Assessment of a Superficial Chemical Peel Combined With a Multimodal, Hydroquinone-Free Skin Brightener Using In Vivo Reflectance Confocal Microscopy

March 2013 | Volume 12 | Issue 3 | Supplement Individual Articles | 38 | Copyright © March 2013

Lisa T. Goberdhan BA, Lora Colvan BA, Elizabeth T. Makino BS CCRA MBA, Caroline Aguilar RN BSN, and Rahul C. Mehta PhD

SkinMedica, an Allergan Company, Carlsbad, CA

The combination of in-office procedures such as chemical peels with topical maintenance therapies has been shown to provide greater efficacy than either treatment by itself in the management of melasma. A series of 3 case studies were conducted to evaluate the efficacy and tolerability of one superficial chemical peel (containing a proprietary blend of resorcinol, lactic acid, salicylic acid, and retinol) combined with a topical multimodal, hydroquinone-free skin brightener as postpeel maintenance therapy. Patients presented with moderate to severe facial hyperpigmentation. At baseline, subjects received the superficial chemical peel treatment followed by a standard postpeel skin care regimen (cleanser, moisturizer, and SPF 30+ sunscreen). Approximately 1 week after the peel procedure, subjects initiated twice-daily application of the skin brightener. Subjects were then evaluated for Global Improvement in Hyperpigmentation by the investigator for up to 7 weeks postpeel. Standardized digital photographs of the subjects facial skin and in vivo reflectance confocal microscopy (RCM) images were taken of a target hyperpigmented lesion at baseline and at follow-up. Standardized photography and in vivo RCM images at baseline and at postpeel show the improvements observed by the investigator. Results from these case studies suggest that the combination of a superficial chemical peel with topical maintenance and the multimodal skin brightener may provide an effective treatment approach for subjects with moderate to severe facial hyperpigmentation.

J Drugs Dermatol. 2013;12(3 suppl 1):s38-s41.


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