tretinoin and Hyperpigmentation

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

Skin disorders associated with photodamage from ultraviolet light include wrinkles, hyperpigmentation, tactile roughness, and telangiectasia, and are more common in people with white compared with other skin types. Wrinkles are also associated with aging, hormonal status, smoking, and intercurrent disease.. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to prevent and treat skin wrinkles? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found 20 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: carbon dioxide laser, chemical peel, dermabrasion, facelifts, glycolic acid, isotretinoin, lactic acid, natural cartilage polysaccharides (oral or topical), retinyl esters, sunscreens, tazarotene, tretinoin, variable pulse erbium:YAG laser, and vitamin C or E (topical).

Topics: Administration, Oral; Humans; Hyperpigmentation; Isotretinoin; Rhytidoplasty; Skin Aging; Tretinoin

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

A major issue in treating acne in individuals of color is the need to treat and prevent postinflammatory hyperpigmentation (PIH), which is common in this population. This subset analysis reports the pigmentary changes in subjects of color with acne who were enrolled in a community-based trial comparing 3 different topical therapeutic regimens. All subjects received combination clindamycin 1%-benzoyl peroxide (BPO) 5% topical gel containing glycerin and dimethicone. Subjects were randomized to receive this combination therapy in addition to either a tretinoin microsphere (RAM) gel at concentrations of either 0.04% or 0.1% or adapalene (AP) gel 0.1%. There was a trend toward better resolution of hyperpigmentation in the subjects receiving the clindamycin-BPO topical gel in combination with RAM gel 0.04%.

Topics: Acne Vulgaris; Adapalene; Anti-Bacterial Agents; Asian People; Benzoyl Peroxide; Black or African American; Clindamycin; Dermatologic Agents; Dimethylpolysiloxanes; Drug Combinations; Drug Therapy, Combination; Glycerol; Hispanic or Latino; Humans; Hyperpigmentation; Keratolytic Agents; Naphthalenes; Randomized Controlled Trials as Topic; Skin Pigmentation; 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

Narrowband UV-B (NBUVB) phototherapy is the mainstay of vitiligo treatment, but hyperpigmentation is one of the limitations. Meanwhile, topical tretinoin is effective against pigmentary disorders.. To determine whether tretinoin 0.05% cream would prevent hyperpigmentation when patients with facial vitiligo underwent phototherapy.. A randomized, controlled, split-face trial was conducted. Adult patients with stable, non-segmental facial vitiligo were enrolled. The left/right sides of the face were randomly allocated to receive either topical tretinoin 0.05% cream or moisturizer twice daily. The entire face was subjected to NBUVB phototherapy twice weekly for 12 weeks. The degree of hyperpigmentation was assessed as the delta L* (brightness) value of the darkest spot in each side of the face at baseline and every 4 weeks. The degree of repigmentation was assessed.. Twenty-five patients were enrolled; 21 completed the study. The delta L* value was significantly different between the two groups: -0.5% in the tretinoin group and -8.7% in the control group at 12 weeks (. Tretinoin 0.05% cream prevented hyperpigmentation during NBUVB phototherapy in patients with facial vitiligo, and did not compromise the overall treatment response.. ClinicalTrials.gov NCT03933774.

Topics: Adult; Humans; Hyperpigmentation; Phototherapy; Treatment Outcome; Tretinoin; Ultraviolet Therapy; Vitiligo

Acne vulgaris (acne) is the most common dermatologic disorder seen in black patients. However, data are lacking on the effects of treatments, such as topical retinoids. Acne in black patients is frequently associated with postinflammatory hyperpigmentation (PIH), which can be of greater concern than the patient's acne and often is the main reason these patients seek a dermatologist consultation. Retinoids can treat both acne and PIH. However, the potential for retinoids to induce an irritant contact dermatitis, which could lead to PIH, is a concern. A lotion formulation of tretinoin was developed to provide an important alternative option to treat acne in black patients who may be sensitive to the irritant effects of other tretinoin formulations or where PIH is a concern.

