aRTicle | dermatology |
significantly decreased hyperpigmentation and increased skin lightness compared with vehicle alone after 4 weeks of use34
.
Combination treatments different combined preparations have been proposed, with the goal of increasing the efficacy and reducing the side-effects of the depigmenting drugs in the treatment of melasma. the most widely used combination is hydroquinone + atra + steroid, the so-called Kligman and Willis formula (tretinoin 0.1%, hydroquinone 5%, and dexamethasone 0.1%). the Pigmentary disorders academy (Pda)35
expert opinion was that topically-fixed
triple combinations with fluocinolone acetonide 0.01%, a low potency (class IV) corticosteroid, plus hydroquinone 4%, a bleaching agent, and tretinoin (atra) 0.05%, a vitamin a derivative, should be used as a first-line therapy for melasma. this has proven to be superior to both hydroquinone and atra alone35
.
triple combination cream is the only US Food and drug administration (Fda)-approved product containing hydroquinone36–38
. In a randomised, single-blind study by taylor et al39
substrate of tyrosinase, it may act as a competitive inhibitor of the formation of melanin precursors26 In a randomised, parallel-group, double-masked study15
.
involving 216 subjects, a mequinol 2%–tretinoin 0.01% solution was found to be a highly effective and well-tolerated treatment for solar lentigines and related hyperpigmented lesions, being superior to hydroquinone 3% for lesions on the forearm, and of similar efficacy for lesions on the face. the results of a trial with a case series of male patients with melasma showed that four out of five patients achieved complete clearance at 12 weeks, and only one patient showed moderate improvements15
.
Side-effects were minimal and consisted of stinging in one patient. all patients maintained results at the 16-week follow-up visit15
.
Ascorbic acid ascorbic acid has antioxidant properties and affects melanogenesis by reducing dopaquinone to doPa, and preventing free-radical production and absorption of UV radiation. Comparing the efficacy of 5% ascorbic acid and 4% hydroquinone in 16 patients with melasma in a double-blind clinical trial, Bandyopadhyay15
concluded
that although hydroquinone showed a better response, ascorbic acid may play a role in the therapy of melasma as it is almost devoid of side-effects and could be used either alone or in combination therapy32
. ,
641 patients with moderate to severe melasma were randomised to four treatment groups. By week 8, a 77% reduction in melasma/pigmentation was observed in more than 70% of the patients treated with triple combination therapy compared with 30% of the patients treated with (tretinoin acetonide
the dual
46.8% + hydroquinone; 42.2% + hydroquinone;
therapy
fluocinolone fluocinolone
acetonide 27.3% + tretinoin; P < 0.001). treatment with triple combination therapy has also been shown, by these authors, to significantly decrease pigmentation over a long period and to improve quality of life (Qol) in patients with melasma. an innovative product containing microencapsulated
hydroquinone 4% and retinol 0.15% with antioxidants has improved hyperpigmentation disorders of the face and demonstrated that reductions in lesion size, darkness, and disease severity were significant as early as 4 weeks after treatment initiation, and remained significantly reduced throughout the study (all P < 0.032)40
. another important trial, according to Kang et al, is the
association of hydroquinone 5%, atra 0.1%, and hydrocortisone 1%, which has been conducted in the treatment of 25 female Korean patients affected by therapy-recalcitrant facial melasma41
. another possible . In an open-label
trial, 25% l-ascorbic acid formulated with a penetration enhancer, was found to have a significant effect in the treatment of melasma33
Niacinamide Niacinamide (nicotinamide) is the biologically active amide form of niacin (vitamin B3) and can reduce pigmentation by reversibly preventing the transfer of melanosomes from melanocytes to the keratinocytes. In a clinical study by greatens et al, niacinamide
22 ❚ July 2011 |
prime-journal.com
trial is the combined topical solution of mequinol 2% and tretinoin (atra) 0.01%, which is normally used for the treatment of solar lentigines42
.
Different combined preparations have been proposed, with the goal of increasing the efficacy and reducing the side-effects of the depigmenting drugs in the treatment of melasma.
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