Topical Hydroquinone Research Articles

Therapeutic Effects of Topical Tranexamic Acid in Comparison with Hydroquinone in Treatment of Women with Melasma.

IntroductionFew studies have focused on therapeutic as well as side effects of tranexamic acid (TXA) as a topical drug compared to other topical drugs in treating melasma. The present study aimed to assess and compare the beneficial therapeutic effects and also side effects of local TXA in comparison with hydroquinone in treating women with melasma.MethodsThis randomized double-blinded clinical trial was performed on 60 women who suffered from melasma and were referred to the skin disorders clinic at the Rasoul-e-Akram hospital in Tehran in 2015. The patients were then randomly assigned via computerized randomization to two groups: group A received TXA%5 (topically twice a day for 12 weeks in the location of the melasma) and group B (received hydroquinone 2% with the same treatment order). Prior to intervention and at 12 weeks after intervention, the intensity and extension of melasma were assessed based on the Melasma Area and Severity Index (MASI) scoring method.ResultsThe mean MASI score in both treatment groups decreased considerably after completion of treatment and was not significant between the two groups. No side effects were detected in group A, but 10% of those in group B complained of drug-related side effects including erythema and skin irritation (p = 0.131). Regarding the level of patient satisfaction, the patients in group A had a significantly higher level of satisfaction level of 33.3% compared with 6.7% in group B (p = 0.015) (Fig. 9). Multivariate linear regression modeling with the presence of age, history of systemic disorder, drug history, and family history of melasma demonstrated no difference in the mean MASI between the two groups.ConclusionTopical use of TXA significantly reduced both melanin level and MASI score. Given its high efficiency and low drug side effects, this regimen results in high patient satisfaction compared with topical hydroquinone. IRCT code: IRCT2016040627220N2.

The Comparison of Efficacy of Oral Finastride and Topical Hydroquinone Versus Placebo and Topical Hydroquinone in Treatment of Melasma: A Randomized Double-Blind Clinical Trial

Introduction Melasma is a common acquired illness with outbreak of brown and often symmetrical hypersegmented patches on frequently sun-exposed areas of the face (1 and 2). Melasma accounts for about 4 to 10 percent of the complaints of those visiting skin clinics and is more common among Hispani

Formulation, Characterisation, and in Vitro Skin Diffusion of Nanostructured Lipid Carriers for Deoxyarbutin Compared to a Nanoemulsion and Conventional Cream.

The long-term use of topical hydroquinone as an anti-hyperpigmentation treatment has well-known, unwanted effects. Deoxyarbutin (4-[(tetrahydro-2H-pyran-2-yl)oxy]phenol) is a relatively new tyrosinase inhibitor, with stronger inhibitory potency than hydroquinone, that exhibited decreased cytotoxicity against melanocytes and other cells. This study developed novel nanostructured lipid carriers (NLCs) for improved topical delivery of deoxyarbutin (dArb), leading to improved depigmenting efficacy. dArb is a hydrophobic substance, but it easily degrades in aqueous medium and is thermolabile. Screening and optimisation of the solid lipid, liquid lipid, surfactant, co-surfactant and production methods were performed to choose the optimum particle size and stability for NLCs. One percent dArb NLCs were obtained from a combination of cetyl palmitate (CP) and caprylic/capric tryglicerides (Myr) in 12% total lipids using poloxamer 188 (P-188) and polyethylene glycol (PEG) 400 as a surfactant and co-surfactant, respectively, with a particle diameter of approximately 500 nm and a polydispersity index (PI) <0.4. These NLCs were produced using the simple method of high-shear homogenisation (10,000 rpm, 5 minutes) and ultrasonication (3.5 min). The compatibility between the substances in the formula was evaluated using Fourier Transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC). The morphology of the NLCs was observed using transmission electron microscopy (TEM). In vitro penetration of dArb NLCs was evaluated and compared to the nanoemulsion (NE) and conventional emulsion (CR) delivery methods across Spangler’s membrane (SS). Delivery improvement was clearly observed, and after 8 h of application, dArb gel-NLCs showed the highest dArb penetration, followed by liquid NLCs, NE, and CR.