Topics: Acne Vulgaris; Administration, Cutaneous; Adolescent; Adult; Black People; Child; Dermatologic Agents; Double-Blind Method; Female; Follow-Up Studies; Humans; Hyperpigmentation; Male; Middle Aged; Severity of Illness Index; Skin Cream; Tretinoin; Young Adult

Postinflammatory hyperpigmentation (PIH) is an acquired hyperpigmentation that involves areas of prior cutaneous inflammation. In addition to prevention, there are a variety of medications and procedures used to treat PIH.. The aim of this work was to evaluate the efficacy, tolerability, and safety of salicylic acid peeling in comparison with topical tretinoin in the treatment of PIH.. This study included forty-five patients with PIH lesions. The patients were divided into three groups, group I was treated with salicylic acid peeling 20-30%, group II was treated with topical tretinoin 0.1%, and group III was treated with combination of salicylic acid peel and topical tretinoin. The patients were assessed clinically to evaluate the efficacy, tolerability, and safety of the treatment. Dermoscopy was carried out to the recurrent or nonimproved cases only.. Combination of salicylic acid peel and topical tretinoin treatment showed significant clinical improvement of PIH than each treatment alone with no complications. There was no significant difference in the recurrence rate between the three groups. There was nonsignificant difference between the efficacy of the treatment and the PIH type in the studied groups. There was nonsignificant difference between the efficacy of the treatment and the duration of the PIH except for group III.. Combination treatment modality is believed to be preferred in the treatment of PIH due to its higher efficacy than single treatment alone, with well tolerability, less side effects, and low recurrence rate.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Chemexfoliation; Child; Combined Modality Therapy; Dermoscopy; Female; Humans; Hyperpigmentation; Inflammation; Keratolytic Agents; Male; Middle Aged; Salicylic Acid; 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

Hyperpigmentation is a common concern and has many causes including lentigines and melasma. Currently available topical products for hyperpigmentation are limited by their potential for irritation, lack of demonstrated efficacy or regulatory concerns.. To compare the efficacy of a new skin lightening product with and without iontophoresis to a known effective product (tretinoin) and placebo on hyperpigmentation caused by lentigines and/or melasma. Secondary objectives included an assessment of the product's effects on the appearance of rhytides and roughness.. Eighty subjects were randomized into one of four treatment groups: proprietary lightening product, proprietary lightening product with iontophoresis, tretinoin 0.05% cream, or vehicle control. Seventy-four subjects completed all study visits. Blinded assessments of subjects were performed at each visit under ambient and Wood's light.. The proprietary skin lightening product improved facial hyperpigmentation versus placebo under ambient light (P= 0.05) and Wood's lamp (P= 0.01) examination. Tretinoin also improved facial hyperpigmentation versus placebo under Wood's lamp (P= 0.01). The proprietary product was better tolerated than tretinoin, with fewer subject reported side effects.. The investigational product was effective and may be better tolerated than tretinoin cream.

Topics: Adult; Dermatologic Agents; Female; Humans; Hyperpigmentation; Iontophoresis; Lentigo; Melanosis; Middle Aged; Single-Blind Method; Skin Aging; Skin Lightening Preparations; 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

The efficacy of topical retinoids is well known according to several clinical studies conducted predominantly among Caucasian patients. This study aimed to evaluate the efficacy and safety profile of adapalene and tretinoin among Mexican patients.. To compare adapalene 0.1 and 0.3% and tretinoin 0.05% in Mexican subjects with acne vulgaris.. We enrolled 171 patients in this single-center, randomized, double-blinded, placebo-controlled clinical trial. The patients applied on the face either adapalene 0.1%, adapalene 0.3%, tretinoin 0.05%, or placebo for 90 days and were evaluated for the reduction in total lesion counts and for the level of irritation.. Tretinoin 0.05% and adapalene 0.3% were more effective than adapalene 0.1% and placebo in the reduction of both inflammatory and noninflammatory lesions. Most of adverse events to adapalene and many on tretinoin group were related to skin irritation, dry skin, scaling, pruritus, burning, and postinflammatory hyperpigmentation.. Adapalene 0.3% and tretinoin 0.05% are comparable in efficacy, and adapalene 0.1% offers a better safety profile in Mexican patients.

