Hyperpigmentation combined therapies

Rutter A, Schwarz T. Ausgepragte Hyperpigmentierung in psoriatischen Plaques als Folge einer Kombinationsbehandlung mit UVB-311 nm und Calcipotriol. [Market hyperpigmentation in psoriatic plaque as a sequelae of combination therapy with UVB-311 and calcipotriol.] Hautarzt 2000 51(6) 431-3. 

Kakita LS, Lowe NJ (1998) Azelaic acid and glycoUc acid combination therapy for facial hyperpigmentation in darker-skinned patients a clinical comparison with hydroquinone. Clin Ther 20 960-970... 

Kojic acid (5-hydroxy-4 pyran 4-1-2 methyl) is a fungal derivative which inactivates tyrosinase via chelation of copper. Concentrations range from 2% to 4%. It can be used for monotherapy or in combination with retinoids or other cosmeceutical products such as glycolic acid. Compared to hydroquinone, these kojic acid formulations usually show less efficacy however, they may be effective in patients who do not tolerate hydroquinone. In addition, they can be used as maintenance therapies for treatment of hyperpigmentation following 4-6 months of hydroquinone treatment. Use of kojic acid has been associated with contact dermatitis in sensitized individuals, however [41 3]. 

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