Elsevier

Dermatologic Clinics

Volume 25, Issue 3, July 2007, Pages 353-362
Dermatologic Clinics

New and Experimental Treatments of Cloasma and Other Hypermelanoses

https://doi.org/10.1016/j.det.2007.04.012Get rights and content

In clinical practice, acquired hyperpigmentations represent the most common disorders of pigmentation the dermatologist has to treat. Despite the large number of depigmenting agents available, the treatment of hyperpigmentations is often unsuccessful and disappointing and is still a challenge for dermatologists. This article focuses on the chemical compounds reported to be in depigmenting or skin lightening agents, their proposed mechanism of action, and their clinical efficacy in the treatment of melasma and hypermelanoses, mainly based on randomized clinical trials. It also reviews chemical peels and their indications, together with the possible uses of laser and intense pulsed light.

Section snippets

Topical skin-lightening agents

Skin depigmentation formulations contain one or several different active compounds that can be classified following their mechanism of melanogenesis inhibition.

Chemical peeling

Chemical peeling is defined as the application of one or more chemical agents that leads to controlled destruction of the skin, thus resulting in the removal of lesions localized in the epidermis or in the upper part of the dermis. Several acids are employed in the treatment of pigmentary disorders but, in addition to other concerning topics, the therapeutic response is often unsatisfactory, and a universally effective chemical peeling has not yet been discovered.

Intradermal microinjection of tranexamic acid

In a prospective open pilot study, 100 women with melasma have been treated weekly with intradermal localized microinjections of tranexamic acid for 12 weeks. The treatment was well tolerated and rated as satisfying by 76.5% of the subjects [46].

Laser treatments

The effectiveness of a laser is based on the theory of selective photodermolysis, which states that when a specific wavelength of energy is delivered in a period of time, shorter than the thermal relaxation time of the targeted chromophore, heating and injury are restricted to the target with less damage to the surrounding tissues. Thermal relaxation of melanosomes, namely time necessary for the target to cool to one-half of its peak temperature after laser light absorption, ranges from 50 nsec

References (49)

  • V.P. Zawar et al.

    Exogenous ochronosis following hydroquinone for melasma

    J Cosmet Dermatol

    (2004)
  • T.J. Kooyers et al.

    Toxicology and health risks of hydroquinone in skin lightening formulations

    J Eur Acad Dermatol Venereol

    (2006)
  • J.J. Nordlund et al.

    The safety of hydroquinone

    J Eur Acad Dermatol Venereol

    (2006)
  • R.M. Halder et al.

    Management of dyschromias in ethnic skin

    Dermatol Ther

    (2004)
  • K. Jimbow

    N-acetyl-4-S-cysteaminylphenol as a new type of depigmenting agent for the melanoderma of patients with melasma

    Arch Dermatol

    (1991)
  • Z.D. Draelos

    The combination of 2% 4-hydroxyanisole (mequinol) and 0,01% tretinoin effectively improves the appearance of solar lentigines in ethnic groups

    J Cosmet Dermatol

    (2006)
  • R.E. Boissy et al.

    DeoxyArbutin: a novel reversible tyrosinase inhibitor with effective in vivo skin lightening potency

    Exp Dermatol

    (2005)
  • V.M. Verallo-Rowell et al.

    Double-blind comparison of azelaic acid and hydroquinone in the treatment of melasma

    Acta Derm Venereol Suppl (Stockh)

    (1989)
  • L.M. Balina et al.

    The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream

    Int J Dermatol

    (1991)
  • Zaumseil RP, Graupe K. Topical azelaic acid in the treatment of melasma: pharmacological and clinical considerations....
  • A. Garcia et al.

    The combination of glycolic acid and hydroquinone or kojic acid for the treatment of melasma and related conditions

    Dermatol Surg

    (1996)
  • T. Takizawa et al.

    Hepatocellular tumor induction in heterozygous p53-deficient CBA mice by a 26-week dietary administration of kojic acid

    Toxicol Sci

    (2003)
  • T. Yokota et al.

    The inhibitory effect of glabridin from licorice extracts on melanogenesis and inflammation

    Pigment Cell Res

    (1998)
  • M. Amer et al.

    Topical liquiritin improves melasma

    Int J Dermatol

    (2000)
  • Cited by (65)

    • Herbal bioactive-based cosmetics

      2022, Herbal Bioactive-Based Drug Delivery Systems: Challenges and Opportunities
    • Acquired brachial cutaneous dyschromatosis

      2021, Clinics in Dermatology
    • Background and different treatment modalities for melasma: Conventional and nanotechnology-based approaches

      2020, Journal of Drug Delivery Science and Technology
      Citation Excerpt :

      It is worthy to note that the frequent daily application of NCAP topical formulation resulted in significant effects after two to four weeks [81]. Ascorbic acid or vitamin C is a potent antioxidant that can inhibit melanogenesis by causing the reduction of dopaquinone to DOPA as well as preventing the formation of free radicals and the absorption of UV radiation [73]. Upon comparing the effectiveness of 4% HQ to 5% ascorbic acid in sixteen patients suffering from hyperpigmentation in a randomized clinical study, results revealed that despite the fact that HQ demonstrated higher efficacy, ascorbic acid was also shown to positively affect melasma treatment.

    • New oral and topical approaches for the treatment of melasma

      2019, International Journal of Women's Dermatology
      Citation Excerpt :

      Others agents include azelaic acid, kojic acid, retinoid treatments, niacinamide, corticosteroid medications, salicylic and glycolic acid, arbutin, resveratrol, and resorcinol. These agents and their mechanisms are cited in Table 1 (Al-Niaimi and Chiang, 2017; Birk, 1985; Bissett, 2002; De Caprio, 1999; Deo et al., 2013; Glowka et al., 2018; Grimes, 1995, 2009; Hashim et al., 2018; Huh et al., 2010; Kang, 2005; Keeling et al., 2008; Lajis et al., 2012; Menter, 2004; Monteiro et al., 2013; Navarrete-Solís et al., 2011; Niwano et al., 2018; Nordlund et al., 2006; Olejnik et al., 2018; Paine et al., 2001; Picardo and Carrera, 2007; Pires et al., 2018; Schulte et al., 2015; Tse, 2010; Videira et al., 2013; Wargniez et al., 2017; Wohlrab and Kreft, 2014). Evidence-based studies have suggested that combination products that contain hydroquinone 4%, tretinoin, and a steroid produce the best response (Jutley et al., 2014; Rivas and Pandya, 2013; Sarkar, 2013; Sarma et al., 2017). (

    • Anti melanogenic effect of Croton roxburghii and Croton sublyratus leaves in α-MSH stimulated B16F10 cells

      2019, Journal of Traditional and Complementary Medicine
      Citation Excerpt :

      Hydroquinone is one of the most popular depigmenting agents which act by reducing melanin content through suppressing tyrosinase activity. However, adverse effects of hydroquinone application may occur such as erythema, stinging, colloid milium, irritation and allergic contact dermatitis, nail discoloration, transient hypochromia, and paradoxical postinflammatory hypermelanosis.9 Moreover, the prolonged usage of hydroquinone may lead to ochronosis.10

    View all citing articles on Scopus
    View full text