Topics: Acne Vulgaris; Adapalene; Adolescent; Adult; Child; Dermatitis, Irritant; Dermatologic Agents; Double-Blind Method; Female; Gels; Humans; Hyperpigmentation; Keratolytic Agents; Male; Mexico; Naphthalenes; Pruritus; 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

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

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

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

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

Long-term (>1 year) placebo-controlled studies of tretinoin in the treatment of photodamaged skin have not been conducted. Recently, we conducted a 2-year placebo-controlled study of tretinoin emollient cream 0.05%, including histopathologic assessment of safety and analysis of markers of collagen deposition.. The objective of the study was to determine the long-term safety and efficacy of tretinoin emollient cream 0.05% in the treatment of moderate to severe facial photodamage.. A total of 204 subjects were treated with tretinoin or placebo (vehicle emollient cream) applied to the entire face once a day for up to 2 years. Clinical and histologic effects were assessed at regularly scheduled clinic visits.. Treatment with tretinoin resulted in significantly greater improvement relative to placebo in clinical signs of photodamage (fine and coarse wrinkling, mottled hyperpigmentation, lentigines, and sallowness), overall photodamage severity, and investigator's global assessment of clinical response (p<0.05). Histologic evaluation showed no increase in keratinocytic or melanocytic atypia, dermal elastosis, or untoward effects on stratum corneum following treatment with tretinoin compared with placebo. Immunohistochemistry studies, conducted at three study centers, showed a significant increase relative to placebo in facial procollagen 1C terminal, a marker for procollagen synthesis, at month 12 (p=0.0074).. Long-term treatment with tretinoin emollient cream 0.05% is safe and effective in subjects with moderate to severe facial photodamage.

Topics: Administration, Topical; Adult; Aged; Double-Blind Method; Female; Humans; Hyperpigmentation; Keratolytic Agents; Male; Middle Aged; Prospective Studies; Skin Aging; Sunlight; Tretinoin; Ultraviolet Rays

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

To compare the efficacy and tolerability of tazarotene 0.1% cream and tretinoin 0.05% emollient cream in the treatment of photodamaged facial skin.. Subjects were eligible to enroll in this multicenter, double-blind, randomized, parallel-group study if they had at least mild levels of facial fine wrinkling and mottled hyperpigmentation, and at least moderate levels of one of these. Subjects were randomly assigned to apply either tazarotene cream or tretinoin emollient cream to their faces once each evening for 24 weeks.. A total of 173 subjects were enrolled, of whom 157 completed. All significant between-group differences in efficacy measures were in favor of tazarotene - for fine wrinkling at the study endpoint and, at earlier timepoints, for treatment success (> or =50% global improvement), and the overall integrated assessment of photodamage, mottled hyperpigmentation, and coarse wrinkling. Both products were comparable in terms of cosmetic acceptability and tolerability except that tazarotene was associated with a transiently higher incidence of a burning sensation on the skin (in the first week of treatment but not thereafter).. Tazarotene 0.1% cream can offer superior efficacy over tretinoin 0.05% emollient cream in the treatment of facial photodamage, particularly with respect to the speed of improvement.

Topics: Administration, Topical; Dermatologic Agents; Double-Blind Method; Emollients; Face; Female; Humans; Hyperpigmentation; Male; Middle Aged; Nicotinic Acids; Skin Aging; Treatment Outcome; Tretinoin

To assess the safety and efficacy of 4 concentrations of tazarotene cream in the treatment of facial photodamage.. Prospective weekly multicenter, investigator-masked, randomized, parallel-group study.. University hospitals and clinical research centers.. Three hundred forty-nine subjects with facial photodamage.. Daily topical application of tazarotene cream (0.01%, 0.025%, 0.05%, and 0.1%) compared with its vehicle and with 0.05% tretinoin emollient cream.. Tazarotene cream and tretinoin cream significantly improved mottled hyperpigmentation and fine wrinkles. At week 24, treatment success rates based on global responses were 67% (39 of 58 subjects) with 0.1% tazarotene, 52% (30 of 58 subjects) with 0.05% tazarotene, 36% (21 of 58 subjects) with 0.025% tazarotene, 41% (24 of 59 subjects) with 0.01% tazarotene, 55% (32 of 58 subjects) with 0.05% tretinoin, and 22% (13 of 58 subjects) with vehicle. Local adverse events, although more frequent with tazarotene at higher concentrations, were generally mild to moderate.. Tazarotene in a cream formulation is safe and is associated with positive changes in the treatment of photodamaged facial skin.

