tretinoin and Melanosis

Melasma is a chronic and acquired pigmentary condition that primarily affects women and undermines patient satisfaction and confidence. Melasma mostly affects females, accounting for 90% of all cases. It affects people of all races, particularly those with skin types IV and V who live in areas with lots of UV radiation. According to the studies, Melasma lesions are seen throughout the face in centrofacial, malar, and mandibular patterns. Melasma lesions on the forehead, cheeks, nose, upper lip, and/or chin are the most prevalent centrofacial pattern. Melasma lesions can also be detected along the periorbital area, especially in Asian people. Melasma is notably resistant to treatment, with many patients experiencing only temporary relief and relapses. Combining therapies that target numerous pathologic components, including photodamage, inflammation, aberrant vascularity, and abnormal pigmentation, generally results in the most dramatic therapeutic improvements. Treatments for dark circles include topical depigmenting medicines like hydroquinone, kojic acid, azelaic acid, and topical retinoic acid, and physical treatments such as chemical peels, surgical adjustments, and laser therapy. The objective of therapy should be to figure out what is causing the hyperpigmentation and what is contributing to it. This article provides an overview of melasma therapies and the efficacy of methimazole and cysteamine for melasma therapy.

Topics: Cysteamine; Female; Humans; Hydroquinones; Melanosis; Methimazole; Treatment Outcome; Tretinoin

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

Topics: Adrenal Cortex Hormones; Cosmeceuticals; Female; Fluocinolone Acetonide; Humans; Hydroquinones; Male; Melanosis; Quality of Life; Silicones; Sunscreening Agents; Tranexamic Acid; Treatment Outcome; Tretinoin; Zinc Oxide

Melasma is a chronic skin condition that involves the overproduction of melanin in areas exposed to ultraviolet radiation. Melasma treatment is long-term and complicated with recurrence and resistance to treatment. The pathogenesis of melasma is highly complex with multiple pathologies occurring outside of the skin pigment cells. It includes photoaging, excessive melanogenesis, an increased number of mast cells, increased vascularization, and basement membrane damage. In addition, skin lesions related to melasma and their surrounding skin have nearly 300 genes differentially expressed from healthy skin. Traditionally, melasma was treated with topical agents, including hydroquinone, tretinoin, glucocorticosteroids and various formulations; however, the current approach includes the topical application of a variety of substances, chemical peels, laser and light treatments, mesotherapy, microneedling and/or the use of systemic therapy. The treatment plan for patients with melasma begins with the elimination of risk factors, strict protection against ultraviolet radiation, and the topical use of lightening agents. Hyperpigmentation treatment alone can be ineffective unless combined with regenerative methods and photoprotection. In this review, we show that in-depth knowledge associated with proper communication and the establishment of a relationship with the patient help to achieve good adherence and compliance in this long-term, time-consuming and difficult procedure.

Topics: Humans; Hydroquinones; Melanins; Melanosis; Treatment Outcome; Tretinoin; Ultraviolet Rays

Chemical peelings are used on a wide scale in cosmetic field including melasma treatment. They often provide clinicians with flexibility in tailoring treatments according to patient needs and satisfaction.. To evaluate safety and efficacy of chemical peeling as single agents in melasma management in patients with darker skin types.. We included randomized controlled trials (RCTs) and prospective studies that assessed efficacy and safety of chemical peeling as single agents for facial melasma. An online bibliographic search was conducted, and data were extracted from the included studies.. Ten RCTs and three prospective comparative studies (No. of patients = 478) were included. The overall effect estimate favored Glycolic acid (GA) over trichloroacetic acid peel in terms of melasma activity and severity index (MASI) (mean difference [MD] -1.89, 95% CI [-3.26, -0.52], P = .007). On the other hand, the overall effect estimates did not favor GA over tretinoin (MD 0.53, 95% CI [-0.46, 1.52], P = .3), vitamin C iontophoresis (MD 1.50, 95% CI [-0.50, 3.50], P = .14), and amino fruit acid (MD 0.39, 95% CI [-0.64, 1.42], P = .46) in terms of MASI. The overall effect estimates favored trichloroacetic acid peel (MD -5.30, 95% CI [-6.41, -4.19], P < .001) and Jessner's solution (MD -3.20, 95% CI [-5.35, -1.05], P = .004) over topical hydroquinone in terms of MASI.. In conclusion, chemical peelings are effective as single agents for management of melasma in patients with darker skin types, with the use of topicals as maintenance treatment.