Effect of Hydroquinone Plus Neodymium-Doped Yttrium Aluminium Garnet Laser With and Without CO2 Fractional Laser on Resistant Dermal Melasma

Background: The use of different types of lasers in the treatment of refractory melasma is still controversial. The present study was designed according to previous studies and used a combination of treatments. Objectives: The purpose of this study was to compare Q-switched (QS) neodymium-doped yttrium aluminium garnet (Nd: YAG) laser and hydroquinone with or without CO2 fractional laser in refractory melasma. Patients and Methods: Seventeen patients with refractory melasma, in a split-face randomized trial, received topical hydroquinone and Nd: YAG laser treatment on one half of their face and topical hydroquinone, Nd: YAG laser and CO2 fractional laser on the other half of their face. The patients were then assessed by Melasma area and severity index (MASI) over 12 weeks in three treatment sessions with an interval of three to four weeks. Results: Seventeen patients with melasma (14 females and three males) with mean (± SD) age of 38.47 (± 6.29) years (range 29 - 53) were included in this study. The only side effect for the Nd: YAG treatment was erythema observed in two cases (11.8%). The mean MASI scores decreased significantly after six weeks for both therapies. Also, a significant reduction was observed in the mean MASI scores from week six till the end of the study. Controlling for the effect of “MASI score at baseline”, the mean MASI score was significantly lower on the side treated with Nd:YAG + CO2 fractional laser in comparison with the Nd: YAG laser. Conclusions: Our study showed that the triple therapy of ND: YAG and ND: YAG + CO2 fractional and hydroquinone cream had high efficiency and low morbidity compared to twofold treatment with ND: YAG and ND: YAG + CO2 fractional.

Rapid method for the quantification of hydroquinone concentration: chemiluminescent analysis.

Topical hydroquinone serves as a skin whitener and is usually available in cosmetics or on prescription based on the hydroquinone concentration. Quantification of hydroquinone content therefore becomes an important issue in topical agents. High-performance liquid chromatography (HPLC) is the commonest method for determining hydroquinone content in topical agents, but this method is time-consuming and uses many solvents that can become an environmental issue. We report a rapid method for quantifying hydroquinone content by chemiluminescent analysis. Hydroquinone induces the production of hydrogen peroxide in the presence of basic compounds. Hydrogen peroxide induced by hydroquinone oxidized light-emitting materials such as lucigenin, resulted in the production of ultra-weak chemiluminescence that was detected by a chemiluminescence analyzer. The intensity of the chemiluminescence was found to be proportional to the hydroquinone concentration. We suggest that the rapid (measurement time, 60 s) and virtually solvent-free (solvent volume, <2 mL) chemiluminescent method described here for quantifying hydroquinone content may be an alternative to HPLC analysis.

Endogenous ochronosis presenting as recalcitrant facial hyperpigmentation aggravated with prolonged use of topical hydroquinone 2%

Ochronosis is an uncommon condition characterized by the deposition of an ochre-colored pigment within the skin, cartilage, and other connective tissues [1]. There are two types of ochronosis: endogenous and exogenous. Alkaptonuria (endogenous ochronosis), is a rare metabolic disorder characterized by a triad of homogentisic aciduria, cutaneous hyperpigmentation, and arthropathy. It is due to the deficiency of the enzyme homogentisic acid oxidase, which catalyzes the conversion of homogentisic acid to maleylacetoacetic acid in the catabolism of tyrosine. Exogenous ochronosis is a cutaneous disorder characterized by the bluish-black hyperpigmentation on the skin due to chronic use of chemical preparation and oral administration of a specific medication [2]. We present an overlap case of exogenous and endogenous ochronosis.

Exogenous Ochronosis Following Self Medication of Topical Hydroquinone : A Case Report and Review of Literature

Man is always obsessed with fair skin since ages. Beauty, it is said, is skin deep. Not so anymore for consumers especially in India who demand from their beauty products more than just a superficial whitening of their skin tone for a short duration. Hydroquinone is the ?rst choice of topical bleaching agents used in treatment of melasma. It is widely prescribed by physicians and often used by patients without prescription. The principal adverse effects of its chronic use are confetti-like depigmentation and exogenous ochronosis. Exogenous ochronosis is an infrequent dermatosis characterized as a dark blue hyperpigmentation localized where the causing agent was applied. It may be caused by the use of systemic medications such as antimalarials and by the use of topical substances such as phenol, resorcinol, benzene, hydroquinone, which is a phenolic compound with depigmenting action. The pathophysiology of this process is not well clear up to this moment, and the therapeutic measures are not satisfactory either. We hereby, reporting a case of 29 years old female who had been using hydroquinone continuously for six years for fairer complexion and ended up with a night mare.

