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: