Melasma is a common problem in Asians, but treatments have not been satisfactory. In the present study, we evaluated the efficacy of a new formula containing 0.1% tretinoin, 5% hydroquinone, and 1% hydrocortisone (RHQ) in Korean patients with melasma. Twenty-five Korean females with therapy recalcitrant melasma applied RHQ on their faces for 4 months and were evaluated before and 4 weeks after treatment clinically and histologically. They were also evaluated clinically 4 months after treatment. To minimize unavoidable side effects (erythema or peeling), we applied RHQ twice a week instead of the usual daily application. However, we obtained clinical and histological results comparable to other reports from white populations. Statistically significant depigmentation in clinical and histological studies and increased subepidermal collagen synthesis were observed in this study. These effects were seen as early as 4 weeks after treatment with RHQ. We used mMASI scoring, a modified version of the original MASI, to quantify the effects of RHQ more objectively and easily.

The authors reviewed two patients showing "vitiligo-like depigmentations" where the skin had been in close contact with a metal spectacle frame made of nickel alloy. In spite of the hypersensitivity to nickel in both patients, they showed clinical and histologic findings indicate that the formation of "vitiligo-like depigmentation" does not result from posinflammatory hypopigmentation but from chemical hypomelanosis. We could not explain the underlying mechanisms; however, the speculation that the "vitiligo-like depigmentation" may come from the direct effect of the nickel itself, prompted us to report these cases.

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