Depigmenting topical

It is very difficult to treat melasma. Better results are obtained if between chemical peeling treatments, patients apply topical depigment-ing agents. The synergic action of the two treatments bleaches the skin and reduces melanin formation. 

Topical depigmenting agents (tirosinase inhibitors, antioxidants, peeling agents, melanogenesis inhibitors) [3]... 

Vitiligo No safe and relfable treatment. Methoxsalen or other psoralen. Topically or syscemically, plus daily exposure to UVA (PUVA) is toxic, and ineffective in Caucasians. Sunscreens to protect the depigmented areas and reduce pigmentation of surrounding skin. Probably an autoimmune disease Note dose-dependent risk of squamous cell cancer with PUVA... 

The well-known Kligman s formulas combine the action of tretinoin, a corticosteroid and hydroquinone, but are more irritating than medical cosmetics. The cosmetics used for hyperpigmentation should be applied very soon after the peels (if possible the very next day). If possible they should be applied two or three times a day, before effective sun protection. For more information on topical depigmenting agents, see the section on hyperpigmentation in Chapter 37. 

Topical depigmenting agents cannot be expected to produce rapid results the active products have to penetrate the... 

When a peel causes localized inflammation that visibly develops into hyperpigmentation, even with sun protection and avoidance, a corticosteroid (preferably a fluoro-corticosteroid) should be applied. It should be applied twice a day locally to the erythema before it develops into hyperpigmentation and should not be used long term (1 week at the most), to avoid the side-effects associated with corticosteroids. This treatment should of course be combined with sun protection/avoidance measures and a topical depigmenting agent. 

Solange (a combination of tretinoin and mequinol, a depigmenting agent) Topical Solar (actinic) lentigines... 

A variety of topical depigmenting agents are at hand for the dermatologists to choose from. Setback however is the length of time needed to effect treatment and patient comphance. 

First line - choose from a variety of topical depig-menting agents, either alone or in combination... 

BocchieftoE, Pecis L, D Abrosca F et al (2001) In vitro testing of innovative depigmenting and low toxicity topic compositions. Pigment Cell Res 14 405... 

Topical depigmenting agents (hydroquinone, tretinoin, kojic acid, azelaic acid, L-ascorbic acid) are the most commonly used home treatment, but several months are required to see results and very often the pigmentation recms after discontinuation of treatment [4],... 

Topical methimazole is used as a skin depigmenting agent for conditions that include epidermal melasma. In 20 patients who used this treatment once daily for 6 weeks there were no significant changes in circulating thyroid hormone or thyroid-stimulating hormone (TSH) and no significant cutaneous adverse reactions [33 ]. 

A cream containing 1% 4-isopropyl-catechol was applied topically to the hyper-pigmented lesions of 29 patients with melasma, freckles or cafe-au-lait spots. The bleaching effect on melasmas was very satisfactory in all patients, but contact dermatitis developed in 3 patients and a reticular hyperpigmentation with areas of depigmented spots could be noted in one case. Freckles and cafe-au-lait spots did not bleach (14 ). 

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