Novel Skin Brightener Used as Monotherapy for Moderate Melasma in Skin of Color

March 2014 | Volume 13 | Issue 3 | Case Reports | 364 | Copyright © March 2014


Pearl E. Grimes MD

The Vitiligo and Pigmentation Institute of Southern California, Los Angeles, CA

Abstract
Melasma is a chronic, relapsing disorder that can be disfiguring and can have adverse effects on quality of life. Recently, a unique hydroquinone-free topical product addressing multiple pathways involved in pigmentation was shown to have similar efficacy and equally well tolerated as 4% hydroquinone in females with facial hyperpigmentation. The goal herein was to further assess the efficacy and tolerability of this new multimodality product for the control of moderate melasma in skin of color.

Six female subjects with Fitzpatrick skin types IV-V in good general health between the ages of 46 and 63 years with moderate epidermal facial melasma are presented herein. Subjects applied the skin brightener twice daily, morning and evening, and returned to the clinic at weeks 4, 8, and 12. By week 12, Investigator Overall Hyperpigmentation scores and MASI scores improved by an average of 22% and 38% from baseline, respectively. Additionally, 100% of subjects showed at least a 25% increase in Global Improvement at week 12. The skin brightener was well tolerated with no reports of erythema, edema, scaling, burning/stinging, or itching.

Results from these case studies suggest that this multimodality skin brightener may provide an alternative treatment to hydroquinone for moderate melasma in skin of color. However additional clinical studies would be needed.

J Drugs Dermatol. 2014;13(3):364-366.

INTRODUCTION

Melasma is a common pigmentary disorder resulting in irregular patches of darkened skin on sun-exposed areas, particularly the cheeks, forehead, upper lip, nose and chin. This symmetric hypermelanosis is most common in women and those with Fitzpatrick skin types IV-VI, especially those living in areas of intense UV radiation.1 Melasma is a chronic, relapsing disorder that can be disfiguring and can have adverse effects on quality of life.2 The precise causes are unknown but multiple factors have been implicated including genetic influences, UV exposure, pregnancy and hormonal therapy.3
Standard treatment for melasma involves elimination of potential causative factors along with diligent use of a broad-spectrum sunscreen and a topical product that regulates the pigmentation pathway. Retinoids, topical corticosteroids, chemical peels, camouflage, lasers and light sources may also be employed. Despite such combination approaches, treatment is often unsatisfactory and frustrating to the patient and clinician.
Topical hydroquinone has a long history of use in hyperpigmentary disorders. While some controversy exists regarding the safety of hydroquinone, its efficacy in melasma is well established.4 However, as a result of this safety controversy, research has increased on hydroquinone-free skin lighteners. This has led to numerous cosmetic products being marketed.
A better understanding of melanogenesis has also resulted in new pathways as targets for topical therapy. Recently, a unique hydroquinone-free topical product addressing multiple pathways involved in pigmentation was shown to have similar efficacy and equally well tolerated as 4% hydroquinone in females with facial hyperpigmentation.5 The goal herein was to further assess the efficacy and tolerability of this new multimodality product for the control of moderate melasma in skin of color.

CASE REPORTS

Methods

Six female subjects with Fitzpatrick skin types IV-V in good general health between the ages of 46 and 63 years with moderate epidermal facial melasma are presented herein. Subjects were required to have a baseline score of 4-6 from the Investigator’s Overall Hyperpigmentation scale, defined in Table 1. Subjects applied the skin brightener twice daily,
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