assigned to groups I and II. The patients were primed with 2% hydroquinone in group I, and in group II with 0.025% tretinoin once daily (night time) 2 weeks before starting trichloroacetic acid peels. Subsequently, all of them received trichloroacetic acid peels at intervals of 2 weeks for 12 weeks, followed by monthly peels for next 12 weeks during the follow-up period. Patients continued to use a sunscreen with an SPF of greater than 15 and the recommended priming agent during the follow-up. Final assessment was made at 6 months, based on the impression of the patient, clinical examination by the physician, and photographic analysis.. A total of 50 patients (25 in each group) participated in the study. The predominant Fitzpatrick skin type observed among them was type IV (56%), and the type of melasma was mixed (44%). The final results at 12 weeks were comparable in two groups. However, a significant difference was seen in the two groups during the follow-up period, with continued improvement in 24% and worsening in 28% of patients in group I and continued improvement in only 16% and worsening in 40% in group II patients.. Hydroquinone is superior to tretinoin as a priming agent in maintaining the results achieved with peels and in decreasing the incidence of postpeel reactive hyperpigmentation.

Topics: Administration, Topical; Adolescent; Adult; Chemexfoliation; Double-Blind Method; Female; Humans; Hydroquinones; Hyperpigmentation; Keratolytic Agents; Male; Melanosis; Tretinoin

A new topical solution containing 4-hydroxyanisole (mequinol) 2%/tretinoin 0.01% (Solagé) was compared with its active components, its vehicle, and hydroquinone (HQ) 3% in the treatment of solar lentigines. In a randomized, parallel-group, double-masked study, 216 subjects applied the treatments twice daily for 16 weeks and were followed up for a further 24 weeks. A significantly higher proportion (P < or = .05) of subjects achieved clinical success with mequinol 2%/tretinoin 0.01% compared with HQ 3% as measured by both the lesional pigmentation on the forearm and the physician global assessment at the end of treatment. The proportion of subjects achieving clinical success on the face in the mequinol 2%/tretinoin 0.01% group was consistently higher than that in the HQ 3% group. Some treatment effects remained at the end of the treatment-free follow-up, with trends apparent on the face in favor of mequinol 2%/tretinoin 0.01% over HQ 3%. In all treatment groups, skin-related adverse events were mild or moderate and transient. In conclusion, the mequinol 2%/tretinoin 0.01% solution is a highly effective and well-tolerated treatment for solar lentigines and related hyperpigmented lesions, being superior to HQ 3% for lesions on the forearm and of similar efficacy for lesions on the face.

Topics: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Anisoles; Double-Blind Method; Drug Therapy, Combination; Face; Female; Forearm; Humans; Hydroquinones; Keratolytic Agents; Lentigo; Male; Middle Aged; Treatment Outcome; Tretinoin

Melasma continues to be a difficult condition to treat, especially in dark-skinned patients, although various topical modalities including hydroquinone, tretinoin, and/or topical steroids have been used singly or in combination with variable results.. To determine if serial glycolic acid peels provide additional improvement when combined with a time-tested topical regimen, a modification of Kligman's formula (hydroquinone 5%, tretinoin 0.05%, hydrocortisone acetate 1% in a cream base). All cases had epidermal melasma as detected by Wood's light examination.. Forty Indian melasma patients were divided into two groups of 20 each. One group received serial glycolic acid peel combined with a topical regimen, modified Kligman's formula. The other, a control group, received only modified Kligman's formula. The results were evaluated by a clinical investigator both subjectively and with photographs taken at baseline, 12 (before the fourth peel), and 21 (3 weeks after the sixth peel) weeks. For clinical evaluation, the Melasma Area and Severity Index (MASI) was used.. A significant decrease in the MASI score from baseline to 21 weeks was observed in both groups (P <.001). The group receiving the glycolic acid peels showed a trend toward more rapid and greater improvement, with statistically significant results (P <.001). Only a few side effects were observed in the peel group.. This study demonstrates that serial glycolic acid peels provide an additional effect to a topical regimen which is a modification of the time-tested Kligman's regimen for treating melasma in dark-complexioned individuals if used judiciously and under supervision. It demonstrates that superficial chemical peels are beneficial in the treatment of melasma.

Topics: Administration, Topical; Adult; Chemexfoliation; Drug Combinations; Female; Glycolates; Humans; Hydroquinones; Keratolytic Agents; Male; Melanosis; Middle Aged; Severity of Illness Index; Treatment Outcome; Tretinoin

Transient hyperpigmentation is the most common complication seen following cutaneous carbon dioxide (CO2) laser resurfacing.. The purpose of this study was to determine whether the use of a topical skin lightening regimen prior to cutaneous laser resurfacing reduces the incidence of post-laser resurfacing hyperpigmentation.. One hundred consecutive CO2 laser resurfacing patients (skin types I-III) were randomized to receive preoperative treatment with 10% glycolic acid cream twice daily (n=25), hydroquinone 4% cream qHS and tretinoin 0.025% cream twice daily (n=25) or no pretreatment (n=50, control) for at least 2 weeks. Clinical and photographic assessments were performed prior to laser resurfacing and at 4 and 12 weeks following treatment.. There was no significant difference in the incidence of post-CO2 laser resurfacing hyperpigmentation between subjects who received pretreatment with either topical glycolic acid cream or combination tretinoin/hydroquinone creams and those who received no pretreatment regimen.. It is postulated that reepithelialization after cutaneous laser resurfacing includes follicular melanocytes that have not been affected by topical pretreatment. When instituted as a component of the skin care regimen postoperatively, topical hydroquinone, tretinoin and/or glycolic acid preparations may be helpful in reducing post-laser resurfacing hyperpigmentation.

Topics: Administration, Cutaneous; Adult; Carbon Dioxide; Dermatologic Surgical Procedures; Facial Dermatoses; Female; Glycolates; Humans; Hydroquinones; Hyperpigmentation; Keratolytic Agents; Laser Therapy; Male; Middle Aged; Premedication; Radiation-Protective Agents; Tretinoin

Melasma is a common disorder of macular hyperpigmentation which involves mostly in sun exposed areas of the face and neck. Those most affected are women. Multiple factors have been postulated to involve in the etiology and pathogenesis of melasma including pregnancy, oral contraceptives, genetics, sun exposure, cosmetics and race. We have conducted a clinical trial utilizing all trans-retinoic acid (tretinoin, Retin-A) cream 0.1% q pm and hydroquinone lotion 3% (Melanex) applied every morning in Korean women with melasma. Our study patients demonstrated all three clinical patterns common to melasma: centrofacial, malar and mandibular. Wood's light examination was performed on all patients and identified two of the four types of melasma described. Most patients showed epidermal melasma and a few manifested a mixed type. No patients exhibited solely dermal or inapparent type in melasma. With open studies of tretinoin cream and hydroquinone lotion followed by sun screen, we have found significant improvement within 5 months with a few side effects. Histopathologic examination of melasma in the pre-trial biopsies revealed increased pigmentation of the epidermis, dermis or both. In addition, significant alterations of the dermis with solar damage was noted in all melasma patients sampled. Biopsies taken after five months of treatment revealed significant decreases in epidermal pigmentation and improvement of solar damage in the dermis. We reconfirmed that a synergistic mechanism between tretinoin and hydroquinone is responsible for the improvement seen in the female Korean melasma patients from our study.