Topics: Chemexfoliation; Dermabrasion; Humans; Melanosis; Treatment Outcome; Tretinoin; Trichloroacetic Acid

BACKGROUND & SCOPE OF THE REVIEW: This review focuses on the UV radiation effects on skin, emphasizing the photoaging process, and the photoprotection conferred by tretinoin (all-trans retinoic acid or ATRA). Tretinoin is still the best tested retinoid to reverse photoaged skin.. Tretinoin can be used for photoaging treatment or combined treatment by different mechanisms. It binds to and activates retinoic acid receptors, inducing changes in gene expression that leads to cell differentiation, decreased cell proliferation, and inhibition of tumourigenesis. It has been demonstrated that photoaging resulting from UV-B radiation can be treated by retinoid formulations. Pretreatment of human skin with tretinoin blocks dermal matrix degradation followed by sun exposure, inhibiting the induction of the activated protein-1 (AP-1) transcription factor and AP-1 regulated matrix-degrading metalloproteinases. GENERAL SIGNIFICANCE AND INTEREST: Tretinoin should be considered as a key factor as it is the most potent and best-studied retinoid. In addition, the development of advanced drug delivery systems, especially novel nanoformulations, has contributed to overpass some technical drawbacks besides the skin irritation potential. The triple combination of tretinoin, hydroquinone and corticosteroids is still considered the gold standard for melasma. Although there are other novel therapeutic approaches, more high-quality clinical trials are still needed.

Topics: Animals; Humans; Keratolytic Agents; Melanosis; Mice; Skin Aging; Tretinoin

Several methods of treatment are available to patients with melasma. First-line therapy usually consists of topical compounds that affect the pigment production pathway, broad-spectrum photoprotection, and camouflage. Second-line therapy often consists of the addition of chemical peels, although these must be used cautiously in patients with darker skin. Laser and light therapies represent potentially promising options for patients who are refractory to other modalities, but also carry a significant risk of worsening the disease. A thorough understanding of the risks and benefits of various therapeutic options is crucial in selecting the best treatment.

Topics: Administration, Topical; Asian People; Chemexfoliation; Dicarboxylic Acids; Drug Therapy, Combination; Glycolates; Glycyrrhiza; Humans; Hydroquinones; Low-Level Light Therapy; Melanins; Melanosis; Monophenol Monooxygenase; Phototherapy; Phytotherapy; Plant Extracts; Pyrones; Sunscreening Agents; Treatment Outcome; 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

As well as for topically used dermatological agents, studies performed according to the rules of evidence-based medicine (EBM) are also needed for cosmetics. Although the concept of evidence-based cosmetics has been only partly developed so far, there are some agents and preparations available that can be considered as evidence-based. In this paper we present data from several studies that claim to have examined and demonstrated the efficacy of cosmetic preparations for the management of solar damage and aging skin as well as lentigo and melanosis according to EBM criteria. Certainly, further controlled studies are needed to cover the main application areas of dermocosmetics. Retinol and antioxidant agents such as vitamin C and coenzymes that positively act via several mechanisms on collagen biosynthesis can be considered evidence-based substances for the management of aging skin. According to the same criteria, the preventive effect of regularly applied dermocosmetic sun screens on the development of actinic keratosis could also be shown. Dermocosmetic sun screens should offer adequate protection against UV-B and UV-A light by combining compatible organic and/or non-organic UV-filters and at the same time be well tolerated. Furthermore, they may contain some additional agents such as antioxidants, DNA repair enzymes, dexpanthenol, glycerin or hamamelis distillate. In the treatment of melanosis, a substantial bleaching effect corresponding to that of 0.1% topical tretinoin can be achieved with 10% all-trans-retinol gel. Preparations containing urea, ammonium lactate or glycerol in different concentrations are considered the best characterized and most effective substances for the care of dry skin. However, the lack of controlled studies confirming the efficacy of dermocosmetic products as well as the superiority of the preparation incorporating the active agent over the corresponding base is a problem yet to be solved. Undoubtedly, the efficacy and the sustainability of the achieved effects have to be examined and proven accordingly to EBM criteria in further active cosmetic agents. Moreover, generally accepted guidelines for the examination of efficacy and tolerability of dermocosmetics have to be developed.

Topics: Antioxidants; Cosmetics; Evidence-Based Medicine; Humans; Keratolytic Agents; Keratosis, Actinic; Lentigo; Melanosis; Randomized Controlled Trials as Topic; Skin Aging; Sunburn; Sunscreening Agents; Tretinoin; Vitamin A

Melasma is a common hyperpigmentation disorder that typically affects women, though up to 10% of white individuals seeking treatment for melasma are men. Melasma can be a source of embarrassment for men because of its association with women and pregnancy. We performed a case series assessing the use of mequinol 2%/ tretinoin 0.01% topical solution in 5 men with melasma. Four of 5 patients achieved complete clearance of melasma at 12 weeks, and 1 patient showed moderate improvement. Side effects were minimal and consisted of stinging in one patient. All patients maintained results at the 16-week follow-up visit. Mequinol 2%/tretinoin 0.01% topical solution was an effective and well-tolerated treatment of melasma in men. The vehicle resulted in good compliance and minimal adverse effects in patients. This is the first report describing the use of mequinol 2%/tretinoin 0.01% topical solution for the treatment of melasma in men; there are no reports in women.

Topics: Administration, Topical; Adult; Anisoles; Antioxidants; Facial Dermatoses; Humans; Keratolytic Agents; Male; Melanosis; Middle Aged; Solutions; Treatment Outcome; 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

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

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

A chemical peel is a procedure in which a topically applied wounding agent creates smooth, rejuvenated skin by way of an organized repair process. This article describes the indications, classifications, operative procedure, and complications of chemical resurfacing. In addition, alternatives to chemoexfoliation are discussed.

