Melaplex for Melasma

In a recently published study (J Drugs Dermatol. 2013;12(3)270-274), Blanche with Melaplex (rom Neocutis), a multi-ingredient skin lightening cream, was compared with triple combination cream containing 4% hydroquinone, 0.05% tretinoin and 0.01% fluocinolone acetonide (Tri-luma) for the treatment of melasma. After 12 weeks of once per day treatment, along with sun protection, the improvement in the Melasma Area and Severity Index was -77% for Melaplex and -79% for triple combination cream.

Melaplex contains disodium glycerophosphate, L-Leucine., phenylethyl resorcinol and undecylenoyl phenylalanine, and the formulation used in this study also added 4% hydroquinone.

1,550 nm Fractional Nonablative Laser for Melasma

The 1,550 nm erbium glass laser is a nonablative device that can deliver fractionated laser energy to the skin. Although this laser can be used to treat hyperpigmentation and melasma, there is a risk of increase in hyperpigmentation with this laser demonstrated in some studies, though others did not show this effect. Caution is warranted, and perhaps this laser should be reserved as second-line treatment.

Q-Switched Nd:YAG Laser for Melasma

The Q-switched 1064 nm Nd:YAG laser is used typically to treat dark tattoos. It can be used carefully to target melanin in the treatment of melasma. Use of the Q-swithced Nd:YAG laser may be more effective than topical treatments alone in the treatment of melasma. The risks of this treatment are primarily hypopigmentation in the treated area and rebound hyperpigmentation. It is best used in conjunction with topical bleaching agents.

Fractional Carbon Dioxide Ablative Laser For Melasma

The Carbon Dioxide (CO2) laser is an ablative laser that destroys the epidermis and superficial dermis. In a fractionated CO2 laser treatment, very small areas are ablated, termed Microthermal Zones (MTZ), leaving uninjured skin in between.    This fractionated approach decreases the risk of scarring and results in quicker recovery as compared with traditional ablation. There are few studies of CO2 ablative lasers for the treatment of melasma. Care must be taken due to the strength of the CO2 laser and the risk of scarring or pigment alteration.

Jessner’s Solution for Melasma

Jessner’s solution is comprised of salicylic acid (14%), lactic acid 914%) and resorcinol (14%) in alcohol. It is a superficial peeling agent with keratolytic activity. Jessner’s peel for melasma is often used in conjunction with a stronger peel, such as TCA, with Jessner’s applied first to make the second peel penetrate further. Jessner’s solution has been show in a small clinical study to be equivalent to 30% salicylic acid in the treatment of melasma.

Amino Fruit Acid Peels for Melasma

Amino fruit acids are carboxylated amino acids, typically derived from sugar cane. Recent studies have show that amino fruit acids might be a good alternative to alpha hydroxy acid peels, such as glycolic acid. In a study comparing amino fruit acids with glycolic acid peels, both were found to be equally effective, but the amino fruit acid treatment was thought to be less irritating. Amino fruit acids can be found in a number of over-the-counter skin care products.

Trichloroacetic Acid Chemical Peels for Melasma

Trichloroacetic acid (TCA) is a modified acetic acid molecule in which hydrogen has been replaced with chlorine molecules. The degree of peeling and tissue necrosis is related to the acid concentration. Concentrations greater than 35% are are rarely used due to the risk of scarring. In a small clinical study of 45 patients for melasma, the application of six weekly 20% TCA peels was more effective in treating melasma than Jessner’s peel or hydroquinone and kojic acid. TCA peels can be an important treatment for melasma, but should probably be used in conjunction with other bleaching agents.

Salicylic Acid Chemical Peels for Melasma

Salicylic acid is categorized as a beta hydroxy acid. It has both keratolytic and antiinflammatory properties, and is often used at low concentration in acne products. At higher concentrations, such as 30%, salicylic acid can be used to perform a chemical peel. Like other chemical peels, it should be performed every few weeks for 4 to 12 sessions for optiomal results. In a clinical study in Asian skin, salicylic acid peels resulted in a decrease in MASI score (a measure of melasma severity) similar to that obtained with Jessner’s colution, another common peeling agent. Excessive crusting occurred in a number of patients, and hyperpigmentation in one patient. Salicylic acid chemical peels are a useful adjunct for treating melasma, and are best used in combination with another bleaching agent and sunscreen.

Glycolic Acid Chemical Peels for Melasma

Glycolic acid is categorized as an alpha hydroxy acid. Glycolic acid chemical peels have many beneficial effects on the skin. For melasma, the use of glycolic acid peels exfoliates the stratum corneum and and disperses melanin. It also helps other drugs to penetrate the skin better, making it a useful agent in combination with other topical treatments such as hydroquinone or tretinoin. Glycolic acid peels are best used as a series of 4 to 12 peels a few weeks apart. Glyolic acid peels vary in strength from 20-70%, with the percentage used often increased over time. The pH of glycolic acid peels also varies depending on the buffering. Glycolic acid peels can be an important part of treating melasma.

Lumixyl Oligopeptides for Melasma

Lumixyl is a non-hydroquinone oligopeptide molecule that serves as an inhibitor of tyrosinase, a key enzyme in the synthesis of the melanin pigment. Oligopeptides are defined as peptide sequences ranging from 2 to 20 amino acids in length. In several small studies, the use of Lumixyl has resulted in an improvement in melasma. However, larger clinical studies are still needed to firmly establish efficacy.

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