Topics: Adult; Demography; Female; Humans; Hydroquinones; Keratolytic Agents; Melanosis; Middle Aged; Radiation-Protective Agents; Sunlight; Treatment Outcome; Tretinoin

Melasma is a common problem in Asians, but treatments have not been satisfactory. In the present study, we evaluated the efficacy of a new formula containing 0.1% tretinoin, 5% hydroquinone, and 1% hydrocortisone (RHQ) in Korean patients with melasma. Twenty-five Korean females with therapy recalcitrant melasma applied RHQ on their faces for 4 months and were evaluated before and 4 weeks after treatment clinically and histologically. They were also evaluated clinically 4 months after treatment. To minimize unavoidable side effects (erythema or peeling), we applied RHQ twice a week instead of the usual daily application. However, we obtained clinical and histological results comparable to other reports from white populations. Statistically significant depigmentation in clinical and histological studies and increased subepidermal collagen synthesis were observed in this study. These effects were seen as early as 4 weeks after treatment with RHQ. We used mMASI scoring, a modified version of the original MASI, to quantify the effects of RHQ more objectively and easily.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Asian People; Dermis; Drug Administration Schedule; Drug Therapy, Combination; Epidermis; Female; Follow-Up Studies; Humans; Hydrocortisone; Hydroquinones; Keratolytic Agents; Melanosis; Middle Aged; Radiation-Protective Agents; Treatment Outcome; Tretinoin

Treatment of postinflammatory hyperpigmentation in patients of Fitzpatrick skin types IV, V, and VI is difficult. Glycolic acid peels are useful for pigment dyschromias in caucasians; however, there are no controlled studies examining their safety and efficacy in dark-complexioned individuals.. To determine if serial glycolic acid peels provide additional improvement when compared with a topical regimen of hydroquinone and tretinoin.. Nineteen patients with Fitzpatrick skin type IV, V, or VI were randomized to a control or peel group. The control group applied 2% hydroquinone/10% glycolic acid gel twice daily and 0.05% tretinoin cream at night. The peel patients used the same topical regimen and, in addition, received six serial glycolic acid peels (68% maximum concentration). Patients were evaluated with photography, colorimetry, and subjectively.. Sixteen patients completed the study. Both treatment groups demonstrated improvement, but the patients receiving the glycolic acid peels showed a trend toward more rapid and greater improvement. The peel group also experienced increased lightening of the normal skin.. This pilot study demonstrates that serial glycolic acid peels provide an additional benefit, with minimal adverse effects, for the treatment of postinflammatory hyperpigmentation in dark-complexioned individuals.

Topics: Administration, Topical; Adult; Black People; Chemexfoliation; Dermatitis; Drug Combinations; Female; Glycolates; Humans; Hydroquinones; Hyperpigmentation; Keratolytic Agents; Middle Aged; Pilot Projects; Tretinoin

Melasma is a circumscribed brown macular hypermelanosis of the areas of the face and neck that are exposed to light. Clinical trials with various depigmenting formulations containing hydroquinone were conducted to determine the ideal concentration of hydroquinone, retinoic acid, and corticosteroids for the treatment of melasma. The compounds were tested with and without the concomitant use of topical sunscreen preparations. Based on the results of the trials and our earlier clinical experience, we conclude that treatment of melasma should involve the following: avoidance of sun exposure, constant use of broad-spectrum sunscreens, and topical application of a cream or lotion containing 2% hydroquinone and 0.05% to 0.1% retinoic acid (tretinoin). Patients should suspend use of oral contraceptives and other agents that promote skin pigmentation. The monobenzyl ether of hydroquinone should never be used in melasma therapy.

Topics: Administration, Topical; Clinical Trials as Topic; Drug Combinations; Female; Humans; Hydroquinones; Melanosis; Sunlight; Sunscreening Agents; 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

A new simple and robust HPLC-DAD method was developed for the concurrent analysis of hydroquinone (HQ), hydrocortisone acetate (HCA) and tretinoin (TRN) triple combination for the first time using an Inertsil ODS 3-C18 column (150 mm × 4.6 mm, 5 μm particle size) column with 0.05 M phosphate buffer (pH 5.0) and acetonitrile at a ratio of (10:90, v/v) as a mobile phase, eluted by an isocratic elution mode at a flow rate of 1.0 mL/min and detected at 265 nm. Mefenamic acid was used as an internal standard (I.S.). The method produced linear responses in the concentration range of 10-200, 5-100 and 1-40 μg/mL, with detection limits of 2.01, 1.13 and 0.28 × 10-3 and quantitation limits of 6.11, 3.41 and 0.87 × 10-3 μg/mL for HQ, HCA and TRN, respectively, and a correlation coefficient higher than 0.9998. All validation requirements were satisfied by proving its linearity, precision, accuracy, robustness and specificity. The method was extended for application in triple combination cream, HQ/TRN co-formulated cream and HQ and TRN single ingredient cream with a recovery >97%.

Topics: Chromatography, High Pressure Liquid; Dermatologic Agents; Drug Combinations; Humans; Hydrocortisone; Hydroquinones; Limit of Detection; Linear Models; Mefenamic Acid; Melanosis; Reproducibility of Results; Tretinoin

Retinoic acid (RA) enhances skin-lightening capabilities of hydroquinone (HQ), at least in part, by facilitating desquamation which leads to increase penetration of HQ. The desquamation also affects skin irritation levels. The mechanism of RA-induced desquamation, however, has not been completely explored and no such data has been available for HQ uses.. To examine the role of HQ, RA, and their combination in the desquamation.. Primary cultured normal human keratinocytes, which were treated with HQ and/or RA in presence or absence of serine-specific inhibitor Kazal type5 (SPINK5)/lympho-epithelial Kazal-type-related inhibitor (LEKTI) knockdown or recombinant human SPINK5/LEKTI, and biopsied skin samples applied with HQ or RA were examined. Expression levels of corneodesmosin (CDSN), desmocollin1 (DSC1), kallikrein5 (KLK5), KLK7, and SPINK5/LEKTI, and proteolysis activity against extracted human skin epidermal protein were determined using time-course real-time PCR, Western blotting, ELISA, and immunofluorescence staining.. HQ increased but RA decreased the synthesis of CDSN and DSC1. HQ reduced corneodesmosome degradation by the upregulation of SPINK5/LEKTI, whereas RA showed opposite results without upregulation of SPINK5/LEKTI. The combination of HQ and RA was close to the sum of the individual components.. HQ reduced corneocyte desquamation. However, RA enhanced desquamation. The combination induced more desquamation than HQ but less than RA.

Topics: Adult; Cell Adhesion; Desmocollins; Desmosomes; Drug Synergism; Epidermal Cells; Epidermis; Female; Glycoproteins; Healthy Volunteers; Humans; Hydroquinones; Intercellular Signaling Peptides and Proteins; Keratinocytes; Male; Middle Aged; Primary Cell Culture; Proteolysis; Real-Time Polymerase Chain Reaction; RNA Interference; RNA, Small Interfering; Serine Peptidase Inhibitor Kazal-Type 5; Skin Absorption; Skin Lightening Preparations; Skin Physiological Phenomena; Tretinoin; Up-Regulation

Melasma treatment with combined retinoic acid (RA) and hydroquinone (HQ) usually causes unsatisfactory outcomes and safety concerns. This study attempted to evaluate the cutaneous absorption and skin tolerance of the codrug conjugated with RA and HQ via ester linkage. The codrug's permeation of the pig skin was estimated using Franz diffusion cell. The codrug and parent drugs were comparatively examined for anti-inflammatory activity and tyrosinase inhibition. In vivo cutaneous irritation was assessed on nude mouse skin. Chemical conjugation of RA with HQ increased the lipophilicity and thus the skin absorption. The codrug absorption produced a 5.5- and a 60.8-fold increment compared to RA skin deposition at an equimolar (1.2mM) and saturated solubility dose, respectively. The cumulative amount of HQ derived from the codrug in the receptor was comparable to or less than that of topically applied HQ. The RA-HQ codrug was partly hydrolyzed on penetrating the skin. The hydrolysis rate in intact skin was significantly lower than that in esterase medium and skin homogenates. The codrug showed an interleukin (IL)-6 inhibition activity comparable to RA. A therapeutic index 6-fold greater than RA was obtained with the topical codrug. The tyrosinase inhibition percentage of the codrug and HQ was 13% and 21%, respectively. The skin tolerance test determined by transepidermal water loss (TEWL), redness, and histopathology had exhibited minor skin irritation caused by the codrug compared to the physical mixture of RA and HQ at an equivalent dose. Topical codrug delivery not only promoted RA absorption, but also diminished the adverse effects of the parent agents.