Topics: Acne Vulgaris; Administration, Topical; Chemexfoliation; Contraindications; Dermabrasion; Female; Humans; Hydroxy Acids; Laser Therapy; Male; Melanosis; Phenols; Preoperative Care; Skin Aging; Tretinoin; Trichloroacetic Acid

Clinical studies of patients with melasma have shown that topical 20 percent azelaic acid is superior to 2 percent hydroquinone and as effective as 4 percent hydroquinone, without the latter's undesirable side effects. Tretinoin appears to enhance this effect of azelaic acid. Azelaic acid with tretinoin caused more skin lightening after three months than azelaic acid alone, and a higher proportion of excellent responders at the end of treatment. The effect of azelaic acid can be attributed to its ability to inhibit the energy production and/or DNA synthesis of hyperactive melanocytes, and partially to its antityrosinase activity. This may also account for the beneficial effect on postinflammatory hyperpigmentation. Destruction of malignant melanocytes by a combination of the same activities, enhanced by the greater permeability of tumoral cells to azelaic acid, may account for the clinical effects of azelaic acid observed in lentigo maligna and individual lesions of primary melanoma.

Topics: Administration, Topical; Dermatologic Agents; Dicarboxylic Acids; Drug Therapy, Combination; Humans; Melanosis; Tretinoin

Intrinsic (chronological) skin ageing is characterized by atrophy of the skin with loss of elasticity and slowed metabolic activity. The superposition of environmental damage, particularly exposure to ultraviolet radiation (photodamage), on the intrinsic ageing process results, at least initially, in a hypertrophic repair response, with a thickened epidermis and increased melanogenesis. Even more striking changes occur in the dermis: massive elastosis (deposition of abnormal elastic fibres), collagen degeneration, and twisted, dilated microvasculature. Regular use of a sunscreen alone appears to allow some repair as well as protection from further photodamage. Topical tretinoin has been shown to partially reverse the clinical and histological changes induced by the combination of sunlight exposure and chronological ageing. A formulation of tretinoin in an emollient cream (Retinova, Renova), developed specifically for the treatment of photodamaged skin, has been extensively investigated in multicentre, double-blind trials and has been shown to produce significant improvement within 4-6 months of daily use, compared with vehicle alone, as part of a regimen including sun protection and moisturizer use. Histological changes in the epidermis and dermis noted after 12 months suggest tretinoin repairs photodamage by reconstitution of the rete pegs, repair of keratinocyte ultrastructural damage, more even distribution of melanocytes and melanin pigment, deposition of new papillary dermal collagen, and improvements in vasculature. Alpha-hydroxy acids (AHAs) have also been widely used for therapy of photodamaged skin, and these compounds have been reported to normalize hyperkeratinization and increase viable epidermal thickness and dermal glycosaminoglycans content. The single randomized controlled study now available appears to substantiate AHA efficacy and safety. In summary, recent work has substantially elucidated the ageing processes that affect the skin and has demonstrated that many of the unwanted changes can be improved by topical therapy.

Topics: Humans; Melanosis; Skin; Skin Aging; Sunscreening Agents; Tretinoin; Ultraviolet Rays

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

Topical vitamin A acid (VAA) has various mechanisms of action which may be responsible for its therapeutic success in many different disorders. Although the absorption, metabolism, and excretion of VAA are not completely understood, VAA appears to remain mainly on the skin surface. The question of carcinogenicity is unresolved, and more research is needed to clarify this problem. This article reviews the literature regarding the therapeutic uses of VAA and summarizes various investigators' experiences with VAA.

Topics: Acne Vulgaris; Animals; Callosities; Cocarcinogenesis; Fox-Fordyce Disease; Humans; Ichthyosis; Keloid; Keratoacanthoma; Keratosis; Lichen Planus; Melanoma; Melanosis; Molluscum Contagiosum; Nevus; Psoriasis; Skin Absorption; Skin Diseases; Skin Neoplasms; Tretinoin

Kligman's trio (KT), combining hydroquinone, retinoic acid and corticosteroid, is considered as the gold standard treatment of melasma. Its efficacy has never been matched before, but it is tempered by frequent adverse effects.. To assess the efficacy and tolerance of a New Trio (NT) combination with isobutylamido-thiazolyl-resorcinol, retinoic acid and cortosteroid compared to KT.. We conducted a 24-week monocentric trial, randomized, double-blind, controlled versus KT, with 40 melasma patients. NT and KT were applied for 12 weeks and associated with the same sunscreen applied for 24 weeks. The primary endpoint was the modified Melasma Area Severity Index (mMASI) at 12 weeks. Patient quality of life was investigated using MelasQoL.. After 12 weeks, KT and NT groups both demonstrated a significant improvement in mMASI, respectively -2.84 (SE 0.69, p < 0.0002) and -4.33 (SE 0.71, p < 0.0001). The mean difference between the two groups was -1.49 (IC 95% -3.52 to 0.54, p = 0.14). MelasQoL improvement was -6.66 (SE 3.29, p = 0.0515) with KT and -12.57 (SE 3.29, p = 0.0006) with NT.. The NT combination appears to be an effective treatment option for treating melasma and could be considered as a well-tolerated alternative to KT.

