Skin pigmentation disorders occur because the body produces either too much or too little melanin. Skin may appear uneven, blotchy, or discolored in concentrated areas. Pigmentation problems are most often a result of a history of unprotected sun exposure or hormone changes - and misdiagnosis is not uncommon. It is important to realize that diligent protection from the sun over the years can eliminate pigmentation problems all together. There are numerous safe and effective topical treatment options available for combating various pigmentation problems, such as hydroquinone, tretinoin, AHA's and kojic acid. However, proper diagnosis by a physician is crucial for positive treatment results.
Grimes et al of the Division of Dermatology, University of California, Los Angeles, sought to determine the efficacy and safety of continuous therapy followed by a maintenance treatment regimen during a period of 24 weeks with a TC cream containing hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01%. The study concluded that TC cream is safe in the treatment of moderate to severe melasma for up to 24 weeks when used intermittently or continuously.
J Am Acad Dermatol. 2010 Jun;62(6):962-7. Epub 2010 Apr 15.
Continuous therapy followed by a maintenance therapy regimen with a triple combination cream for melasma.
Grimes PE et al.
Click here to access the PubMed abstract of this article.
The purpose of this study was to evaluate the efficacy of trichloroacetic acid as well as glycolic acid associated with kojic acid in the treatment of cutaneous hyperpigmentations. This study concludes that both peelings can be considered effective.
Dermatol Surg. 1999 Jun;25(6):450-4.
The use of chemical peelings in the treatment of different cutaneous hyperpigmentations.
Cotellessa C et al.
Click here to access the PubMed abstract of this article.
Patients with vitiligo have low catalase levels in their epidermis in association with high levels of hydrogen peroxide. Topical application of a UVB-activated pseudocatalase cream can successfully remove epidermal H2O2 resulting in a remarkable repigmentation.
J Investig Dermatol Symp Proc 1999 Sep;4(1):91-6
In vivo and in vitro evidence for hydrogen peroxide (H2O2) accumulation in the epidermis of patients with vitiligo and its successful removal by a UVB-activated pseudocatalase.
Click here to access the PubMed abstract of this article.
Researchers concluded that "although hydroquinone showed a better response, ascorbic acid may play a role in the therapy of melasma as it is almost devoid of side-effects; it could be used alone or in combination therapy."
Int J Dermatol. 2004 Aug;43(8):604-7.
A double-blind randomized trial of 5% ascorbic acid vs. 4% hydroquinone in melasma.
Espinal-Perez LE, Moncada B, Castanedo-Cazares JP.
Click here to access the PubMed abstract of this article.
Melasma is a circumscribed brown macular hyperpigmentation of areas of the face and neck that are exposed to light, and is aggravated by sunlight, birth control pills, and pregnancy. This study demonstrates that a cream containing hydroquinone, glycolic acid, vitamins C and E, and sunscreen is a safe and effective treatment therapy for melasma.
Int J Dermatol. 2003 Dec;42(12):966-72.
Safety and efficacy of 4% hydroquinone combined with 10% glycolic acid, antioxidants, and sunscreen in the treatment of melasma.
Guevara IL, Pandya AG.
Click here to access the PubMed abstract of this article.
The antioxidant N-acetyl cysteine (NAC) has an antiproliferative effect on human keratinocytes and NAC has been used topically to satisfactorily treat lamellar ichthyosis.
Lancet. 1999 Nov 27;354(9193):1880.
Topical N-acetylcysteine for lamellar ichthyosis.
Redondo P, Bauzá A.
Click here to access the PubMed abstract of this article.
Topically applied NAC can prevent skin irritation resulting from radiotherapy and protects from sun-induced erythema.
Semin Oncol. 1983 Mar;10(1 Suppl 1):86-92.
Topical use of N-acetylcysteine for reduction of skin reaction to radiation therapy.
Kim JA, Baker DG, Hahn SS, Goodchild NT, Constable WC.
Click here to access the PubMed abstract of this article.