Topics: Administration, Cutaneous; Adult; Dermatologic Agents; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Face; Female; Humans; Hyperpigmentation; Male; Nicotinic Acids; Prospective Studies; Retinoids; Skin Aging; Treatment Outcome; Tretinoin; United States

Solar lentigines are a chronic condition of the aging population resulting from years of cumulative sun exposure. A topical treatment that is both safe and effective would be welcome and useful. Combinations of therapeutic agents are often used and allow synergy of mechanisms with tolerability. A tyrosinase inhibitor in use in Europe, 4-hydroxyanisole (Mequinol), and the retinoid tretinoin have been used singly as depigmenting agents.. The efficacy and safety of the combination product of 2% 4-hydroxyanisole (4HA [mequinol]) /0.01% tretinoin solution (tradename Solagé) were evaluated in two phase III, randomized, controlled, double-blind trials.. Subjects were randomized to treatment with 4HA/tretinoin solution, one of the active components (4HA or tretinoin), or vehicle. Subjects applied the test solution with a wand applicator twice daily to all solar lentigines and related hyperpigmented lesions on the face, forearms, and backs of hands for up to 24 weeks. Trial 1 had a 24-week no-treatment regression phase and trial 2 had a 4-week no-treatment regression phase. Information collected included clinical assessments of Target Lesion Pigmentation, Physician's Global Assessment of Improvement/Worsening, an Assessment of Overall Cosmetic Effect, and a Subject's Self-Assessment Questionnaire.. The 4HA/tretinoin combination was clinically superior to each of its active components and to the vehicle in the treatment of solar lentigines. At the end of treatment, in trial 1 and trial 2, 4HA/tretinoin was statistically superior to each of its active components and vehicle on the forearms and face (P

Topics: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Anisoles; Antioxidants; Arm; Double-Blind Method; Drug Therapy, Combination; Facial Dermatoses; Female; Hand Dermatoses; Humans; Hyperpigmentation; Keratolytic Agents; Lentigo; Male; 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

Treatment-related changes in hyperpigmentation are difficult to quantify with visible light photography, especially when the changes are subtle.. Our purpose was to determine the utility and reliability of fluorescence photography to measure changes in mottled and diffuse hyperpigmentation.. Thirty-two subjects, with mildly to moderately photodamaged skin, completed a 36-week, double-blind, vehicle-controlled study of tretinoin cream 0.025%. Clinical evaluation of hyperpigmentation as well as standard flash photographs and fluorescence photographs were obtained at baseline and week 36.. The fluorescence photographs were evaluated blindly and yielded macule counts that decreased significantly from baseline in tretinoin-treated subjects compared with vehicle-treated subjects (31% vs 11% decrease; p = 0.02). Diffuse hyperpigmentation, as evaluated from the fluorescence photographs, decreased 16% from baseline for tretinoin-treated subjects and increased 5% for vehicle-treated subjects (p < 0.01). No significant differences in mottled or diffuse hyperpigmentation were observed between groups through clinical evaluation.. Fluorescence photography is a noninvasive method that is sensitive in the evaluation and quantification of distribution and changes of mottled and diffuse hyperpigmentation.

Topics: Adult; Aged; Double-Blind Method; Evaluation Studies as Topic; Fluorescence; Humans; Hyperpigmentation; Keratolytic Agents; Middle Aged; Photography; Reproducibility of Results; Sensitivity and Specificity; Skin Aging; 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

Hyperpigmented lesions are a predominant component of photoaging in Chinese and Japanese persons. Topical 0.1% tretinoin cream improves the hyperpigmentation associated with photoaging in Caucasian persons.. Our purpose was to assess the efficacy of 0.1% tretinoin cream treatment of hyperpigmented lesions associated with photoaging in Chinese and Japanese patients.. Forty-five photoaged patients (23 Chinese, 22 Japanese) completed a double-blind, randomized study in which 21 applied 0.1% tretinoin cream and 24 applied vehicle cream once daily to face and/or hands for 40 weeks. Patients' hyperpigmented lesions were evaluated clinically and by colorimetry throughout the study and by histologic analysis of skin biopsy specimens taken before therapy and at the end of treatment.. At the end of treatment, hyperpigmented lesions of the face and hands were lighter or much lighter in 90% of patients receiving tretinoin compared with 33% receiving vehicle (p < 0.0001). Colorimetry demonstrated significant lightening of lesions after tretinoin compared with vehicle (p < 0.05). Histologic analysis of hyperpigmented lesions demonstrated a statistically significant 41% decrease in epidermal pigmentation with tretinoin therapy as compared with a 37% increase in the vehicle group (p = 0.0004). No patient withdrew for adverse effects.. By clinical, colorimetric, and histologic evaluation, 0.1% tretinoin cream significantly lightens the hyperpigmentation of photoaging in Chinese and Japanese patients.