Topics: Administration, Cutaneous; Animals; Drug Combinations; Female; Hydrolysis; Hydroquinones; Interleukin-6; Irritants; Melanosis; Mice; Mice, Nude; Skin Absorption; Solubility; Swine; Tretinoin

A sensitive and selective stability-indicating successive ratio subtraction coupled with constant multiplication (SRS-CM) spectrophotometric method was studied and developed for the spectrum resolution of five component mixture without prior separation. The components were hydroquinone in combination with tretinoin, the polymer formed from hydroquinone alkali degradation, 1,4 benzoquinone and the preservative methyl paraben. The proposed method was used for their determination in their pure form and in pharmaceutical formulation. The zero order absorption spectra of hydroquinone, tretinoin, 1,4 benzoquinone and methyl paraben were determined at 293, 357.5, 245 and 255.2 nm, respectively. The calibration curves were linear over the concentration ranges of 4.00-46.00, 1.00-7.00, 0.60-5.20, and 1.00-7.00 μg mL(-1) for hydroquinone, tretinoin, 1,4 benzoquinone and methyl paraben, respectively. The pharmaceutical formulation was subjected to mild alkali condition and measured by this method resulting in the polymerization of hydroquinone and the formation of toxic 1,4 benzoquinone. The proposed method was validated according to ICH guidelines. The results obtained were statistically analyzed and compared with those obtained by applying the reported method.

Topics: Antineoplastic Agents; Antioxidants; Benzoquinones; Calibration; Drug Stability; Hydroquinones; Limit of Detection; Parabens; Pharmaceutical Preparations; Preservatives, Pharmaceutical; Spectrophotometry; Tretinoin

To evaluate the treatment of mild-to-moderate epidermal melasma and photodamage using a 4% hydroquinone skin care system plus tretinoin 0.02% cream.. Single-center, investigator-blinded study in 39 adult females with mild-to-moderate epidermal melasma, mild-to-marked pigmentation intensity, and Fitzpatrick skin type III to VI treated for 24 weeks. Improvements in melasma severity, pigmentation intensity, photodamage, and patient satisfaction were assessed at weeks 4, 8, 12, 18, and 24. Cutaneous tolerability was assessed by investigator (erythema, dryness, peeling) and patients (burning and stinging). Adverse events (AEs) were monitored throughout.. Melasma severity, pigmentation intensity, and melasma area and severity index (MASI) scores relative to baseline were all significantly reduced from week 4 onward (P<.001). In addition, signs of facial photodamage were significantly improved. At week 24, 87.9% of patients were "satisfied" or "very satisfied" with the overall treatment effectiveness and Quality of Life (QoL) was much improved. No patient discontinued due to lack of efficacy or treatment-related AEs. One patient (2.8%) reported severe cutaneous intolerability (erythema at week 4).. Treating mild-to-moderate melasma using a 4% hydroquinone skin care system plus 0.02% tretinoin cream can significantly reduce the severity and intensity of melasma and associated pigmentation, and improve signs of photodamage within four weeks. Treatment was generally well tolerated and associated with high levels of patient satisfaction.

Topics: Administration, Cutaneous; Adult; Aged; Drug Compounding; Drug Therapy, Combination; Female; Humans; Hydroquinones; Melanosis; Middle Aged; Single-Blind Method; Skin Aging; Skin Care; Treatment Outcome; Tretinoin

An important group of suspected illegal cosmetics consists of skin bleaching products, which are usually applied to the skin of the face, hands and décolleté for local depigmentation of hyper pigmented regions or more importantly, for a generalized reduction of the skin tone. These cosmetic products are suspected to contain illegal active substances that may provoke as well local as systemic toxic effects, being the reason for their banning from the EU market. In that respect, illegal and restricted substances in cosmetics, known to have bleaching properties, are in particular hydroquinone, tretinoin and corticosteroids. From a legislative point of view, all cosmetic products containing a prohibited whitening agent are illegal and must be taken off the EU market. A newly developed screening method using ultra high performance liquid chromatography-time off flight-mass spectrometry allows routine analysis of suspected products. 163 suspected skin whitening cosmetics, collected by Belgian inspectors at high risk sites such as airports and so-called ethnic cosmetic shops, were analyzed and 59% were classified as illegal. The whitening agents mostly detected were clobetasol propionate and hydroquinone, which represent a serious health risk when repeatedly and abundantly applied to the skin.

Topics: Belgium; Chromatography, High Pressure Liquid; Clobetasol; Cosmetics; Dermatologic Agents; European Union; Glucocorticoids; Humans; Hydroquinones; Legislation, Drug; Mass Spectrometry; Skin Lightening Preparations; Tretinoin

Skin irritation is one of the most common adverse reactions in hydroquinone (HQ) and retinoic acid (RA). Although melanocytes have rarely been considered to be involved in skin irritation, RA and particularly HQ could induce melanocyte toxicity, resulting in depigmentation. We chose S100B as a candidate gene for melanocytotoxicity from a genome-wide transcriptional profiling analysis after applying irritant doses of HQ, RA and sodium lauryl sulphate (SLS) to cultures of keratinocytes and/or melanocytes. In this study, the role of S100B on melanocyte viability and cytotoxicity was examined. S100B was detected in melanocytes, but not in keratinocytes or fibroblasts. Melanocytes after treatment with increasing concentrations of HQ, RA, SLS and urushiol showed significant increases in intracellular and extracellular S100B expression with reduced viable cell number and increased release of lactate dehydrogenase. No RAGE expression and no significant function of CD166/ALCAM in melanocyte survival and cytotoxicity favoured the role of intracellular S100B in chemically irritated melanocytes. S100B knock-down increased apoptosis through inhibition of PI3K/AKT, NF-κB and ERK activation, suggesting the increased intracellular S100B expression by chemical irritation as a compensatory reaction to reduce cytotoxicity. The numerical decrease in S100B/c-kit-double-positive melanocytes was also examined in human skin epidermis irritated by HQ or RA with stronger staining intensities of S100B. Collectively, the decrease in viable cell number by reduced intracellular S100B levels in vitro and by chemical irritation in vivo suggests that S100B could be a potential biomarker for melanocytes cytotoxicity.

Topics: Adult; Antigens, CD; Apoptosis; Biomarkers; Catechols; Cell Adhesion Molecules, Neuronal; Cell Survival; Cells, Cultured; Dermatologic Agents; Extracellular Signal-Regulated MAP Kinases; Female; Fetal Proteins; Fibroblasts; Gene Knockdown Techniques; Humans; Hydroquinones; Keratinocytes; L-Lactate Dehydrogenase; Male; Melanocytes; Middle Aged; NF-kappa B; Phosphatidylinositol 3-Kinases; Phosphorylation; Proto-Oncogene Proteins c-akt; Proto-Oncogene Proteins c-kit; Receptor for Advanced Glycation End Products; Receptors, Immunologic; S100 Calcium Binding Protein beta Subunit; Skin; Sodium Dodecyl Sulfate; Tretinoin

Hydroquinone (HQ) with or without retinoic acid (RA) is routinely used for the treatment of hyperpigmented conditions. Skin irritation is a major problem with popular depigmenting agents, resulting in postinflammatory hyperpigmentation.. To examine the molecular mechanism associated with skin irritation by RA or HQ.. A genome-wide transcriptional profiling analysis was performed using monolayer cultures of human keratinocytes treated with or without irritant doses of RA, HQ, or sodium lauryl sulfate (SLS), a representative irritant. Differentially expressed genes (DEGs) were mapped on human chromosomes using a Manhattan plot. For the validation of candidate DEGs, the chemicals with different concentrations of varying irritation intensities were applied in vitro and in vivo and analyzed using real time-PCR and Western blotting.. DEGs mapped to the 1q21 locus, which is composed of a cluster of genes encoding the cornified envelope precursors, showed an inverse expression pattern in response to HQ and RA. Concentrations of RA and HQ that induced a broad range of irritant responses in cultured cells or mice skin also induced inverse effects on the expression of cornified envelope-associated proteins.. Genetic modulation on cornified envelope-associated proteins by RA-induced irritation, which may be involved in physiological skin barrier disturbance, could be inverse to that by HQ- or SLS-induced irritation.

