Successful Short-Term and Long-Term Treatment of Melasma and Postinflammatory Hyperpigmentation Using Vitamin C With a Full-Face Iontophoresis Mask and a Mandelic/Malic Acid Skin Care Regimen
January 2013 | Volume 12 | Issue 1 | Original Article | 45 | Copyright © 2013
Mark B. Taylor MDa, Jamal S. Yanaki MS EdDb, David O. Draper PhDc, Joe C. Shurtz BSc, and Mark Coglianese PhDc
aGateway Aesthetic Institute, Salt Lake City, UT bActivaTek Inc, Salt Lake City, UT cDepartment of Exercise Sciences, Brigham Young University, Provo, UT
Background: Treatment of melasma and postinflammatory hyperpigmentation is often challenging. No ideal short-term and long-term treatment is available. Vitamin C alone and in combination with iontophoresis has been studied and found to be useful; however, no long-term studies have been published.
Methods: In this study, 35 patients (34 female, 1 male) were treated with a novel full-face iontophoresis mask (FFIM) and a proprietary vitamin C (ascorbyl glucoside) preparation. Patients received one in-office treatment and 12 to 24 at-home treatments over 1 to 2 months in conjunction with a strict maintenance regimen consisting of a mandelic/malic acid skin care regimen, broad-spectrum ultraviolet A/ultraviolet B sunblock, a wide-brimmed hat, and sun-avoidance behavior. Follow-up after the initial in-office treatment ranged from 1 to 54 months (mean, 26 months). Four independent observers graded improvement of melasma and PIH using a 4-point scale. Before the study, high-performance liquid chromatography was used to verify iontophoretic penetration of vitamin C into the skin to a level of 0.2 cm in healthy volunteers (2 male, 2 female).
Results: A mean 73% improvement in abnormal pigmentation was observed at the end of FFIM/vitamin C treatment. Greater than 25% improvement was observed in 32 of 35 patients, and greater than 50% improvement in 22 of 35 patients. Melasma Area and Severity Index scores demonstrated substantial improvement from baseline for all patients, with a mean improvement of 15.7.
Conclusions: Full-face iontophoresis of vitamin C appears to be an effective short-term treatment for melasma and postinflammatory hyperpigmentation. A protocol of strict sun avoidance in combination with a mandelic/malic acid skin care regimen appears to be useful in maintaining the improvement.
J Drugs Dermatol. 2013;12(1):45-50.
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Melasma is a disorder of symmetrical hyperpigmentation predominantly affecting the faces of women with Fitzpatrick skin types III and IV. Sun exposure and hormone stimulation of localized hyperpigmentation are considered to be exacerbating factors.1-5 A comprehensive review of melasma etiopathogenesis and treatment has recently been published.6,7 Postinflammatory hyperpigmentation (PIH) is abnormal pigment darkening in areas of trauma, inflammation, and irritation.8 Melasma and PIH are more common in skin of color than in white skin.
The most common treatment for melasma and PIH is the topical application of hydroquinone, alone or in combination with other ingredients such as tretinoin and a corticosteroid. Other topical agents used to treat melasma include retinoids, azelaic acid, kojic acid, α-hydroxy acids, β-hydroxy acids, beta carotene, mequinol, arbutin and deoxyarbutin, licorice extract, rucinol, resveratrol, 4-hydroxyanisole, 2,5-dimethyl-4-hydroxy- 3(2H)-furanone, N-acetylglucosamine, soybean trypsin inhibitor, and tranexamic acid.6,7 Superficial and deep chemical peels, lasers, and intense pulsed light have all been used with mixed success.6,7 Vitamin C is an excellent agent for the treatment of abnormal pigmentation; however, its instability and lack of penetration into the skin prevent it from being a highly effective means of treating melasma and PIH.9-12 None of the aforementioned treatments provide an ideal short-term and long-term solution for melasma and PIH.
Iontophoresis is the use of a direct electrical current consisting of a negative (–) and a positive (+) charge to push an ionic molecule with the same charge (either + or –) through the epidermal barrier of the skin. Positively charged ions are driven into the skin at the anode, while negatively charged ions are driven into the skin at the cathode. Historically, iontophoresis has been used by medical professionals to deliver certain drugs through the skin to treat a wide range of conditions, including inflammation, pain, scar tissue, and calcium deposits, as well as providing dermal anesthesia.13-15 Iontophoresis is a well-established drug delivery