Topics: Administration, Topical; Adult; Aged; Asian; Biopsy; China; Double-Blind Method; Facial Dermatoses; Female; Hand Dermatoses; Humans; Hyperpigmentation; Japan; Male; Middle Aged; Photography; Skin Aging; Treatment Outcome; Tretinoin

Irregular disfiguring skin hyperpigmentation due to inflammation may develop in black persons. We investigated the treatment of this hyperpigmentation with topical tretinoin (0.1 percent retinoic acid cream). Fifty-four subjects completed a 40-week randomized, double-blind, vehicle-controlled study. Twenty-four subjects applied tretinoin daily to the face, arms, or both areas, and 30 subjects applied vehicle cream. At base line and after 40 weeks of treatment, each subject's post-inflammatory hyperpigmented lesions and normal skin were assessed by clinical and colorimetric evaluations and by analysis of biopsy specimens.. The facial post-inflammatory hyperpigmented lesions of the tretinoin-treated subjects were significantly lighter after the 40 weeks of therapy than those of the vehicle-treated subjects (P < 0.001); overall improvement was first noted after four weeks of tretinoin treatment. At the end of treatment, colorimetry demonstrated a 40 percent lightening of the lesions toward normal skin color in the tretinoin-treated lesions, as compared with an 18 percent lightening in vehicle-treated lesions (P = 0.05). The epidermal melanin content in the lesions decreased by 23 percent with tretinoin and by 3 percent with vehicle (P = 0.24). Normal skin was minimally lightened by tretinoin as compared with vehicle, according to both clinical evaluation (0.1 vs. -0.1 unit change on an 8-point scale; P = 0.055) and colorimetry (P < 0.001). Retinoid dermatitis developed in 12 of the 24 tretinoin-treated subjects who completed the study (50 percent) and in 1 tretinoin-treated subject who withdrew from the study, but diminished as the study progressed.. Topical application of tretinoin significantly lightens post-inflammatory hyperpigmentation and, to a clinically minimal but statistically significant degree, lightens normal skin in black persons.

Topics: Administration, Cutaneous; Adult; Black People; Dermatitis; Double-Blind Method; Female; Humans; Hyperpigmentation; Male; Middle Aged; Skin; Tretinoin

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

Topics: Animals; Betamethasone; Hydroquinones; Hyperpigmentation; Rats; Rats, Long-Evans; 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

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

Although combined use of tretinoin (all-trans-retinoic acid; atRA) and hydroquinone improves various hyperpigmented lesions, the pharmacologic instability of atRA and atRA-induced irritant dermatitis are difficult unsolved problems.. The objective was to evaluate the efficacy and adverse effects of a newly formulated gel containing inorganic-coated atRA nanoscale particles (nano-atRA gel).. Nano-atRA gel was used in our two-phased bleaching protocol: 5% hydroquinone and 7% lactic acid ointment were used along with nano-atRA gel in the bleaching phase (2-8 weeks), and 5% hydroquinone and 7% ascorbic acid ointment were used alone during the healing phase (4-8 weeks). Eighty-four patients with facial hyperpigmented lesions were enrolled in this study, and 77 of them (88 lesions) followed up for more than 10 weeks were analyzed.. Hyperpigmentation was improved in 84 of 88 lesions (95.5%) after a mean treatment period of 14.3 weeks and was almost eliminated in 52 lesions (59.1%). Nano-atRA gel caused exfoliation and scaling similar to that seen with conventional atRA gel, whereas the erythema seen in the bleaching phase appeared to be weaker.. Nano-atRA gel can improve hyperpigmentation to a similar extent as conventional atRA gel. It also induces irritant dermatitis, but with less erythema.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Drug Therapy, Combination; Female; Humans; Hyperpigmentation; Male; Middle Aged; Nanoparticles; Ointments; Quinidine; 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

