On the Spot

Though it remains challenging to treat, physicians are finding valuable topicals and tools to address hyperpigmentation.
Hyperpigmentation

Patients searching online for solutions to the brown spots, dark patches and uneven skin tone created by sun damage, post-inflammatory hyperpigmentation (PIH) and melasma are advised to consult with a qualified dermatologist or facial plastic surgeon to receive the best treatments for their specific problems. Yet methods of treating hyperpigmentation vary widely. When it comes to hyperpigmentation, which treatments are the best and why? We asked four physicians to share their approaches.
Fading Sun Damage
“My standard approach to treating patients with dark spots or patches from sun damage was to dispense a topical containing hydroquinone with retinol until we were advised a year or so ago that dispensing products containing 4% hydroquinone was illegal,” says Suzanne Bruce, MD, dermatologist and director of Suzanne Bruce and Associates, Houston. In 2010, Texas state officials began warning physicians that based on the Texas Food, Drug and Cosmetic Act and the Texas Deceptive Trade Practices Act, it is against the law for them to dispense prescription drugs such as 4% hydroquinone products.
“Although it now looks as if we will be able to get access to these products again soon,” Dr. Bruce continues, “we have had to find other options. Fortunately, companies like Obagi (www.obagi.com) make products for countries in Europe where hydroquinone is banned, so we are able to offer our patients similar products that contain arbutin rather than hydroquinone. We have also used Vivite Vibrance (Allergan, www.allergan.com) and elure (Syneron, www.syneron.com), which came along just at the right time. We often use these products in combination—arbutin with elure and retinoids with elure. We haven’t done any head-to-head trials, but based on anecdotal evidence, I still think we got better results with products using 4% hydroquinone and retinoids.”
A head-to-head study of the elure Advanced Skin Lightening product (lignin peroxidase cream) compared to 2% hydroquinone cream appeared in the December 2011 issue of the Journal of Cosmetic Dermatology. The single-center, randomized, double-blind, placebo-controlled study included 51 Asian women who received elure on one side of the face and either 2% hydroquinone cream or a placebo on the other. Results showed a statistically significant change from baseline in the melanin index on the skin treated with elure on day 31 while neither the placebo nor the 2% hydroquinone cream demonstrated a significant reduction in melanin. Researchers noted that patients treated with elure showed significant skin lightening in only eight days. The active ingredient, Melanozyme, actually breaks down the melanin in the skin. Hydroquinone and most other skin lightening creams work by preventing the production of melanin and, therefore, take longer to show effects.

This 62-year old patient was treated with mybody’s myPROBIOTIC peel (4 peels in 8 weeks) plus the company’s 4% hydroquinone-based Sledgehammer for 8 weeks.
Image courtesy of Mybody