Topics: Animals; Cells, Cultured; Chromosomes, Human, Pair 1; Female; Gene Expression Profiling; Humans; Hydroquinones; Irritants; Mice; Mice, Inbred C57BL; Skin; Sodium Dodecyl Sulfate; Tretinoin

Uniaxially aligned cellulose acetate (CA) nanofibers were successfully fabricated by electrospinning and applied to use as stationary phase for thin layer chromatography. The control of alignment was achieved by using a drum collector rotating at a high speed of 6000 rpm. Spin time of 6h was used to produce the fiber thickness of about 10 μm which was adequate for good separation. Without any chemical modification after the electrospinning process, CA nanofibers could be readily devised for screening hydroquinone (HQ) and retinoic acid (RA) adulterated in cosmetics using the mobile phase consisting of 65:35:2.5 methanol/water/acetic acid. It was found that the separation run on the aligned nanofibers over a distance of 5 cm took less than 15 min which was two to three times faster than that on the non-aligned ones. On the aligned nanofibers, the masses of HQ and RA which could be visualized were 10 and 25 ng, respectively, which were two times lower than those on the non-aligned CA fibers and five times lower than those on conventional silica plates due to the appearance of darker and sharper of spots on the aligned nanofibers. Furthermore, the proposed method efficiently resolved HQ from RA and ingredients commonly found in cosmetic creams. Due to the satisfactory analytical performance, facile and inexpensive production process, uniaxially aligned electrospun CA nanofibers are promising alternative media for planar chromatography.

Topics: Cellulose; Chromatography, Thin Layer; Cosmetics; Hydroquinones; Nanofibers; Silicon Dioxide; Tretinoin

Although bleaching treatment using all-trans retinoic acid (RA) and hydroquinone (HQ) improves epidermal melanosis, the application of two medications and the irritant dermatitis induced by RA inconvenience patients. To overcome these problems, we developed a silicone sheet containing RA and HQ.. To compare the efficacy of a silicone sheet containing RA and HQ with that of conventional bleaching treatment.. Silicone sheets containing 1% RA and 5% HQ were applied at night during the bleaching phase of 4 weeks, followed by application of sheets containing 5% HQ during the healing phase of 4 weeks. Hemifacial epidermal melanosis, for which the sheets were applied, was compared with a contralateral face which was treated conventionally using RA and HQ. Twenty-four Japanese women who were enrolled in this study and followed up for more than 6 months were analyzed.. RA/HQ sheets improved epidermal melanosis, as did the conventional bleaching method, but irritant dermatitis occurred less in patients treated using silicone sheets.. RA/HQ sheets, which are easily applied to face skin, can improve epidermal melanosis to the same extent as conventional bleaching.

Topics: Adult; Aged; Antioxidants; Drug Therapy, Combination; Female; Humans; Hydroquinones; Keratolytic Agents; Lentigo; Male; Melanosis; Middle Aged; Silicones; Skin; Skin Lightening Preparations; Tretinoin

Disorders characterized by cutaneous hyperpigmentation (HP) are among the most common complaints in dermatologists' offices. These patients are also some of the most difficult to treat since current therapeutic regimens have high irritation rates and mediocre efficacy. Moreover, current regimens have the potential to induce post-inflammatory HP (PIH), a secondary disease that is more difficult to treat.. To measure the effectiveness of a novel blend of primarily natural ingredients that inhibits all but one of the steps in melanin synthesis, activation and distribution. Three common types of HP were treated and compared with one of the most commonly prescribed available regimens. This comprises two prescription products and two nonprescription products containing known depigmenting lightening ingredients.. The initial trial consisted of 56 females of 3 different races were treated in a 3-armed parallel, investigatorblinded prospective controlled clinical trial of 18 weeks duration. The treatment phase was 12 weeks long, followed by a 6 week, nontreatment regression phase. This trial was conducted in the winter at over 6,000 feet above sea level. The natural ingredient (NI) blend consists of two cosmeceutical products together containing 22 ingredients. A second 1-year open trial of 31 panelists of 3 races was instituted to document continual improvement using both NI products without irritation and sensitization.. The novel herbal blend regimens had comparable efficacy in treating HP and preventing rebound of mottled HP, dyschromia and melasma as the commercial regimen containing two prescription products. The 12-month open study demonstrated continued visible improvement of the HP with NI regimens without irritation and sensitization.. The novel primarily natural ingredient product regimens are equally effective in treating three types of cutaneous HP as is a regimen containing prescription hydroquinone 4%, tretinoin 0.05% and two nonprescription leave on products.

Topics: Adult; Biological Products; Dermatologic Agents; Female; Follow-Up Studies; Humans; Hydroquinones; Hyperpigmentation; Melanins; Melanosis; Middle Aged; Nonprescription Drugs; Prospective Studies; Single-Blind Method; Treatment Outcome; Tretinoin

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Antioxidants; Chemexfoliation; Drug Combinations; Face; Female; Fluocinolone Acetonide; Glycolates; Humans; Hydroquinones; India; Keratolytic Agents; Male; Melanosis; Middle Aged; Treatment Outcome; Tretinoin; Young Adult

Topics: Adrenal Cortex Hormones; Cosmetics; Humans; Hydroquinones; Mercury; Skin; Skin Pigmentation; Tretinoin

Topics: Abnormalities, Drug-Induced; Adrenal Cortex Hormones; Cosmetics; Female; Humans; Hydroquinones; Mercury; Pregnancy; Risk; Skin Pigmentation; Tretinoin; Wound Healing

Melasma, a disorder of facial hyperpigmentation, presents a treatment obstacle to many physicians. Combination therapy with hydroquinone, tretinoin, and fluocinolone acetonide has proven effective, but it is generally more expensive than other treatments.. To assess the cost-effectiveness of daily triple combination therapy (TCT) compared with daily use of each possible pair of agents (dyads) and twice daily use of hydroquinone (HQ) alone from a payer's perspective.. Efficacy data were obtained from two clinical trials with the primary endpoint being complete clearance at 8 weeks. For all treatments, total cost per successful treatment was calculated. The incremental cost-effectiveness ratio (ICER) was calculated for each dyad and for HQ monotherapy in comparison with TCT. Sensitivity analyses for efficacy and number of office visits were similarly performed.. TCT consistently had the lowest cost per primary success in all the analyses performed. Furthermore, ICERs were low, indicating that TCT's superior efficacy is attained at marginal cost increases. Our results indicate that TCT is the most cost-effective treatment when compared with any of its dyads or with hydroquinone alone.

Topics: Administration, Cutaneous; Clinical Trials as Topic; Cost-Benefit Analysis; Dermatologic Agents; Drug Combinations; Drug Costs; Drug Therapy, Combination; Fluocinolone Acetonide; Humans; Hydroquinones; Melanosis; Ointments; Treatment Outcome; Tretinoin; United States

Melasma is often recalcitrant to treatment. Triple combination (TC) cream is an effective and approved treatment for melasma.. We sought to determine the efficacy and safety of continuous therapy followed by a maintenance treatment regimen during a period of 24 weeks with a TC cream containing hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01%.. Seventy patients with melasma were treated with a TC cream daily for 12 weeks, after which, if clear or almost clear, they applied the cream twice per week for 12 more weeks. For patients who were not clear or almost clear after 12 weeks, daily treatment was continued.. In all, 25 patients completing the study per protocol were treated daily for 24 weeks (cohort A); 6 patients were treated daily for 12 weeks followed by 12 weeks of maintenance therapy (cohort B); and 21 patients were treated daily for 12 weeks, relapsed during the maintenance phase, and returned to daily dosing (cohort C). Pigmentation was significantly reduced at weeks 12 and 24 and global melasma severity improved at week 24 in cohorts A and C compared with baseline. Adverse events occurred in 53% of patients and were primarily mild in severity.. This was an open-label trial.. About half of patients treated with a TC cream for melasma were able to begin maintenance therapy twice per week after 12 weeks; however, relapses occurred in most of these patients, requiring resumption of daily therapy. The cream is safe in the treatment of moderate to severe melasma for up to 24 weeks when used intermittently or continuously. Significant reductions in melasma severity scores were seen at weeks 12 and 24 when compared with baseline scores in all evaluable study groups.

