Intermittent Therapy for Melasma in Asian Patients with Combined Topical Agents (Retinoic Acid, Hydroquinone and Hydrocortisone): Clinical and Histological Studies

Abstract

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.

Functions of peroxisome proliferator‐activated receptors (PPAR) in skin homeostasis

“…Consistent with the role of PPAR agonists in cellular proliferation and differentiation in keratinocytes, PPARα (Wy-14,643) and PPARγ (ciglitazone) ligands were shown to inhibit the proliferation and to stimulate the melanin synthesis of cultured melanocytes (Table 1), whereas bezafibrate, a preferential activator for PPARβ in Xenopus (44), had no effect on melanin content (42). In agreement with this study, several PPARγ agonists, including troglitazone and rosiglitazone, were previously demonstrated to inhibit cell growth in human malignant melanoma (43), and topical application of retinoic acid was shown to improve hyperpigmented skin lesions such as melasma (45). Because of their antiproliferative and prodifferentiative effect on melanocytes, it is tempting to suggest that PPAR and RXR ligands may be beneficial in the treatment of melanomas.…”

Therapeutic Effect of Topical Application of Linoleic Acid and Lincomycin in Combination with Betamethasone Valerate in Melasma Patients

“…This may explain the lower response rate in this study. The formula containing tretinoin and/or hydroquinone induces irritation dermatitis in many cases (22), which hampers the use of this formula. Other investigators have reported increased pigmentaion in Asian patients on daily tretinoin and hydrocortisone; the increased pigmentation was presumably caused by retinoid dermatitis, with resultant postinflammatory hyperpigmentation (17).…”

Efficacy and Safety of Tranexamic Acid in Melasma: A Meta-analysis and Systematic Review

“…Of the 11 trials, 4 were from Korea (7,15,22,23), 3 from India (17, 18, 21) and 1 from each of the following countries: Brazil (16), Iran (19), Nepal (20) and Singapore (14). Melasma severity was assessed by MASI (8 studies were assessed with the original MASI scoring (24) and 3 with 2 different forms of modified MASI scoring (18,25)). …”