Hydroquinone-Free Multimodal Topical Regimen for Facial Hyperpigmentation
March 2013 | Volume 12 | Issue 3 | Supplement Individual Articles | 42 | Copyright © March 2013
Mona S. Foad MD and Erin Winters BA
Cincinnati Dermatology Center, Cincinnati, OH
To assess the treatment of hyperpigmentation, a series of 5 case studies were conducted to evaluate the efficacy and tolerability of a novel hydroquinone-free treatment regimen combining a multimodal skin brightener with a cleanser, high strength retinol product and sunscreen SPF 30+. Patients presented with moderate to severe facial hyperpigmentation as determined by a score of 4 to 8 on the Overall Hyperpigmentation scale. Physician-graded Overall Hyperpigmentation, Global Improvement in Hyperpigmentation, and standardized photography were conducted at weeks 3, 6, and 12. At week 12, the majority of patients demonstrated Global Improvements in Hyperpigmentation of at least 50%, with at least a 2-grade reduction in Overall Hyperpigmentation scores, as assessed by the physician. Standardized photographs also support the physician and patient findings. Results from these case studies demonstrate that this unique 12-week treatment regimen can provide an effective and simple option for patients with facial hyperpigmentation. J Drugs Dermatol.
2013;12(3 suppl 1):s42-s44.
Hyperpigmentation, presenting as dark spots or patches, results from excess melanin
in the skin and can be caused by hormonal or endocrinal disorders such as melasma
or by long-term sun exposure resulting in photodamage. Successful treatment of hyperpigmentation
often proves difficult and challenging for patients due its recurrent nature.1 Several cutaneous pathways contribute to hyperpigmentation, including melanocyte
activation, melanin synthesis, and melanin transfer. Topical therapies have the
opportunity to target these areas in the sequence of pigment production. Recently,
a multimodal skin brightener was found to provide comparable efficacy to 4% hydroquinone
(HQ) in patients with moderate to severe facial hyperpigmentation.2 Case
studies are presented herein using this unique multimodal skin brightener with a
facial cleanser, a high strength retinol product, and a sunscreen SPF 30+ in patients
with facial hyperpigmentation.
Five female patients between the ages of 30 and 62 years with Fitzpatrick skin types
II or III are presented herein. At baseline, each patient manifested moderate to
severe facial hyperpigmentation (from sun exposure or melasma) as assessed by a
grade of 4 to 9 on an Overall Hyperpigmentation scale. The combination regimen was
composed of 4 products, including a cleanser, a novel mulimodal skin brightener,
sunscreen SPF 30+, and a high strength retinol product (Facial Cleanser, Lytera™ Skin Brightening Complex, Daily Physical Defense™ SPF 30+ Sunscreen,
Tri-Retinol Complex ES™; SkinMedica Inc., Carlsbad, CA). For 1
of the patients, patient 3, the combination regimen was combined with a superficial
chemical peel procedure received at week 6. The remaining 4 patients only used the
topical regimen for 12 weeks. Patients returned to the office at weeks 3, 6, and
12 for physician grading of Global Improvement in Hyperpigmentation and Overall
Hyperpigmentation as well as standardized digital photography. At week 12, patients
were also asked about their self-assessed improvement with the treatment program.
The grading scales for Global Improvement and Overall Hyperpigmentation are:Global Improvement in Hyperpigmentation: 0 = no change or worsening;1 = mild improvement, a noticeable improvement of the condition with a distinctive
amount of remaining signs/symptoms (approximately 25% overall improvement); 2 =
moderate improvement, a very noticeable improvement of the condition with a fair
amount of remaining signs/symptoms (approximately 50% overall improvement); 3 =
marked improvement (approximately 75% overall improvement); 4 = complete clearing,
nearly complete improvement of the condition with a trace of remaining signs/symptoms
(approximately 95% or more overall improvement). Overall Hyperpigmentation:
0 = none; 1-3 = mild; 4-6 = moderate; 7-9 = severe.