Topics: Administration, Topical; Adolescent; Adult; Aged; Drug Administration Schedule; Drug Combinations; Female; Fluocinolone Acetonide; Humans; Hydroquinones; Male; Melanosis; Middle Aged; Ointments; Skin Pigmentation; Tretinoin; Young Adult

Topics: Acanthosis Nigricans; Administration, Topical; Adult; Drug Combinations; Female; Fluocinolone Acetonide; Humans; Hydroquinones; Treatment Outcome; Tretinoin

Topics: Administration, Cutaneous; Adolescent; Drug Combinations; Hand; Humans; Hydroquinones; Lasers, Solid-State; Male; Melanocytes; Mometasone Furoate; Pigmentation Disorders; Pregnadienediols; Skin; Treatment Outcome; Tretinoin

Hyperpigmentation has frustrated men and women as a cosmetic concern and as a reminder of past skin injury. While photoprotection is an important part of preventing dark marks on skin, therapeutic interventions are important as well. The authors review new treatment data for fractional thermolysis,Tri-Luma, azelaic acid and chemical peels. Many therapies have been available for years, although evidence is not always extensive. The emergence of new treatments and long-term safety data offers dermatologists a greater degree of confidence as to the treatment approaches they can offer patients with hyperpigmentation.

Topics: Chemexfoliation; Dermatologic Agents; Dicarboxylic Acids; Fluocinolone Acetonide; Humans; Hydroquinones; Hyperpigmentation; Laser Therapy; Tretinoin

Hyperpigmentation is the most common cosmetic skin complaint in Asians, but there is no standard treatment strategy. The aim of this study was to establish a simple therapeutic strategy based on the histological features of hyperpigmented skin lesions in Asians. Fifty-nine biopsies were analysed from 49 Japanese patients with 17 types of hyperpigmented skin lesions. In 10 patients, skin samples were also taken during a topical bleaching treatment that used tretinoin and hydroquinone. These samples were evaluated after staining with haematoxylin-eosin and Fontana-Masson stains. Our experience of treating a variety of pigmented lesions with aggressive topical bleaching and lasers was reviewed. Hyperpigmented lesions were classified into seven categories based on pathological features, especially on the degree of hyperkeratosis and epidermal melanin deposits, and on the existence of melanin incontinence and the location of dermal melanocytes. Tretinoin and hydroquinone therapy was histologically effective for treating epidermal melanin deposits, but not dermal melanosis or dermal melanocytes. Based on pathological features and our extensive clinical experience with hyperpigmented skin, we propose a therapeutic strategy for treating hyperpigmented skin lesions, which may be particularly useful in Asian populations.

Topics: Administration, Topical; Adolescent; Adult; Asian People; Biopsy; Combined Modality Therapy; Dermatologic Agents; Female; Humans; Hydroquinones; Hyperpigmentation; Laser Therapy; Male; Melanins; Middle Aged; Skin; Tretinoin; Young Adult

Periorbital skin hyperpigmentation, so-called dark circles, is of major concern for many people. However, only a few reports refer to the morbidity and treatment, and as far as the authors know, there are no reports of the condition in Asians.. A total of 18 Japanese patients underwent combined therapy using Q-switched ruby laser to eliminate dermal pigmentation following topical bleaching treatment with tretinoin aqueous gel and hydroquinone ointment performed initially (6 weeks) to reduce epidermal melanin. Both steps were repeated two to four times until physical clearance of the pigmentation was confirmed and patient satisfaction was achieved. Skin biopsy was performed at baseline in each patient and at the end of treatment in three patients, all with informed consent. Clinical and histologic appearances of periorbital hyperpigmentation were evaluated and rated as excellent, good, fair, poor, or default.. Seven of 18 patients (38.9 percent) showed excellent clearing after treatment and eight (44.4 percent) were rated good. Only one (5.6 percent) was rated fair and none was rated poor. Postinflammatory hyperpigmentation was observed in only two patients (11.1 percent). Histologic examination showed obvious epidermal hyperpigmentation in 10 specimens. Dermal pigmentation was observed in all specimens but was not considered to be melanocytosis. Remarkable reduction of dermal pigmentation was observed in the biopsy specimens of three patients after treatment.. The new treatment protocol combining Q-switched ruby laser and topical bleaching treatment using tretinoin and hydroquinone is considered effective for improvement of periorbital skin hyperpigmentation, with a low incidence of postinflammatory hyperpigmentation.

Topics: Administration, Topical; Adult; Asian People; Dermatologic Agents; Eyelids; Female; Humans; Hydroquinones; Hyperpigmentation; Laser Therapy; Lasers; Male; Middle Aged; Ointments; Skin Pigmentation; Tretinoin

The dermatologist has a variety of tools for improving the appearance of aging skin. These include injectable botulinum toxins and dermal fillers, laser treatments, chemical peels, and various topical agents, including cosmeceuticals. A combined approach using more than one facial rejuvenation tool is considered ideal for many patients, as it targets the various areas of the face and numerous dynamic and static changes associated with aging. A topical cosmeceutical regimen, such as one containing tretinoin and hydroquinone, can enhance the effects of facial rejuvenation procedures and encourage patients to adopt a daily cleansing and rejuvenation regimen that they can continue after the procedure to help maintain the aesthetic effects.

Topics: Administration, Topical; Antioxidants; Botulinum Toxins, Type A; Cosmetic Techniques; Drug Combinations; Esthetics; Face; Humans; Hydroquinones; Keratolytic Agents; Laser Therapy; Rejuvenation; Skin; Skin Aging; Tretinoin

Melasma (cloasma) is a typical hypermelanosis and a common dermatologic skin disease that involves sun-exposed areas of the skin. It mostly affects women of reproductive age. Solar and ultraviolet exposure are the most crucial etiologic factors. Pregnancy, certain endocrine disorders and hormonal treatments, cosmetics, phototoxic drugs, and antiseizure medications are well-known inducing and exacerbating factors. A classification of melasma is based on Wood's light examination, classifying it in four major clinical types and patterns: epidermal, dermal, mixed, and indeterminate. Different treatment options are currently available for melasma. The choice of proper treatment should take into account the type of melasma to be treated, the skin complexion of the patient, possible previous treatments, the expectations and compliance of the patient, and the season in which the treatment is started.

Topics: Chemexfoliation; Cosmetics; Dermatologic Agents; Dicarboxylic Acids; Drug Combinations; Humans; Hydroquinones; Hydroxybenzoates; Laser Therapy; Melanosis; Pyrones; Tretinoin

Melasma is a common disorder of hyperpigmentation typically characterized by relatively symmetric brown or gray-brown patches on sun-exposed facial areas. Treating melasma is challenging because of the prolonged time to response and the substantial relapse rate when therapy is discontinued. The objective of this 12-week study was to compare the clinical efficacy and tolerability of 3 hydroquinone 4%-containing creams in the treatment of melasma. The 3 creams were cream A (microencapsulated hydroquinone 4% and retinol 0.15% with antioxidants); cream B (hydroquinone 4% and retinol 0.3% with antioxidants); and cream C (fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%). This 2-arm, split-face, right-left bilateral, evaluator-blinded study compared cream A and cream B in treatment arm 1, and cream A and cream C in treatment arm 2. Evaluator-blinded study assessments were conducted at baseline and weeks 4, 8, and 12. Results from treatment arm 1 demonstrated that at weeks 8 and 12, treatment with cream A showed statistically significant improvements over cream B in the efficacy assessments of overall disease severity (week 8, P=.005; week 12, P=.028), lesion area (week 8, P=.005; week 12, P=.003), pigmentation intensity (week 8, P=.012; week 12, P=.012), and Melasma Area and Severity Index (MASI) score (week 8, P= .002; week 12, P= .012). Results from treatment arm 2 demonstrated that at weeks 4 and 8, treatment with cream A was similar to cream C in the efficacy assessments of overall disease severity, lesion area, pigmentation intensity, MASI score, and global evaluation of response to treatment. At week 12, cream A continued to demonstrate sustained improvements in each of the above efficacy assessments; however, cream C showed a decrease in improvement of these efficacy assessments because subjects were switched to placebo for the last 4 weeks of treatment. All 3 treatments were well-tolerated. These data confirm previous findings that the unique delivery system of microencapsulated hydroquinone 4% and retinol 0.15% with antioxidants is safe and effective for use in treating melasma, and the data show that this novel nonsteroidal product should be considered when weighing long-term treatment options.

Topics: Administration, Topical; Adult; Antioxidants; Female; Fluocinolone Acetonide; Humans; Hydroquinones; Melanosis; Middle Aged; Treatment Outcome; Tretinoin; Vitamin A

Melasma and acquired dermal melanocytosis (ADM; acquired bilateral nevus of Ota-like macules) are both seen most commonly symmetrically on the face of women with darker skin and are also known as difficult conditions to treat.. Our topical bleaching protocol with 0.1 to 0.4% tretinoin gel and 5% hydroquinone was performed repeatedly (1-3 times) for melasma (n=163), and a combination treatment with topical bleaching and Q-switched ruby (QSR) laser was performed repeatedly (1-3 times) for ADM (n=62).. There is a significant correlation between clinical results (clearance of pigmentation) and the number of sessions in both melasma (p=.019) and ADM (p<.0001).. The repeated treatment protocol for melasma and ADM showed successful clinical results compared with conventional ones, and they may be applied to other pigment conditions. It may be better that epidermal and dermal pigmentations are treated separately, especially in dark-skinned people who are more likely to suffer postinflammatory hyperpigmentation after inflammation-inducing therapies.

Topics: Adult; Antioxidants; Asian People; Combined Modality Therapy; Drug Therapy, Combination; Facial Neoplasms; Female; Follow-Up Studies; Humans; Hydroquinones; Keratolytic Agents; Low-Level Light Therapy; Male; Melanosis; Middle Aged; Nevus, Pigmented; Retreatment; Skin Neoplasms; Treatment Outcome; Tretinoin

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

Pigmentation disorders, such as melasma, greatly influence the quality of life (QoL) of affected individuals who usually consider the disorder to be more severe than the objective clinical scores. Several instruments have been successfully developed to evaluate QoL. However, they must be adapted to the target population in terms of language and cultural diversity. The first, specific QoL questionnaire for melasma (MelasQoL) was developed for English speaking patients.. To validate the Brazilian Portuguese version of the MelasQoL evaluation questionnaire for patients with melasma (MelasQoL-BP) and to assess the impact of treatment with a triple combination cream (hydroquinone, fluocinolone acetonide and tretinoin) on the QoL of patients with moderate-to-severe melasma.. Three hundred individuals from the five Brazilian geographic regions took part in this multicentre study. Their mean age was 42 years and skin phototype distribution was: type II 7.0% of patients, III 23.7%, IV 42.7% and V 22.7%. Melasma Area and Severity Index (MASI), MelasQoL-BP and the short version of the QoL assessment instrument from the World Health Organization (WHOQOL-BREF) were used to assess melasma severity and QoL at baseline. MelasQoL-BP was previously translated and culturally adapted from the English version, with participation of the authors and according to the standards of the World Health Organization (WHO). From the original sample, we randomized150 volunteers to treat melasma and repeated the evaluation after 8 weeks. The analysis of the MelasQoL-BP baseline answers demonstrated an important impact of the disease on skin appearance (65% of patients were bothered all the time or most of the time), frustration (55%), embarrassment (57%) and influence of the disease on interpersonal relationships (42%). Forty-three per cent of patients felt not attractive or even dirty due to their skin condition. MelasQoL-BP results showed significant internal consistency (Cronbach's alpha coefficient 0.919; P < 0.001) and good correlation with MASI scores. After treatment, the global assessment showed good or excellent results in 91.4% of the patients. The clinical outcome was not associated with the initial MASI score (P = 0.814; chi-square), skin colour (P = 0.449; probability ratio) or skin pigmentation (P = 0.814; chi-square). There was also a significant reduction on MelasQoL-BP scores (Wilcoxon test; P < 0.001) after treatment, with the mean +/- SD results shifting from 44.4 +/- 14.9 at baseline to 24.3 +/- 15.5 after treatment. The analysis of the MelasQoL-BP before and after treatment showed an important effect of the impact of treatment on a number of QoL measures. Of note, skin appearance (69.8 vs. 10.1% of patients were bothered all the time or most of the time, respectively), frustration (59.7% vs. 12.2%, respectively), embarrassment (56% vs. 9.3%, respectively) and influence of the disease on interpersonal relationships (35.3% vs. 5.8%, respectively) were greatly improved.. This study demonstrates that MelasQoL-BP is a valid instrument and can be used to evaluate the quality of life and response to melasma treatment in Brazilian patients. The triple combination treatment produced significant results, regarding both clinical severity and quality of life.

Topics: Adult; Drug Therapy, Combination; Female; Fluocinolone Acetonide; Glucocorticoids; Humans; Hydroquinones; Keratolytic Agents; Language; Male; Melanosis; Middle Aged; Psychiatric Status Rating Scales; Quality of Life; Reproducibility of Results; Surveys and Questionnaires; Tretinoin

Topics: Administration, Topical; Dermatologic Agents; Dexamethasone; Drug Combinations; Humans; Hydroquinones; Melanosis; Treatment Outcome; Tretinoin

Many of the well-known depigmenting agents such as hydroquinone and 4-hydroxyanisole are, in fact, melanocytotoxic chemicals which are oxidized in melanocytes to produce highly toxic compounds such as quinones. These cytotoxic compounds are responsible for the destruction of pigment cells, which results in skin depigmentation. However, cells are capable of protecting themselves against cytotoxic agents by intracellular glutathione (GSH). This protection takes place under the enzymatic action of the detoxification enzyme glutathione S-transferase (GST), which is responsible for the conjugation of toxic species to GSH. The depigmenting effect of hydroquinone is shown to be potentiated by buthionine sulfoximine (BSO) and cystamine as the result of the reduction of intracellular levels of GSH by these two agents. Additionally, BSO and cystamine are shown to inhibit the activity of GST. The combination of all-trans-retinoic acid (tretinoin, TRA) with hydroquinone or 4-hydroxyanisole is also known to produce synergetic skin depigmentation. TRA serves as a potent inhibitor of mammalian GSTs and is known to make cells more susceptible to the cytotoxic effect of chemicals by inhibiting the activity of this enzyme. This agent is also shown to reduce the level of intracellular GSH in certain cells. We have proposed that the mechanism of action of TRA to synergistically enhance the melanocytotoxic effect of chemicals involves the inhibition of GST and the impairment of glutathione-dependent cytoprotection against melanocytotoxic agents.

Topics: Animals; Anisoles; Drug Therapy, Combination; Enzyme Inhibitors; Glutathione; Glutathione Transferase; Guinea Pigs; Humans; Hydroquinones; Keratolytic Agents; Melanocytes; Skin Pigmentation; Swine; Tretinoin

Hydroquinone has been successfully used to treat hyperpigmentation disorders for many years. Recently, new formulations containing hydroquinone have become available, including Lustra and Lustra-AF (Medicis). These products also contain glycolic acid 2%, an active antioxidant system (ascorbyl palmitate and tocopherol acetate), and moisturizers. Lustra-AF also contains a broad-spectrum sunscreen. Alustra contains a stabilized, high-concentration of retinol. The above formulations inhibit melanogenesis, stimulate epidermal desquamation, inhibit free radical-mediated photodamage and restore the antioxidant reservoir. The addition of retinoids may facilitate epidermal penetration of hydroquinone and prevent its oxidation. Comparative studies have shown that these agents can be effective in reducing blotchiness, mottled hyperpigmentation, post-inflammatory hyperpigmentation, and surface roughness. In addition, these formulations have been generally well tolerated with patients rarely reporting mild-to-moderate adverse events such as dryness, redness, or peeling of the skin.

