Stopping Melanin Formation Through Combinations

In several studies, it has been shown that using tretinoin (Retin-A) or alpha hydroxy acids in combination with a skin lightening agent produces far greater results than just using a lightener alone. Many of these studies refer to the combo of hydroquinone and tretinoin, such as the one featured in the American Journal Clinical Dermatology (Oct. 2000) which demonstrated a significant lightening in photodamaged skin when using 2% hydroquinone and 1% tretinoin. The skin lightening results were not only sped up, but stronger and more intense.

It doesn't necessarily have to be the combination of hydroquinone and tretinoin though. Skin lightening can be achieved efficiently through other combinations. There is usually a general rule to follow: one agent has to act as the penetration enhancer, while the other suppresses melanin. Together they produce profound results.

Enhancers or penetrators can be anything from AHA peels used before applying a skin lightener, or leave-on products such as toners and creams that have AHA in them that are buffered or mixed with a lightener. They can also be rx retinoids, which not only exfoliate but reverse UV-induced sun damage. These penetration enhancers allow the lightening ingredients to actually reach beyond the lower epidermal layer and deep into the stratum where change can occur. A lot of times, we use skin lighteners but our skin does not fully absorb them with each use. Using an AHA, BHA or retinoid regularily or mixed or beforehand is proven to enhance the lightening process. Check out this study about why enhancers are so important to skin whitening: Microemulsions and nanoemulsions: novel vehicles for whitening cosmeceuticals

Upon researching about optimal combinations for skin whitening and skin lightening, I found several studies showing how combination therapy is excellent for treating and fading melasma. Melasma is approached a bit more aggressively than other pigmentation concerns. The irregular melanin synthesis of melasma patches must  be treated with some sort of exfoliation or penetration enhancer. In a study done using 4% hydroquinone, 0.05% tretinoin and 0.01% fluocinolone acetonid, patients with melasma saw complete fading and lightening of their melasma or at least 90% of it. Here is the link to the study.

Most of the studies used hydroquinone in combination with tretinoin. There are several that I found that showed 100% clearing, as opposed to using just tretinoin(Retin-A) on it's own, or hydroquinone on it's own. There are few studies involving using a HQ and tretinoin cream with regular use of a glycolic acid peel, and with that combination, melasma was successfully lightened.

Optimal combinations in skin lightening have rules though. You cannot just combine everything and anything and expect drastic results. In fact, in many cases you can be doing the exact opposite as certain products shouldn't be mixed or combined with others. Here is an outline or summary if you will, of certain do's and don'ts involving combination therapy and skin lightening.

What you can combine:

1) Tretinoin & Hydroquinone: It doesn't have to be Retin-A gel (pure tretinoin), it can be synthetic forms of rx retinoids like adapalene (Differin) and tazarotene (Tazorac) which eventually become tretinoin in the skin. OTC retinoids like retinaldehyde are alright, but not in the same league as rx ones since only minimal amounts of it are converted into tretinoin.

This combination is ideally for melasma patches. I would never recommend using HQ as an all over face lightener. You all know that, right? LOL

2) Glycolic Acid & Hydroquinone: This one was proven in a study as well. Not as powerful as tretinoin and hydroquinone, but it has a similar setup since the glycolic acid is a penetration enhancer. It sloughs off the dead skin cells which are filled with dark melanin and the hydroquinone works to suppress existing melanin. Again, when talking about hydroquinone, this is for melasma or localized dark spots

3) Tretinoin & Botanical Lightener: I talk about this notion throughout my blog. I even apply this rule (using Skinceuticals Phyto+ with Retin-A gel at night). A botanical lightener can be anything from arbutin, bearberry extract, paper mulberry, mulberry extract, kojic acid, licorice extract, rumex extract the list goes on. Check out my featured ingredients tag on the right side for more extensive info on some of these.

You can either mix the tretinoin with the lightener (like in the palm of your hand and then apply), or you can buffer (which is probably the most easiest for novices). Buffering is applying the lightener first on clean, bare skin. Wait 10 minutes and apply tretinoin sparingly on top.

4) AHA & Botanical Lightener:  Similar to the concept of tretinoin + botanical lighteners. AHA's can come in the form of using a peel, mask, toner or a leave on product. AHA's can be glycolic acid, lactic acid, mandelic acid, malic acid or azealic acid. Azealic acid, Lactic Acid and Mandelic Acid are the most ideal for skin lightening.

You can either dilute a leave-on AHA product like a serum or cream with your lightener, mix it or buffer it. You can also use masks and peels that have AHAs, and use your skin lightener right after to ensure completle absorption.

Many skin lighteners now have AHAs built in them.

5) AHA & Vitamin C: This one cannot be applied to everybody since it can be potentially irritating. Using Vitamin C with or right after using an AHA can be tricky since Vitamin C is essentially acidic. With synthetic forms of vitamin C like magnesium ascorbyl phosphate and ascorbyl glucoside it is much easier, but with pure Vitamin C (L-ascorbic acid) it can be potentially irritating.

For those that don't get irritating with this method, it can produce great results as well. Vitamin C on it's own has a good penetration quality and actually remains in the skin layers for 48 hours. Daily application of Vitamin C is actually optional, but it can still be done to ensure optimal free radical damage prevention and instant skin brightening.

What you cannot combine:

1) Vitamin C & Copper Peptides
2) Vitamin C & Benzoyl Peroxide (Vit. C is antioxidant, and BP is pro-oxidant. They cancel each other out)
3) Vitamin C & Tretinoin  ( the combination can be done, but the general rule is that lower pH products like vitamin C are applied first. You must wait a full 30 minutes to allow the skin to neutralize back to around a pH of 5.5 before applying the Tretinoin on top).

Combinations aside, the general rule that I have learned and apply for skin lightening is this:

Prevention (sunscreen daily), exfoliation (gentle regular, consistent exfoliation through AHAs or retinoids), and treatment (using topical antioxidants, copper peptides, niacinamide or botanical lighteners).

=)