Topics: Emollients; Humans; Hydroquinones; Melanosis; Prospective Studies; Quality of Life; Treatment Outcome; Tretinoin

This study aimed to evaluate the effectiveness of isolated treatment with retinoic acid and its combination with the microneedling technique in facial melasma, seeking to associate these results with possible oxidative damage. This is a blinded randomized clinical trial with 42 women with facial melasma (skin phototype I-IV), randomized into Group A (microneedling and 5% retinoic acid) or Group B (5% retinoic acid alone). Four procedures were applied with 15 days intervals (4 blood collections). Clinical improvement was assessed using the Melasma Area Severity Index (MASI). Serum oxidative stress levels were evaluated by protein oxidation (carbonyl), lipid peroxidation (TBARS) and sulfhydryl groups, as well as enzyme activities of superoxide dismutase (SOD) and catalase (CAT). The statistical analyzes were performed by generalized estimation equation (GEE). There was a reduction in MASI scale and TBARS levels in both groups over time (p < 0.05), with no difference between groups (p = 0.416). There was also a substantial increase in the carbonyl levels at 30 days (p = 0.002). The SOD activity decreased after 30 days, regardless of group (p < 0.001), which was maintained after 60 days. In Group A, there was a reduction in sulfhydryl levels at 60 days (p < 0.001). It is important to highlight that both groups demonstrated efficacy in the clinical improvement of melasma within at least 60 days, reducing the MASI score by almost 50%. However, microneedling with retinoic acid seems to be the worst treatment because there is a reduction in the non-enzymatic antioxidant defense, which is important to protect against oxidative stress.

Topics: Administration, Cutaneous; Adult; Combined Modality Therapy; Dry Needling; Facial Dermatoses; Female; Humans; Keratolytic Agents; Lipid Peroxidation; Melanosis; Middle Aged; Oxidative Stress; Patient Satisfaction; Severity of Illness Index; Treatment Outcome; Tretinoin

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

Melasma is a chronic recalcitrant pigmentary disorder whose treatment frustrates physician and patient alike. Tranexamic acid, a plasmin inhibitor, has demonstrated hypopigmenting properties.. To compare safety and efficacy of combination of oral tranexamic acid (TXA) and topical fluocinolone-based combination cream (FbTC) with that of topical FbTC alone in melasma.. One hundred and eighty patients patients of facial melasma of either sex attending dermatology OPD were screened. Consenting 130 participants were randomized into two blinded groups with 65 patients in each group. Group A patients received oral tranexamic acid 250 mg and oral ranitidine 150 mg twice daily and applied a triple combination cream containing fluocinolone acetonide 0.01%, tretinoin 0.05% and hydroquinone 2% once daily, and Group B was asked to take placebo tablets (calcium lactate and multivitamin) and apply the cream only for 12 weeks. Response was evaluated using modified melasma area severity index (mMASI) and graded mMASI improvement at 4th, 8th and 12th weeks, and at 24th week for recurrence. Data were analysed using SPSS software.. Results were analysed in 120 patients who completed the study with 61 and 59 patients in group A and B, respectively. Demographic profile was equally distributed in both the groups. In group A, 13.1% patients showed marked improvement (>75%) in mMASI as compared to group B (1.7%) at 4th week. By 12th week, 65.6% patients had marked improvement in group A in contrast to only 27.1% in group B. At 24th week, group A (65.6%) had sustained improvement as compared to group B (11.9%) despite stopping treatment; all of which were statistically significant. Recurrence observed was 18.03% in group A vs. 64.4% in group B at 24th week.. Oral tranexamic acid is definitely a boon to the armamentarium of melasma management and should be used as an adjuvant to fluocinolone-based triple combination cream for a faster, sustained improvement and to prevent recurrence.

Topics: Asian People; Humans; Melanosis; Prospective Studies; Tranexamic Acid; Tretinoin

Malar melasma has a chronic and recurrent character that may be related to epigenetic changes.. To recognize the expression and DNA methylation of DNA methyltransferases (DNMTs) in malar melasma and perilesional skin, as well as the changes in DNMTs after their treatment with sunscreen in combination with 4% niacinamide, 0.05% retinoic acid, or placebo.. Thirty female patients were clinically evaluated for the expression of DNMT1 and DNMT3b using real-time PCR and immunofluorescence. These initial results were compared to results after eight weeks of treatment with sunscreen in combination with niacinamide, retinoic acid, or placebo.. The relative expression of DNMT1 was significantly elevated in melasma compared with unaffected skin in all subjects, indicating DNA hypermethylation. After treatment, it was decreased in all groups: niacinamide (7 versus 1; p<0.01), retinoic acid (7 versus 2; p<0.05), and placebo (7 versus 3; p<0.05), which correlates with clinical improvement. DNMT3b was not overexpressed in lesional skin but reduced in all groups.. We found DNA hypermethylation in melasma lesions. Environmental factors such as solar radiation may induce cellular changes that trigger hyperpigmentation through the activation of pathways regulated by epigenetic modifications. However, limiting or decreasing DNA methylation through sunscreen, niacinamide, and retinoic acid treatments that provide photoprotection and genetic transcription can counteract this.