Topics: Drug Therapy, Combination; Humans; Hydroquinones; Hyperpigmentation; Melanosis; Tretinoin

Acquired dermal melanocytosis (ADM; acquired bilateral nevus of Ota-like macules) is known for its recalcitrance compared with Nevus of Ota, and we assume that one of the reasons is a higher rate and degree of postinflammatory hyperpigmentation (PIH) seen after laser treatments.. Topical bleaching treatment with 0.1% tretinoin aqueous gel and 5% hydroquinone ointment containing 7% lactic acid was initially performed (4 to 6 weeks) to discharge epidermal melanin. Subsequently, Q-switched ruby (QSR) laser was irradiated to eliminate dermal pigmentation. Both steps were repeated two to three times until patient satisfaction was obtained (usually at a 2-month interval for laser sessions). This treatment was performed in 19 patients with ADM. Skin biopsy was performed in six cases at baseline, after the bleaching pretreatment, and at the end of treatment.. All patients showed good to excellent clearing after two to three sessions of QSR laser treatments. The total treatment period ranged from 3 to 13 (mean of 8.3) months. PIH was observed in 10.5% of the cases. Histologically, epidermal hyperpigmentation was observed in all specimens and was dramatically improved by the topical bleaching pretreatment.. QSR laser combined with the topical bleaching pretreatment appeared to treat ADM consistently with a low occurrence rate of PIH and lessen the number of laser sessions and total treatment period and may also be applied to any other lesions with both epidermal and dermal pigmentation.

Topics: Adolescent; Adult; Combined Modality Therapy; Dermatologic Agents; Female; Humans; Hydroquinones; Hyperpigmentation; Laser Therapy; Middle Aged; Nevus, Pigmented; Treatment Outcome; Tretinoin

A successful treatment to improve the color of nipple-areola complex (NAC) has never been reported, although the number of women seeking the more attractively colored NAC is not small.. To determine the effectiveness of our bleaching protocol for cosmetic improvement of the NAC.. The protocol was composed of two phases: bleaching phase (4-8 weeks) and healing phase (4-6 weeks). 0.2-0.4% tretinoin aqueous gel was applied concomitantly with 5% hydroquinone, 7% lactic acid ointment for bleaching twice a day. Tretinoin was applied to the NAC with a small cotton applicator, while hydroquinone was widely applied beyond the NAC area. After obtaining sufficient improvement in NAC color, the application of tretinoin was discontinued and hydroquinone alone was continually applied in the healing phase until the reactive erythema was eliminated. Fifteen female patients were involved in this study.. The average treatment period was 16.6 weeks. Improvement of NAC color was obtained in 12 patients (80%) by the physician's estimation, and 11 patients (73%) satisfied with their final results. The treatment was repeated after a 1-month interval of tretinoin application in 4 patients: 2 desired further improvement in color, and 2 had the second course conducted to treat the postinflammatory hyperpigmentation on the surrounding mound induced by the first course.. This approach appeared to be most effective for cosmetic improvement of NAC color among treatments available so far.

Topics: Administration, Cutaneous; Adolescent; Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Gels; Humans; Hydroquinones; Hyperpigmentation; Keratolytic Agents; Nipples; Treatment Outcome; Tretinoin

Topics: Adult; Anti-Inflammatory Agents; Antioxidants; Clinical Trials as Topic; Drug Combinations; Female; Humans; Hydroquinones; Keratolytic Agents; Melanosis; Middle Aged; Retrospective Studies; Skin; Treatment Outcome; Tretinoin; Triamcinolone

The effects of all-trans retinoic acid (RA) on melanogenesis and the mechanism of its action in topical treatment have not been elucidated. The purpose of this study was to determine the effects of RA on melanogenesis in the pigmented skin equivalent as well as in monolayer culture of melanocytes, and to determine whether RA, hydroquinone (HQ), and hydrocortisone (HC) show synergistic depigmenting effects in combined treatments of each other. The suppressing effect of RA on melanogenesis was not observed in pigmented skin equivalents and monolayer culture of murine and human melanocytes, although HQ showed strong inhibition of melanogenesis. The synergistic effects between RA, HQ, and HC were not particularly seen. The results suggested that RA neither has direct inhibitory effects on melanogenesis of melanocytes, nor influences the cell-cell interactions between melanocytes, keratinocytes and fibroblasts, such as paracrine actions with regard to melanin production. The role of RA in bleaching treatments appears to be in other specific actions, such as promotion of keratinocytes proliferation and acceleration of epidermal turnover.

Topics: Animals; Cell Line; Cells, Cultured; Drug Synergism; Humans; Hydrocortisone; Hydroquinones; Keratolytic Agents; Melanins; Melanocytes; Mice; Monophenol Monooxygenase; Skin; Skin Pigmentation; Tretinoin

Although a variety of topical treatments have been used for skin hyperpigmentation, the effectiveness of each varies after prolonged treatment. In this study, 136 Oriental patients who were followed up for more than 12 weeks were analyzed. The treatment protocol was composed of two steps: bleaching (2 to 6 weeks) and healing (2 to 6 weeks); 0.1% to 0.4% all-trans retinoic acid aqueous gel was originally prepared and applied concomitantly with hydroquinone-lactic acid ointment for bleaching. After obtaining sufficient improvement of the hyperpigmentation, a corticosteroid was applied topically with hydroquinone and ascorbic acid for healing. Improvement was evaluated with a narrow-band reflectance spectrophotometer. The results were successful in more than 80 percent of cases of senile lentigines and postinflammatory hyperpigmentations, especially on the face. Sixty percent of cases of nevus spilus were also successfully treated. Although the transient adverse effects of this treatment may be more severe than conventional treatment, this strong bleaching protocol improves a variety of hyperpigmented lesions, including nevus spilus, with a higher success rate and a shorter treatment period than conventional protocols.

Topics: Administration, Topical; Adolescent; Adult; Asian People; Female; Gels; Humans; Hydroquinones; Hyperpigmentation; Keratolytic Agents; Male; Middle Aged; Ointments; Tretinoin

Topical hydroquinone is used in the treatment of a number of skin conditions. A 33-year-old male presented with brown discolouration of the fingernails following the application of 4% hydroquinone in sorbolene cream and 0.1% tretinoin cream to the face intermittently for 9 months. The discolouration resolved when the creams were ceased.

Topics: Administration, Topical; Adult; Coloring Agents; Facial Dermatoses; Follow-Up Studies; Humans; Hydroquinones; Hyperpigmentation; Male; Nail Diseases; Tretinoin

Postinflammatory hyperpigmentation (PIHP) is a frequently encountered problem in many cosmetic procedures. The treatment of PIHP is difficult and remains a challenge.. To treat a patient who developed multiple hyperpigmented macules on her thighs due to sun exposure after treatment of unwanted hair using a normal-mode ruby pulse laser.. The patient was treated daily with tretinoin (Retin A) 0.1% cream, triamcinolone 0.1% cream, and hydroquinone 4% cream with sunscreen (Solaquin forte), and was to avoid sun exposure. Several sites received monthly treatment of 40% trichloroacetic acid (TCA). The degree of clinical improvement of the hyperpigmentation was assessed by both the physician and the patient.. Cosmetic results were fair. The amount of hair in her thighs was reduced but the PIHP responded only slightly to therapy.. To our knowledge this is the first case of solar-induced PIHP following laser hair removal. The treatment of PIHP is difficult because there are few therapeutic options that are consistently successful. Avoidance of exposure to ultraviolet light should be emphasized to all patients prior to laser therapy. We demonstrated that serial TCA peels provided an additional benefit compared to medical treatment.