Treatment of Erythema Ab Igne with Combination of Topical Hydroquinone and 1,064-nm Q-switched Neodymium-Doped Yttrium Aluminum Garnet Laser with Low Fluence

Jung-In Kim, Hyun-Min Seo, Yoon-Hwan Kim, Joon Lee, Seung-Jae Lee, Ji-Hye Park, Ga-Young Lee, and Won-Serk Kim. Medical Lasers; Engineering, Basic Research, and Clinical Application 2013;2:73-5. https://doi.org/10.25289/ML.2013.2.2.73

Exogenous ochronosis – successful outcome after treatment with Q-switched Nd:YAG laser

Background: Exogenous ochronosis (EO), a disfiguring cutaneous complication of topical hydroquinone use, is difficult to treat. There are few reports of successful outcomes following treatment with different modalities. Objective: We assessed the results of treatment of EO with the Q-switched Nd:YAG laser. Material and methods: Patients with histologically-confirmed EO were treated with the Q-switched Nd:YAG laser. Results and conclusion: Q-switched Nd:YAG laser treatment appears to be effective in reducing the dyschromia of EO.

Exogenous ochronosis: case report and literature review

Exogenous ochronosis is a rare, cosmetically disfiguring condition, resulting from the longterm use of topical hydroquinone in treatment of melasma. It manifests as gray-brown or blue-black macules in hydroquinone-exposed regions. The exact incidence of ochronosis is unknown. High rates have been reported in the South African population, and it is rare in the United States. We report the case of a patient who developed exogenous ochronosis while using topical hydroquinone. It is necessary to recognize this disorder at the earliest stage and discontinue hydroquinone immediately, as its treatment is difficult. Sun exposure facilitates the formation of exogenous ochronosis and must be strictly avoided, although it is a practical problem in the tropical climate of Brazil, particularly for those who work outdoors.

Hepatic and Renal Histological Alterations Induced by Topical Hydroquinone Administration

Problem statement: Although the regulatory agencies of the United States and Europe banned hydroquinone in cosmetics skin lightening but it is still used in most of Middle East countries, including Saudi Arabia. Few studies were carried out on the histological alterations of hydroquinone on kidney and liver. Approach: The present study was carried out to investigate the histological alterations in liver and kidney caused by hydroquinone topical administration. Results: The induced histological alterations in the liver were mainly hydropic degeneration, bile duct hyperplasia and glycogen depletion. The kidney of treated rabbits showed hydropic degeneration, hyaline casts, congestion, perivascular edema and fibrosis together with lymphocytic aggregation. The skin showed hyperkeratosis, lymphocytic and eosinophilic infiltration together with congestion of dermal blood vessels. Conclusion: Taken together, the histological findings of this study indicate that chronic exposure to hydroquinone produce significant histological alterations that might affect the liver and kidney.

Exogenous ochronosis after prolonged use of topical hydroquinone (2%) in a 50-year-old Indian female

Ochronosis is a rare disease characterized by speckled and diffuse pigmentation symmetrically over the face, neck, and photo-exposed areas. It is characterized histologically by banana-shaped ochre-colored deposits in the dermis. It can present in exogenous or endogenous form. We report a case of exogenous ochronosis in a 50-year-old Indian woman after prolonged use of topical hydroquinone which is a rare complication with a commonly used drug which is available over the counter.