Topics: 5-Methylcytosine; Adult; DNA Methylation; DNA Modification Methylases; Epidermis; Female; Fluorescence; Gene Expression Regulation, Enzymologic; Humans; Melanosis; Niacinamide; Placebos; Sunscreening Agents; Tretinoin

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

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

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

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

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

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

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

Melasma is an irregular brownish pigmentation observed on the faces of young to middle-aged women, especially of Asian races, which may contribute to various emotional disturbances. Although not any favorable treatment being approved yet, one appropriate approach is peeling by glycolic acid 70% (GA 70%). Considering the efficiency of Tretinoin in lower concentrations as over-the-counter lightening agents, peelings with higher strength Tretinoin may effectively relieve the pigmentation (melasma) sooner than other topical therapies.. The main purpose was to compare the efficiency and complications of GA 70% with Tretinoin 1% peeling.. A randomized, double-blinded clinical trial performed on 63 female patients with bilateral melasma. One facial side was treated by drug A (GA 70%) and the opposite side by agent B (Tretinoin 1%) peeling for four sessions with 2-week intervals. Descending changes in Melasma Area and Severity Index (MASI) scores, patients' discomfort and untoward complications following peeling all were evaluated and compared during the research period.. The efficiency of Tretinoin 1% peelings in declining the MASI score (treatment of melasma) was similar to GA 70%, as well as the rare unwanted complications of them. However, the patients' discomfort following procedures as expressed by their own, was significantly lower with Tretinoin 1% compared to GA 70% peeling. The cases' satisfaction with the intervention was statistically similar to each other. Furthermore, we experienced almost the equal times of beginning the therapeutic responses in both groups.

Topics: Adult; Double-Blind Method; Facial Dermatoses; Female; Glycolates; Humans; Keratolytic Agents; Melanosis; Middle Aged; Patient Satisfaction; Treatment Outcome; Tretinoin; Young Adult

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

Melasma is a uichronic, often relapsing skin disorder, with poor long-term results from all current therapies.. To assess efficacy and safety of non-ablative 1,550 nm fractional laser therapy (FLT) as compared to the gold standard, triple topical therapy (TTT).. Twenty-nine patients with melasma were included in a randomized controlled observer-blinded study with split-face design. Each side of the face was randomly allocated to either 4-5 non-ablative FLT sessions (15 mJ/microbeam, 14-20% coverage) or TTT (hydroquinone 5%, tretinoin 0.05%, triamcinolone acetonide 0.1% cream). TTT was applied once daily for 15 weeks until the last FLT session. After this last treatment, patients were asked to apply TTT twice weekly on both sides of the face during follow-up. Improvement of melasma was assessed by patient's global assessment (PGA), patient's satisfaction, physician's global assessment (PhGA), melanin index, and lightness (L-value) at 3 weeks, and at 3 and 6 months after the last treatment.. Mean PGA and satisfaction were significantly lower at the FLT side (P<0.001). PhGA, melanin index, and L-value showed a significant worsening of hyperpigmentation at the FLT side. At the TTT side, no significant change was observed. At 6 months follow-up, most patients preferred TTT. Side effects of FLT were erythema, burning sensation, edema, and pain. Nine patients (31%) developed PIH after two or more laser sessions. Side effects of TTT were erythema, burning sensation, and scaling.. Given the high rate of postinflammatory hyperpigmentation, non-ablative 1,550 nm fractional laser at 15 mJ/microbeam is not recommendable in the treatment of melasma. TTT remains the gold standard treatment.

Topics: Administration, Topical; Adult; Drug Therapy, Combination; Face; Female; Humans; Low-Level Light Therapy; Male; Melanosis; Middle Aged; Patient Satisfaction; Treatment Outcome; Tretinoin; Triamcinolone Acetonide

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

Topics: Administration, Cutaneous; Adult; Ascorbic Acid; Chemexfoliation; Dermatologic Agents; Drug Administration Schedule; Drug Therapy, Combination; Facial Dermatoses; Female; Humans; Melanosis; Middle Aged; Severity of Illness Index; Treatment Outcome; Tretinoin; Trichloroacetic Acid