The purpose of this open-label study was to determine the adverse event rate of topical 4HA/tretinoin when used twice daily for up to 24 weeks with concomitant sunscreen in the treatment of solar lentigines and related hyperpigmented lesions. There were two treatment areas: bilateral dorsal forearms, including the back of the hands; and the face, including the forehead and cheek areas. Each treatment area had a target lesion at least 5 mm in diameter and was moderately darker than the surrounding skin. A nine-point bipolar scale was used for evaluation of Target Lesion Pigmentation (0 = extremely lighter than pigment of the surrounding skin, 4 = equal with pigment of surrounding skin, 8 = extremely darker than pigment of surrounding skin). The other solar lentigines present in the treatment areas also had to have an overall pigmentation grade of at least Grade 6. Twice daily applications to individual lesions in each treatment area were made for up to 24 weeks followed by a 4-week follow-up phase. Sunscreen applications (sunscreen with sun protection factor (SPF) 25 or greater) were made every morning and reapplied after six hours if additional sun exposure was expected. Clinical evaluations were performed at weeks 0, 4, 8, 16, 24 and 28. The clinical signs of Target Lesion Pigmentation and Overall Lesion Pigmentation were evaluated at each visit. A total of 96 subjects were enrolled at four study centers; 77 (80%) subjects completed the study. Treatment-related adverse events (AEs) for 4HA/tretinoin included erythema, burning/stinging/tingling, desquamation, pruritus, skin irritation, halo hypopigmentation and hypopigmentation. Five (5%) subjects discontinued from the study due to adverse events considered to be related to study medication. When used with sunscreen of SPF 25 or greater, 4HA/tretinoin was safe and well tolerated and did not produce any unexpected or unusual adverse events.

Topics: Adult; Aged; Aged, 80 and over; Anisoles; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Hyperpigmentation; Male; Middle Aged; Sunscreening Agents; 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

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

Nevoid hyperkeratosis of the nipple and areola is a rare dermatosis with unknown etiology, (Perez-Izquierdo JM, Vilata JJ, Sanchez JL, et al. Retinoic acid treatment of nipple hyperkeratosis. Arch Dermatol 1990;126:687-688). Only 40 cases have been reported until 1997 (Alpsoy E, Yilmaz E, Aykol A. Hyperkeratosis of the nipple: report of two cases. J Dermatol 1997;24:43-45). The disease has a benign course and may only be a cosmetic problem. Different modalities have been used in the treatment of NHNA. In our case treatment with topical retinoic acid induced an acceptable response.

Topics: Administration, Cutaneous; Adult; Breast Diseases; Female; Humans; Hyperpigmentation; Keratins; Keratolytic Agents; Keratosis; Nipples; Tretinoin; Warts

Topics: Administration, Cutaneous; Adult; Breast Diseases; Female; Humans; Hyperpigmentation; Keratolytic Agents; Keratosis; Nipples; Tretinoin

Hyperkeratosis of the nipple and areola is a rare condition; its characteristic properties are verrucous thickening and brownish discoloration of the nipples and areola. The nevoid form of the disease is extremely rare, usually seen in women in the second or third decade of life. The nipple is seldom affected alone. We report two cases of the nevoid form of hyperkeratosis of the nipple. In both female patients, lesions developed after puberty and were confined to both nipples alone. One of the patients' lesions became darker and more verrucous during pregnancy, making breast feeding impossible.

Topics: Adolescent; Adult; Breast Diseases; Breast Feeding; Female; Humans; Hyperpigmentation; Keratolytic Agents; Keratosis; Nipples; Pregnancy; Pregnancy Complications; Tretinoin; Warts

Because of the climate in Bangkok, Thailand, a prematurely aged appearance is common in adults beyond 40 years of age. Sixty-one Thai people with moderate to severe signs of dermatoheliosis applied 0.05% tretinoin cream to the face once daily for 6-12 months. Four-mm punch biopsies were obtained from the cheeks before and after treatment. These were formalin-fixed and evaluated histochemically. A surprising degree of photodamage was noted histologically in these dark-skinned people. After 6 months of tretinoin, epidermal atypia and atrophy were largely corrected. There was a great diminution in the density of melanin granules within keratinocytes and corneocytes. Tretinoin did not significantly affect the dermal matrix after 6 months. However, after 12 months, a thin band of new collagen was deposited beneath the epidermis, accompanied by the formation of new vessels (angiogenesis). By global assessment, after 12 months most subjects experienced at least moderate improvement in appearance, especially with regard to hyperpigmented spots and fine wrinkles.

Topics: Administration, Topical; Adult; Aged; Face; Humans; Hyperpigmentation; Middle Aged; Skin; Skin Aging; Tretinoin

Topics: Acne Vulgaris; Black People; Humans; Hyperpigmentation; Tretinoin

Topics: Black People; Dermatitis; Humans; Hyperpigmentation; Tretinoin