Post-inflammatory hyperpigmentation

As a result of excessive pigment deposition secondary to an inflammatory dermatosis, postinflammatory hyperpigmentation (PIH) is a common clinical entity and has a predilection for dark skin phenotypes. It is an acquired hyperpigmentation that can be caused by alterations occurring at any level in melanogenesis. Although studies have been carried out at home and abroad, litde is known about its pathogenesis. Topical tretinoin,hydroquinone, azelaic acid, kojic acid and various types of epidermal peels have shown some therapeutic effect. Recent reports also have demonstrated the efficacy of some lasers in accelerating the pigment removal, which may serve as a hot topic in future research. Key words: Melanocytes; Pigmentation; Inflammation; Therapy

Different therapeutic modalities for treatment of melasma

Chemical peels and topical depigmenting agents have become a popular modality in the treatment of melasma. To compare the clinical efficacy of trichloroacetic acid peel 20%vs. Jessner's solution peel vs. the topical mixture of hydroquinone 2% and kojic acid. Forty five patients with melasma were randomly assigned into three groups of fifteen patients each. Group A received Jessner's solution peel, group B received trichloroacetic acid peel 20%, and group C received topical hydroquinone 2% and kojic acid. All patients were seen in follow-up period after 16 weeks; clinical evaluation using Melasma Area and Severity Index (MASI) score and photography were recorded before and after treatment and after 16 weeks. There was a decrease in MASI score in all three groups after treatment and after follow-up period but after treatment MASI score was statistically significantly lower in group A than group C (P = 0.01), and it was also statistically significantly lower in group B than group C (P < 0.001) but there was no statistically significant difference between groups A and B. After the follow-up period, MASI score was statistically significantly lower in group A than group C (P < 0.001), statistically significantly lower in group B than group C (P < 0.001), and statistically significantly lower in group B than group A (P = 0.035). The statistical analysis was done through one-way anova followed by least significant difference (LSD). Trichloroacetic acid 20% showed better results than Jessner's solution as peeling agent and hydroquinone 2% with kojic acid as a topical agent in the treatment of melasma.

Melasma: Treatment evaluation

Introduction: Melasma is a common disorder of facial hyperpigmentation that can be resistant to treatment. Our purpose is to evaluate the clinical efficacy of the different available modalities of treatment of melasma among Egyptian patients who have mostly skin types IV–V under a sunny climate. Methods: A total of 45 patients with moderate‐to‐severe melasma were subjected to topical application of hydroquinone 4% cream, chemical peeling with 30% trichloroacetic acid (TCA) and/or frequency‐doubled Q‐switched Nd:YAG laser therapy for an average of 6 months. Clinical evaluation and melasma severity were recorded using the melasma area and severity index (MASI) score. Results: The improvement score was significantly higher among the topically treated group compared with other lines of therapy (p<0.0001). No significant difference in improvement score was detected in the laser group compared with the peeling group. The epidermal type of melasma was also significantly improved compared with the dermal type (p<0.01). Conclusion: Topical hydroquinone remains the most effective agent for the treatment of melasma in dark‐skinned people with rare side effects.

Successful Full-Term Live Birth in an Allogeneic Stem Cell Transplant Patient with Active Extensive Chronic Graft-Versus-Host Disease.