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

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

Treatment of melasma, a hyperpigmentation disorder, remains a challenge. The primary objective of two 8-week, multicenter, randomized, investigator-blind studies was to compare the efficacy and safety of a hydrophilic cream formulation containing tretinoin 0.05%, hydroquinone 4.0%, and fluocinolone acetonide 0.01% (RA+HQ+FA) with the dual-combination agents tretinoin plus hydroquinone (RA+HQ), tretinoin plus fluocinolone acetonide (RA+FA), and hydroquinone plus fluocinolone acetonide (HQ+FA). All agents had the same drug concentration and vehicle. A total of 641 adult patients, predominantly female, with moderate to severe melasma and Fitzpatrick skin types I through IV, were randomized to the various treatment groups. Due to the similarity of the study designs, the results of the 2 studies were combined and are reported here. The primary efficacy analysis involved the proportion of intent-to-treat patients in each treatment group whose condition had completely cleared by week 8. The results of the combined clinical trials demonstrated that significantly more of the patients treated with RA+HQ+FA (26.1%) experienced complete clearing compared with the other treatment groups (4.6%) at the end of week 8 (P<.0001). In addition, at week 8, a 75% reduction in melasma/pigmentation was observed in more than 70% of patients treated with RA+HQ+FA compared with 30% in patients treated with the dual-combination agents. The most common adverse reactions seen with all treatment groups were erythema, skin peeling, burning, and/or stinging sensation. The majority of treatment-related adverse events were of mild severity.

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

Topics: Adapalene; Adult; Dermatologic Agents; Facial Dermatoses; Female; Humans; Keratolytic Agents; Melanosis; Naphthalenes; 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

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

Melasma can be resistant to topical therapy.. Our purpose was to evaluate the efficacy of superficial peels in conjunction with topical tretinoin and hydroquinone in patients with melasma and to evaluate the ability of Wood's light examination to predict response to treatment.. We measured increased light reflectance in melasma areas with a colorimeter. Clinical observations were scored through an index designed to weigh numerically homogeneity, intensity of color, and area of melasma.. Colorimetric analysis showed an average lightening of 3.14 +/- 3.1 on the glycolic acid-treated side and 2.96 +/- 4.84 on the Jessner's solution-treated side. There was no statistically significant difference between the right and left. There was an overall decrease in melasma area and severity of 63%.. Superficial peels hasten the effects of topical therapy in melasma. Wood's light examination did not help predict response to treatment.

Topics: Chemexfoliation; Colorimetry; Drug Combinations; Ethanol; Facial Dermatoses; Female; Glycolates; Humans; Keratolytic Agents; Lactic Acid; Melanosis; Resorcinols; Salicylates; Tretinoin

Melasma is an acquired, masklike, facial hyperpigmentation. The pathogenesis and treatment of melasma in black (African-American) patients is poorly understood. We investigated the efficacy of topical 0.1% all-trans-retinoic acid (tretinoin) in the treatment of melasma in black patients. Twenty-eight of 30 black patients with melasma completed a 10-month, randomized, vehicle-controlled clinical trial in which they applied either 0.1% tretinoin or vehicle cream daily to the entire face. They were evaluated clinically (using our Melasma Area and Severity Index), colorimetrically, and histologically.. After 40 weeks, there was a 32% improvement in the Melasma Area and Severity Index score in the tretinoin treatment group compared with a 10% improvement in the vehicle group. Colorimetric measurements showed lightening of melasma after 40 weeks of tretinoin treatment vs vehicle. Lightening of melasma, as determined clinically, correlated well with colorimetric measurements. Histologic examination of involved skin revealed a significant decrease in epidermal pigmentation in the tretinoin group compared with the vehicle group. Side effects were limited to a mild "retinoid dermatitis" occurring in 67% of tretinoin-treated patients. Among the patients in this study in comparison with comparably recruited white patients, melasma was reported to have begun at a later age and was more likely to be in a malar distribution.. This controlled study demonstrates that topical 0.1% tretinoin lightens melasma in black patients, with only mild side effects.

Topics: Adult; Aged; Black People; Colorimetry; Female; Humans; Male; Melanosis; Middle Aged; Tretinoin

Melasma is a common disorder of cutaneous hyperpigmentation predominantly affecting the faces of women. Little is known about the aetiology of melasma, and treatment is frequently disappointing. Topical tretinoin is of benefit in treating other forms of hyperpigmentation, for example liver spots, and we therefore investigated its effectiveness in melasma. Thirty-eight women completed a randomized, vehicle-controlled study, in which they applied 0.1% tretinoin (n = 19) or vehicle cream (n = 19) once daily to the face for 40 weeks. At the end of treatment 13 (68%) of 19 tretinoin-treated patients were clinically rated as improved or much improved, compared with 1 (5%) of 19 in the vehicle group (P = 0.0006). Significant improvement first occurred after 24 weeks of tretinoin treatment. Colorimetry (an objective measure of skin colour) demonstrated a 0.9 unit lightening of tretinoin-treated melasma and a 0.3 unit darkening with vehicle (P = 0.01); these results correlated with clinical lightening (r = 0.55, P = 0.0005). Histologically, epidermal pigment was reduced 36% following tretinoin treatment, compared with a 50% increase with vehicle (P = 0.002). Reduction in epidermal pigment also correlated with clinical lightening (r = -0.41, P = 0.01). Moderate cutaneous side-effects of erythema and desquamation occurred in 88% of tretinoin-treated and 29% of vehicle-treated patients. Topical 0.1% tretinoin produces significant clinical improvement of melasma, mainly due to reduction in epidermal pigment, but improvement is slow.

