Aspen, Colorado – At the Cosmetic Bootcamp (CBC), Miami-based dermatologist Joely Kaufman, M.D., offered new twists on established regimens for melasma.
“If you’re using something that’s very irritating, it may improve melasma for a little while. But then it’s going to rebound as soon as the inflammation triggers the pigment pathway again.”
Although the Kligman regimen (combining retinoids with hydroquinone) is very effective, she said, “Many patients don’t want to peel or get red.” Instead, researchers evaluated the combination of hydroquinone 4% with tretinoin 0.02% and found that response rates were nearly equal to those achieved with the more intense tretinoin 0.1% (Rendon M, et al. J Drugs Dermatol. 2016;15(4):466-75.).
The modified Kligman regimen also works with retinol, she said. “In the past, I would say either you tolerate it – just peel and get through it – or skip a couple days” to minimize side effects. But in a small clinical trial, combining hydroquinone 4% with retinol 1% led to significant improvement in melasma area severity index scale scores (Farris PK et al. Poster presented at Fall Clinical Dermatology Meeting. October 1-4, 2015. Las Vegas.). “The biggest surprise for me was not only that it worked, but it was significantly better tolerated than using the higher strength tretinoin.”
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