Objective: Little information exists regarding pregnancy after allogeneic stem cell transplantation. Pregnancy in the setting of active graft-versus-host disease (GVHD) is even less common. We report an interesting case of a patient with active GVHD who had a spontaneous pregnancy four years after allogeneic stem cell transplant and whose GVHD remained stable during her pregnancy.Patient information: Our patient is a 27 year-old African-American female who was diagnosed with aplastic anemia in January 2002. She was initially treated with anti-thymocyte gamma globulin (ATG) and cyclosporine with minimal response. She was red blood cell and platelet transfusion dependent during this time. She was referred to the UAB Bone Marrow Transplant Center for evaluation for allogeneic stem cell transplant in June 2002. Her conditioning regimen included cyclophosphamide and ATG. She received her stem cell transplant on July 30, 2002 and was no longer transfusion dependent seven months after her transplant. In January 2003, the patient was diagnosed with GVHD of her oropharynx and skin. She was treated with cyclosporine and oral solumedrol initially. By February 2003, mycophenolate mofetil was added to her regimen. She was tapered off of the solumedrol by day +366 and maintained on cyclosporine and mycophenolate. Tapering of her immunosuppressive medication was attempted multiple times unsuccessfully. Unfortunately, she progressed to sclerodermatous changes of the skin that were confirmed as GVHD by biopsy. She started psoralen and UVA light therapy (PUVA) in August 2004. Subsequently, she was treated with topical hydroquinone and FK-506 along with photopheresis and physical and occupational therapy. Pentoxifylline and vitamin E were added in August 2005. By August 2006, photopheresis had been decreased to every month and she was controlled on mycophenolate and photopheresis. Planned immunosuppressant taper at four years post-transplant was complicated by an unplanned pregnancy at that time. The patient's photopheresis was discontinued because of concerns for teratogenicity with psoralens. During her pregnancy, the patient was maintained on full dose mycophenolate and low dose oral FK-506. Of note, the patient was not on any estrogen supplementation at the time of conception. The patient was monitored by the transplant team serially throughout her pregnancy. Her GVHD did not progress objectively, and the patient reported subjective improvement. The patient went on to deliver a healthy female infant at term via C-section.Conclusions: Ours is the first reported case of pregnancy and successful delivery of a healthy infant in a patient with active extensive chronic GVHD. On review of the literature, only a few cases of spontaneous pregnancies after allogeneic stem cell transplant have been reported, and they typically involve reduced dose intensity chemoradiotherapy or occur in premenarchal patients. There are twenty unconfirmed cases of pregnancy in the transplant registry. More cases have been reported in solid organ transplant patients on immunosuppressive medications. As transplants for non-malignant disorders and the use of nonmyeloablative transplants increase, we expect to see more cases of pregnancy after transplant. Attention to fertility issues and monitoring for pregnancy in potentially fertile patients needs to be considered. Also, further research into the altered immune state during pregnancy may lead to further understanding of the mechanism of GVHD and possibly novel treatments.

Trichostasis spinulosa: possible association with prolonged topical application of clobetasol propionate 0.05% cream

A 20-year-old woman of south Asian descent was concerned about her dark complexion, predominantly affecting the exposed areas of her body, including the face, neck, upper chest, and extremities. She tried multiple over-the-counter products, including topical hydroquinone, kojic acid, and various herbal formulations, without success. Three years previous to her presentation, she was given clobetasol propionate 0.05% cream by a friend, which she applied to the face, neck, upper chest, and arms. After 6 weeks of twice-daily application, she noted marked improvement of her complexion; thus, she continued to use clobetasol propionate cream thereafter. She applied approximately 10 g of cream daily. One year previous to her presentation, she noticed an asymptomatic eruption of tiny dark-brown papules and “open pores” on the face, neck, upper chest, and arms. She thought her dark complexion was returning, and continued to use topical corticosteroid for another year without improvement. She was advised to see a dermatologist. Physical examination revealed multiple, dark-brown, follicular papules involving the face, neck, upper chest, arms, and antecubital areas (1-3). There was a rough sensation on palpation. On examination with a hand lens, tufts of hairs were visible projecting through each of the tiny papules. Manual attempts to express material from the lesions were unsuccessful. A few of the horny plugs were removed with a sterile needle. Multiple vellus hairs were seen embedded in keratinous material on light microscopy of the extracted plugs (Fig. 4). The patient refused a skin biopsy. Figure 1Open in figure viewerPowerPoint Dark-brown follicular papules on the face Figure 2Open in figure viewerPowerPoint Dark-brown follicular papules on the chest Figure 3Open in figure viewerPowerPoint Dark-brown follicular papules on the arm and antecubital area Figure 4Open in figure viewerPowerPoint Bundle of vellus hairs surrounded by a keratinous sheath (magnification, ×10) In addition to the dark follicular papules, multiple open comedones were present on the malar areas, and hypertrichosis was evident on the chin and lower cheeks. Telangiectasias were also visible over the malar areas and the arms. Her past medical history, the rest of the physical examination, and routine blood and urinalyses, including serum free testosterone, blood urea nitrogen, and serum creatinine levels, were unremarkable. On the basis of the clinical and light microscopic findings, a diagnosis of trichostasis spinulosa (TS) was made. She was advised to discontinue the use of corticosteroid cream. Her treatment consisted of daily tretinoin 0.05% cream over the affected areas at bedtime. A marked improvement of the TS lesions and comedonal acne was noted at the 3-month follow-up visit (5-7). There was no improvement of the hypertrichosis and telangiectasias. Figure 5Open in figure viewerPowerPoint Marked improvement of comedonal acne and trichostasis spinulosa lesions on the face after topical therapy with tretinoin 0.05% cream at the 3-month follow-up Figure 6Open in figure viewerPowerPoint Marked improvement of trichostasis spinulosa lesions on the chest after topical therapy with tretinoin 0.05% cream at the 3-month follow-up Figure 7Open in figure viewerPowerPoint Marked improvement of trichostasis spinulosa lesions on the arm and the antecubital area after topical therapy with tretinoin 0.05% cream at the 3-month follow-up. Postinflammatory hyperpigmentation is evident

