A combination of treatments targeting various points in the sequence of pigment formation is becoming a more common option for hyperpigmentation therapy. Indeed, treatment success is often facilitated by a combination
of therapies, including topical treatments and chemical peels.1-3 Chemical peels focus on the removal of hyperpigmented
lesions and have been established as effective treatments.4 However, exfoliation of hyperpigmented lesions only addresses one aspect of the pigmentation pathway. A unique multimodal and hydroquinone (HQ)-free skin brightener has been clinically shown to provide reductions in moderate to severe facial hyperpigmentation when used as monotherapy.5 The ingredients of the skin brightener were selected to address
key pathways in pigmentation including melanocyte activation, melanin synthesis, and melanin transfer, as described
previously.5 Combining a chemical peel with such a skin brightener may provide subjects with an effective option for managing hyperpigmentation.
In the case studies presented below, patients received 1 superficial
chemical peel treatment (containing a proprietary blend of resorcinol, lactic acid, salicylic acid, and retinol) followed by up to 6 weeks of maintenance therapy with a topical multimodal and HQ-free skin brightener. Investigator assessments, standardized digital photography with standard lighting, and cross-polarized brown channel lighting (Canfield VISIA-CR®; Fairfield, NJ) as well as dermoscopy and in vivo reflectance confocal microscopy (RCM) images (VivaScope 1500; Caliber Imaging and Diagnostics, Inc., Rochester, NY) were taken at baseline and at follow-up visits.
The use of in vivo RCM to observe pigmentary changes produced
by the treatment of a superficial chemical peel and skin brightener in these case studies presents a novel application of this instrument. In recent years, in vivo RCM has become an effective noninvasive tool, used by clinicians to support the diagnosis of skin cancers.6-9 Due to melanin’s high reflectance index (1.7), pigmented keratinocytes and melanocytes appear as bright white structures relative to the surrounding skin.10 Generally, reductions in pigment result in a decreased quantity and intensity of bright white structures and appear similar to the surrounding normal skin.
Case Report 1
A 46-year-old Caucasian female patient with Fitzpatrick skin type III presented with moderate facial hyperpigmentation, as
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