Topics: Administration, Topical; Adult; Colorimetry; Facial Dermatoses; Female; Humans; Melanosis; Middle Aged; Skin; Skin Pigmentation; Time Factors; Tretinoin; Ultraviolet Rays

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

Melasma is acquired hyperpigmentation that mainly affects the face, can cause negative changes in self-esteem, and mostly affects women. Treatment is difficult, and different drugs can be used in mono or combination therapy. In this article, we present a brief overview of melasma, how to evaluate it, and a synthesis of the most commonly used topical therapies and their indications, including sunscreens, pharmacological agents, and plant extracts. Hydroquinone (4%) in monotherapy or combined with corticosteroids (dexamethasone and fluocinolone acetonide) and retinoids (tretinoin); arbutin (1%); methimazole (5%); kojic (2%), azelaic (20%), and tranexamic (5%) acids are the pharmacological agents that stand out. Correct application of these substances determines a variable improvement in melasma but often causes adverse reactions such as erythema, itching, and burning at the application site. Vitamin C can contribute to the reduction of melasma and have little or no adverse effects while sunscreens are normally used as coadjuvant therapies. In conclusion, we have compiled specific topical therapies for treating melasma and discussed those that are the most used currently. We consider it important that prescribers and researchers evaluate the best cost-benefit ratio of topical therapeutic options and develop new formulations, enabling efficacy in the treatment with safety and comfort during application, through the reduction of adverse effects.

Topics: Female; Fluocinolone Acetonide; Humans; Hydroquinones; Melanosis; Retinoids; Sunscreening Agents; Treatment Outcome; Tretinoin

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

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

Topics: Antiviral Agents; Conjunctival Neoplasms; Humans; Interferons; Melanosis; Tretinoin

Topics: Antiviral Agents; Humans; Interferons; Melanosis; 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

Topics: Administration, Ophthalmic; Aged; Aged, 80 and over; Antineoplastic Agents; Conjunctival Diseases; Drug Therapy, Combination; Female; Humans; Interferon alpha-2; Male; Melanosis; Middle Aged; Ophthalmic Solutions; Retrospective Studies; Tretinoin

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

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

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; Antioxidants; Combined Modality Therapy; Drug Combinations; Female; Fluocinolone Acetonide; Glucocorticoids; Humans; Hydroquinones; Keratolytic Agents; Lasers, Solid-State; Melanosis; 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

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

Melasma is one of the most frequently acquired hyperpigmentation disorders clinically characterized by symmetrical brown patches on sun exposed areas. The first approach is an avoidance of sun exposure and inflammation combined with a use of photoprotection. Patient treatment is particularly difficult and challenging, and necessitates consideration of many therapies, including tretinoin to obtain an amelioration of this important skin condition.. To evaluate the efficacy of a 10% tretinoin peeling mask before and after treatment using standardized digital photos, mexameter measures, and melasma area and severity index (MASI) evaluation.. The present study was carried out on 20 female patients.. Physician global evaluation showed moderate or marked improvement of melasma in all patients using three parameters of assessment: digital photography, mexameter measurement, and the MASI.. Tretinoin peeling mask can be considered an alternative treatment modality in treating melasma. We noted a particular high tolerability and efficacy without adverse events.

Topics: Administration, Topical; Adult; Chemexfoliation; Female; Humans; Keratolytic Agents; Melanosis; Severity of Illness Index; Treatment Outcome; 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

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

Melasma is a symmetric progressive hyperpigmentation of facial skin that occurs in all races but has a predilection for darker skin phenotypes. Melasma has been associated with hormonal imbalances, sun damage, and genetic predisposition. Clinically, melasma can be divided into centrofacial, malar, and mandibular according to the pigment distribution on the skin. On Wood light examination, the pigment can be found within the epidermis, where it will enhance, or within the dermis, where it will not enhance. Melasma can be classified as mild, moderate, or severe for evaluation and treatment purposes. In this article, we will discuss the objective evaluation of the patient with melasma, as well as the treatments based on disease severity. Further recommendations for maintenance in these patients also will be addressed.

Topics: Chronic Disease; Dermatologic Agents; Drug Therapy, Combination; Estrogens; Humans; Melanosis; Neurocutaneous Syndromes; Progesterone; Skin; Treatment Outcome; Tretinoin; Vitamin A