Exogenous ochronosis following hydroquinone for melasma

A female Indian farmer with melasma developed progressive worsening of facial pigmentation while using topical hydroquinone. It manifested as bluish-black pigmentation, confirmed microscopically as ochronotic change, i.e. exogenous ochronosis (EO). Failure to follow adequate sun protective measures and usage of overly high concentrations of hydroquinone were the most likely causes of EO in this case. It is necessary to recognize this disorder at the earliest stage to avoid treatment disappointments.

A small open-label study of a 2% 4-hydroxyanisole and 0.01% tretinoin solution for the treatment of post-inflammatory hyperpigmentation

Post-inflammatory hyperpigmentation (PIH) is a frequent sequel to inflammatory eruptions in the skin. PIH is particularly common in dark complected individuals with a relatively higher level of melanin production whose melanocytes overreact to cutaneous injury. PIH may persist for months to years after resolution of the initial lesion and is, to most patients, of great concern. Topical hydroquinone has been a mainstay of therapy for PIH, however, in many hyperpigmentation disorders, combination products or treatments appear to be more useful than single agents. Some studies suggest that prolonged use of hydroquinone may result in the development of exogenous ochronosis. This poster will present the results of a small study utilizing a dual agent topical solution containing 2% 4-hydroxyanisole and 0.01% tretinoin in patients with PIH from various skin disorders and conditions, including acne, burn scars, post-electrodessication, and others. Efficacy evaluations were made by means of photography and mexameter reading to assess hyperpigmented macules and safety parameters were noted. Animal studies have shown this combination to be effective in lightening skin without causing irreversible depigmentation and with minimal local irritation. 4-HA has no known cytotoxicity to human melanocytes

A retrospective study on the efficacy and complications of Q-switched alexandrite laser in the treatment of acquired bilateral nevus of Ota-like macules.

Acquired bilateral nevus of Ota-like macules (ABNOM), or Hori's macules, is a common Asian condition that is characterized by bluish hyperpigmentation in the bilateral malar regions. Unlike nevus of Ota, ABNOM is an acquired condition that often develops after 20 years of age and involves both sides of the face, but there is no mucosal involvement. Recently Q-switched (QS) 1064 nm Nd:YAG lasers have been effective in clearing this condition. The effectiveness of QS alexandrite lasers has not yet been studied. To retrospectively assess the efficacy and complications of QS alexandrite lasers in the treatment of ABNOM. Thirty-two Chinese women with ABNOM ranging in age from 28 to 66 years were involved in the study. All underwent QS alexandrite laser treatment (755 nm, spot size 3 mm, 8 J/cm(2)). Topical hydroquinone and tretinoin cream were given to those with hyperpigmentation after the laser surgery. Clinical photographs were taken before and after laser surgery and assessed by two independent observers. The degree of clearing was scored and complications, including hypopigmentation, hyperpigmentation, scarring, and erythema, were assessed. The mean number of treatment sessions was 7 (range 2-11) and the mean treatment interval was 33 days. Both observers identified more than 80% of the patients as having more than a 50% degree of clearing, and complete clearance was seen in more than 28% of patients. Although most patients had postlaser hyperpigmentation and were on depigmentary regimes, the hyperpigmentation was seen in only 12.5% of the patients during photographic evaluation. Hypopigmentation was seen in 50% of patients and erythema in 41%. QS alexandrite appears to be effective in the treatment of ABNOM. Postoperative pigmentary changes were frequent and the use of topical depigmentary agents was necessary to achieve a satisfactory result. Transient hypopigmentation risk was high, affecting up to 50% of the patients. Further study is warranted to compare the efficacy and complications of different laser systems in the treatment of this condition.