Treatment of Mild to Moderate Facial Melasma With the Lumixyl Topical Brightening System

Melasma is a common cutaneous disorder that presents as patches of darker pigmentation on the cheeks, forehead, upper-lip, nose, and chin.¹ Melasma most commonly affects females of Asian and Hispanic descent and those with Fitzpatrick phototypes IV and higher.² Moreover, pregnancy appears to be a contributing factor, supporting the proposed role of hormones in the regulation of melanogenesis in women.^3,4 Various skin lightening agents such as kojic acid, azelaic acid, ascorbic acid (and its derivatives), and hydroquinone (and its arbutin derivatives) are currently used to treat melasma but are either efficacious and cytotoxic or mildly efficacious and non-toxic.⁵ Hence there remains a need for novel compounds with an improved therapeutic index.

It is well known that tyrosinase is the key enzyme that catalyzes the first two steps in the melanin synthetic pathway, making it a therapeutic target for regulating the overproduction of melanin in conditions such as melasma. The first author previously reported the in vitro tyrosinase-inhibiting properties of a novel oligopeptide (Lumixyl^TM) as compared to that of hydroquinone.⁶ Results showed that the oligopeptide was 17-times more potent at inhibiting mushroom tyrosinase than hydroquinone. Moreover, it was shown that hydroquinone was highly cytotoxic to human melanocytes whereas the oligopeptide showed negligible cytotoxicity at all tested concentrations. We also previously reported the clinical efficacy of a 0.01% oligopeptide cream for treatment of recalcitrant facial melasma in Asian and Hispanic females with Fitzpatrick type IV skin that had previously failed 6 months of Tri-Luma^TM.⁷ The aim of this case study is to report the synergistic efficacy of a 0.01% oligopeptide cream when used in combination with an antioxidant cleanser, 20% glycolic acid lotion, and a physical sunscreen (Lumixyl Topical Brightening System) for the treatment of mild-to-moderate facial melasma over 12 or 24 weeks.

All patients used the topical regimen over 12 or 24 weeks as follows: 1) antioxidant cleanser twice a day (am/pm) 2) 0.01% oligopeptide cream twice a day (am/pm), 3) 20% glycolic acid lotion every other day (am) for 2 weeks, then daily (am) for 2 weeks, then daily (am) and every other day (pm) for 2 weeks, followed by twice a day (am/pm) for 6 weeks (patient 4 used the lotion twice a day for 18 weeks), and 4) physical sunscreen every day (am). Standardized digital photography was used to document severity of melasma at baseline, and 6, 8, and 12 weeks. Digital photographs for patient patient 4 were taken at baseline and 24 weeks.