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Melasma Best Treated With Triple Topical Therapy

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Tuesday, September 28, 2010

Melasma Best Treated With Triple Topical Therapy

The etiology of melasma is so varying and complex that dermatologists recommend treating it in a combination approach. The technical term is known as TTT (Triple Topical Therapy).

A study was released recently that basically announced that triple topical therapy is the ultimate treatment of melasma and other treatments are either useless or just contributing to the problem. Other treatments would be fractional laser therapy and botanical skin lighteners.

The breakdown of Triple Topical Therapy is this:

- Hydroquinone
- Tretinoin
- Topical Corticosteroids

This combination produces greater results than any other treatment. It attacks all possible sources of melasma. Tretinoin and hydroquinone work in a synergy to lighten abnormal pigmentation. The sloughing off keratinocytes and dead skin cells not only allows for greater penetration but prevents many of the adverse effects of hydroquinone such as oxidation. Topical Corticosteroids dramatically reduce any chance of irritation and inhibit melanin production by degrading cellular metabolism.

In a double-blind control trial – patients with moderate to severe melasma were given a topical of 4% Hydroquinone, 0.05% Tretinoin, and 0.01% Fluocinolone Acetonide. 77% of patients saw a complete fading of melasma or almost clearing of it. Results were seen in 4-8 weeks.

Sources:

Triple Topical Therapy Verified as Gold Standard for Melasma

MedScape Today: Topical Treatments for Melasma

Labels: ,

posted by Mileena at 4:54 PM

9 Comments:

Blogger wickedkewl said...

hey, can you explain to me the part of topical corticosteroids. what are they and how does degrading cellular metabolism inhibit melanin production? a friend of mine was using hydroquinone and retin a. he also experienced irritation. i wonder why that is. *__*

January 14, 2011 at 7:54 PM  
Blogger Mileena said...

Alone corticosteroids won't do much for melasma or any type of melanin inhibition. Combined with hydroquinone and tretinoin is where it works effectively.

The actual melanin suppression is very low from the corticosteroids standpoint. What they do is inhibit many of the functions of the melanocytes. The anti-inflammatory effect also gives way for the tretinoin and hydroquinone to work more efficiently at the depigmenting process.

The degrading of cellular metabolism is a significant method of reducing irritation (prevents quick penetration of the tretinoin which is known to cause a lot of pesky irritation problems. This is one of the reasons why many Rx retinoid labels suggest to wait a full 20 mins before applying a retinoid, so that the skin is fully dry to prevent increased absorption. Wet skin absorbs active ingredients more completely, but this isn't always good for sensitive/reactive skin types. A slower penetration and assimilation is needed).
=)

January 14, 2011 at 10:13 PM  
Blogger Mileena said...

Was he using fluocinolone acetonide 0.01%? Corticosteroids generally have levels of strength. Weak or mild strength types are needed for these kinds of treatments on facial skin.

Some people are just allergic to corticosteroids are needed to be more flexible and create tolerance with them (much like a retinoid or vitamin c) by using every other day and building up from there.

January 14, 2011 at 10:15 PM  
Blogger wickedkewl said...

thanks so much.
nah, he wasnt using fluocinolone acetonide. just the retinoid and hydroquinone. he used hydroquinone for well over a year. but he didnt like the irritation. so he stopped.

January 15, 2011 at 8:45 AM  
Blogger wickedkewl said...

"The anti-inflammatory effect also gives way for the tretinoin and hydroquinone to work more efficiently at the depigmenting process."

"The degrading of cellular metabolism is a significant method of reducing irritation (prevents quick penetration of the tretinoin which is known to cause a lot of pesky irritation problems."

so by reducing penetration(and irritation), the retinoid and hydroquinone work better?
wouldnt it take longer to work?

January 15, 2011 at 8:53 AM  
Blogger Mileena said...

Yeah I find HQ a bit irritating as well. I can work with 2% but 4% does give my skin a very irritated feel.

January 15, 2011 at 11:15 AM  
Blogger wickedkewl said...

oh wow, so the people in the study were using 4% hydroquinone for a straight year?

January 16, 2011 at 6:29 PM  
Blogger wickedkewl said...

wouldnt the irritation from these chemicals cause melanin production?

January 16, 2011 at 8:47 PM  
Blogger Mileena said...

It can, but it depends on the person. Administration of triple topical therapy (and hydroquinone in general) is conducted by a dermatologist. A derm can most likely determine (even just by looking at the skin of a patient) their sensitivity level and problem areas. If flushing, broken blood capillaries are seen most likely TTT is not the best choice given since it may irritate the skin and cause increased hyperpigmentation.

People who can tolerate TTT however experience a dramatic decrease in melanin production.

January 17, 2011 at 10:23 AM  

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