Topics: Administration, Topical; Adult; Drug Therapy, Combination; Hair Removal; Humans; Hydroquinones; Hyperpigmentation; Hypertrichosis; Laser Therapy; Sunlight; Sunscreening Agents; Tretinoin; Triamcinolone; Trichloroacetic Acid

Topics: Erythema; Glycolates; Humans; Hydroquinones; Keratolytic Agents; Laser Therapy; Lasers; Pigmentation Disorders; Radiation-Protective Agents; Randomized Controlled Trials as Topic; Time Factors; Tretinoin

The APP gene promoter has multiple regulatory sequences, some of which may contribute to the neuropathology of Alzheimer's disease (AD). In this study, we investigated the effects of phorbol ester (PMA), IL-1, retinoic acid and reactive oxygen species on APP promoter activity in primary hippocampal neurons. We transfected neurons with either of two APP promoter constructs, a -2.8 kb and a shorter -488 bp upstream fragment fused to the chloramphenicol transferase (CAT) reporter gene. We demonstrated that phorbol 12-myristate-13 acetate (PMA), retinoic acid and IL-1 all stimulated both APP promoter constructs in hippocampal neurons after 24 h treatment. PMA and IL-1 treatments led to 2-fold increases of APP promoter activity. Retinoic acid induced a 3-fold increase. In addition, the magnitude of APP promoter responses to PMA and IL-1 treatment was similar between APP -2.8 kb and -488 bp plasmid transfected neurons. This suggests that the AP-1 sequence at -350 to -344 in the APP promoter may mediate the stimulatory effects of PMA and IL-1, as previously observed in endothelial and HeLa cells. In contrast, hydrogen peroxide, which was shown to activate NF-kappaB in primary neurons, failed to stimulate APP promoter activity, suggesting that the regulatory elements in the APP promoter may not respond to reactive oxygen species. Overall, these data indicate that APP expression in primary neurons can be modulated by PMA, IL-1 and retinoic acid. However, the contribution of reactive oxygen to Alzheimer's disease may not be directly related to the activation of the APP gene promoter but instead to neuronal damage associated with oxidative stress. Since elevated levels of IL-1 have been observed in AD brain, IL-1 could contribute to development of Alzheimer's disease by stimulating APP synthesis in primary neurons.

Topics: Amyloid beta-Protein Precursor; Animals; Antineoplastic Agents; Benzoflavones; Carcinogens; Cation Exchange Resins; Cell Survival; Cells, Cultured; Curcumin; DNA; Gene Expression Regulation; Hippocampus; Hydrogen Peroxide; Hydroquinones; Indicators and Reagents; Interleukin-1; Lipids; Mutagens; Neurons; NF-kappa B; Phorbol Esters; Promoter Regions, Genetic; Rats; Reactive Oxygen Species; Transfection; Tretinoin; Tumor Necrosis Factor-alpha

Eleven female patients are reported who underwent full-face resurfacing. Three patients were treated for cosmetic rhytids, five for residual acne scarring, and three for photoaging. There were no complications or side effects in this group of patients. Reepithelialization was achieved in an average of 9.3 days, and erythema disappeared in an average of 8.9 weeks. The UltraPulse carbon dioxide laser with computerized pattern generator (CPG) scanner allows a rapid, uniform laserbrasion. The sequence of the procedure involves close application of adjacent squares at 60 W, 200 to 300 ml, at moderate density. Skin preparation with Retin-A and bleaching agents is important for best wound healing. Postoperative wound care includes maintenance of a moist environment and Zovirax for herpes prophylaxis.

Topics: Acne Vulgaris; Acyclovir; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Antiviral Agents; Carbon Dioxide; Cicatrix; Dexamethasone; Epithelium; Erythema; Facial Dermatoses; Female; Follow-Up Studies; Glycolates; Herpesviridae Infections; Humans; Hydroquinones; Keratolytic Agents; Laser Therapy; Middle Aged; Radiation-Protective Agents; Rhytidoplasty; Skin Aging; Skin Care; Therapy, Computer-Assisted; Tretinoin; Wound Healing

Reactive metabolites of benzene (BZ) play important roles in BZ-induced hematotoxicity. Although reactive metabolites of BZ covalently bind to DNA, the significance of DNA adduct formation in the mechanism of BZ toxicity is not clear. These studies investigated the covalent binding of the BZ metabolites hydroquinone(HQ) and 1,2,4-benzenetriol(BT) using the DNA [32P]postlabeling method and explored the potential relationship between DNA adduct formation and cell differentiation in human promyelocytic leukemia (HL-60) cells, a model system for studying hematopoiesis. Maturation of HL-60 cells to granulocytes, as assessed by light and electron microscopy, was significantly inhibited in cells that were pretreated with HQ or BT prior to inducing differentiation with retinoic acid (RA). The capacity of RA-induced cells to phagocytose sheep red blood cells (RBC) and to reduce nitroblue tetrazolium (NBT), two functional parameters characteristic of mature, differentiated neutrophils, was also inhibited in cells pretreated with HQ or BT. These BZ metabolite treatments induced DNA adduct formation in HQ- but not in BT-treated cells. These results indicate that whereas HQ and BT each block granulocytic differentiation in HL-60 cells, DNA adducts were observed only following HQ treatment. Thus DNA adduct formation may be important in HQ but not in BT toxicity.

Topics: Benzene Derivatives; Cell Death; Cell Differentiation; Cell Division; DNA; DNA Adducts; Granulocytes; HL-60 Cells; Humans; Hydroquinones; Leukemia, Myeloid; Mutagens; Phosphorus Radioisotopes; Tretinoin

Chronic exposure of humans to benzene has been shown to have a cytotoxic effect on hematopoietic progenitor cells in intermediate stages of differentiation, which can lead to aplastic anemia and acute myelogenous leukemia. We studied the effect of hydroquinone (HQ), a toxic metabolite of benzene found in the bone marrow, on the human promyelocytic leukemia cell line (HL-60), which can be induced to differentiate to both monocyte and myeloid cells, and thus has been used as a surrogate for a granulocyte/macrophage progenitor cell. Exposure of HL-60 cells to noncytotoxic concentrations of HQ for 3 hours before induction with phorbol myristate acetate (TPA) caused a dose-dependent inhibition of the acquisition of characteristics of monocytic differentiation, such as adherence, nonspecific esterase (NSE) activity, and phagocytosis, but had no effect on cell proliferation. HQ appeared to be affecting maturation beyond the monoblast/promonocyte stages. HQ also prevented differentiation induced by 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3]; however, the block occurred after the acquisition of adherence. HQ at concentrations that inhibited monocytic differentiation had no effect on differentiation to granulocytes, suggesting that the block in the differentiation of these bipotential cells is a step unique to the monocytic pathway. HQ was unable to prevent differentiation induced by the macrophage-derived cytokine, interleukin (IL)-1, a differentiation factor for cells of the monocytic lineage.

Topics: Benzene Derivatives; Benzoquinones; Calcitriol; Cell Differentiation; Dose-Response Relationship, Drug; Granulocytes; Humans; Hydroquinones; In Vitro Techniques; Interleukin-1; Leukemia, Promyelocytic, Acute; Macrophages; Monocytes; Tetradecanoylphorbol Acetate; Tretinoin; Tumor Cells, Cultured

Several reports have demonstrated that exposure to ultraviolet light elicits increased pigmentation in the skin of the Skh:HR2 mouse. We have reexamined this model to assess its potential as a screen for compounds with skin-depigmenting activity. The application of the previously reported ultraviolet light-B (UVB) doses led to marked necrotic damage to the skin which greatly diminished the usefulness of the model for drug testing. We have modified this model by exposing the mice to a progressively increasing dose of UVB that promotes pigmentation with a marked reduction of skin irritation. Furthermore, for compound evaluation, we preselected only those mice which developed signs of increased pigmentation after the first week of UVB exposure. This was critical for any meaningful compound evaluation, since only about 50% of the mice eventually showed signs of increased pigmentation with UVB. Our modifications make it possible to use this model for evaluating new compounds with skin-depigmenting activity. The validity of this method has been examined with a number of compounds including hydroquinone, 4-hydroxyanisole, kojic acid and all-trans retinoic acid, all with known depigmenting activity.

Topics: Animals; Anisoles; Female; Hydroquinones; Mice; Mice, Hairless; Pyrones; Skin; Skin Pigmentation; Tretinoin; Ultraviolet Rays