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

Chemical peels have become a popular method for treating melasma. Although daily topical 0.05 and 0.1% tretinoin have been used for melasma, the therapy takes at least 4 to 6 months to produce clinically significant lightening. In a recent trial, 1% tretinoin peel has shown good clinical and histologic results after biweekly applications in 2.5 weeks only in the treatment of melasma.. Because there is a paucity of studies evaluating the efficacy and safety of 1% tretinoin peel in the treatment of melasma in dark-skinned Asian population, we conducted a pilot study to evaluate the efficacy and side effects of this potentially new peeling agent versus a standard peeling agent, 70% glycolic acid, in the treatment of melasma in Indian women.. Ten female patients of melasma, after written consent, were taken up for an open left-right comparison pilot study of 12 weeks. One percent tretinoin peel was applied on one-half of the face, whereas 70% glycolic acid was applied on the other at weekly intervals. The results were evaluated by a clinical investigator by using the modified Melasma Area and Severity Index and with photographs at baseline and 6 and 12 weeks.. A significant decrease in the modified Melasma Area and Severity Index from baseline to 6 weeks and then from 6 to 12 weeks was observed on both facial sides (p<0.001). Nevertheless, there was no statistically significant difference between the right and the left sides. Side effects were minimal and 1% tretinoin peel appeared to be well tolerated by the patients.. It was concluded from the present trial that serial 1% tretinoin peel is a well tolerated and as effective a therapy for melasma in dark-skinned individuals as a standard and well-tried chemical peel, 70% glycolic acid, although larger trials over longer periods may be necessary to substantiate such findings.

Topics: Administration, Topical; Adult; Asian People; Chemexfoliation; Face; Female; Glycolates; Humans; India; Keratolytic Agents; Melanosis; Pilot Projects; Prospective Studies; Treatment Outcome; Tretinoin

Topics: Clinical Trials as Topic; Confounding Factors, Epidemiologic; Drug Administration Schedule; Glycolates; Humans; Keratolytic Agents; Melanosis; 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

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

Topics: Administration, Topical; Humans; Keratolytic Agents; Lentigo; Melanosis; Radiation-Protective Agents; Tretinoin

Topics: Acne Vulgaris; Adult; Facial Dermatoses; Female; Humans; Keratolytic Agents; Melanosis; Tretinoin

Fifteen middle aged or elderly patients with chronic solar damage of the skin, eight patients with melasma and three patients with xeroderma pigmentosum were treated with topical tretinoin for 6 months. There was a significant improvement in fine surface lines in periorbital region, but no significant improvement was observed in deep furrows. No significant change was induced in melasma despite the improvement in smoothness of the skin surface. Global improvement was also seen in one patient with xeroderma pigmentosum. With regard to the functions of the stratum corneum that was assessed on the flexor surface of the forearms, values of water content as well as transepidermal water loss were found to increase one month after start of the application of tretinoin cream. On the other hand, there was no significant change in the amino acid content of the stratum corneum when measured after 4 months of the treatment. It is concluded that tretinoin cream is capable of partly reversing fine surface lines in photodamaged facial skin of the Japanese. However the irritation induced by 0.1% tretinoin cream was unexpectedly severe in the Japanese as compared to that reported in Caucasians.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aging; Amino Acids; Female; Humans; Japan; Male; Melanosis; Middle Aged; Photosensitivity Disorders; Skin; Sunlight; Tretinoin; Water Loss, Insensible; Xeroderma Pigmentosum

Case report of a 23-year-old nulliparous woman with facial melanosis manifesting itself as hyperpigmented, symmetrical areas which started during a sunny vacation is presented. Patient used oral contraceptives (Stedril-d or Ortho-Novum) for 2 years; no other drugs or cosmetics were used. Treatment with 5% hydroquinone, 0.1% triamcinolone acetonide, 0.5% tretinoin in equal parts, propyleneglycol, and ethanol 1-2 times daily for 3 months. Ortho-Novum was used during this period. No symptoms for 3 1/2 years, then recurrence after sunlight exposure. Patient used no "pill" at that time. Same treatment used with good results. Sunscreen (RV-paque) used for skin protection. Melasma consists of lightbrown to greyish sharply circumscribed, symmetrically localized spots. Histologically, increased melanin and some melanophages are found in dermal layers. Melasma is influenced by light and hormonal factors. Melanocyte-stimulating-hormone (MSH) promotes melanosome migration in dendrites coupled with skin darkening; it also activates tyrosinase. Progesterone acts on estrogen-primed melanocytes. These hormones play a role in "pill-melasma" which can occur after sunlight exposure. Melasma can result from a phototoxic or photoallergic reaction to cosmetics, tar, or other photosensitizing agents. We examined 74 patients (70 women and 4 men; ages 16-53 years) between 1973-1979. 15 patients were pregnant; 19 used the "pill" or other hormone therapy, 12 resulted from sunburn; there was no apparent cause in 26. Several depigmentation agents have been tested for treatment. Of these, hydroquinone had good results with minimal side effects. Mercaptamines were tested experimentally but not used therapeutically. 0.2% triamcinolone acetonide in cream base was satisfactory. Of 40 patients treated with either 5% hydroquinone, 0.5% tretinoin and 0.1% triamcinolone, or with corticosteroids only, 40% had good results with corticosteroids and 53% with the hydroquinone combination. Sunlight and cosmetics must be avoided and sunscreening agents used to prevent recurrence.

Topics: Adult; Contraceptives, Oral; Contraceptives, Oral, Hormonal; Drug Combinations; Female; Humans; Hydroquinones; Melanosis; Tretinoin; Triamcinolone Acetonide