Hydroquinone-Free Multimodal Topical Regimen for Facial Hyperpigmentation

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.