title: Cosmetic color improvement of the nipple-areola complex by optimal use of tretinoin and hydroquinone.
abstract: BACKGROUND
  A successful treatment to improve the color of nipple-areola complex (NAC) has never been reported, although the number of women seeking the more attractively colored NAC is not small.
  
  
  OBJECTIVE
  To determine the effectiveness of our bleaching protocol for cosmetic improvement of the NAC.
  
  
  METHODS
  The protocol was composed of two phases: bleaching phase (4-8 weeks) and healing phase (4-6 weeks). 0.2-0.4% tretinoin aqueous gel was applied concomitantly with 5% hydroquinone, 7% lactic acid ointment for bleaching twice a day. Tretinoin was applied to the NAC with a small cotton applicator, while hydroquinone was widely applied beyond the NAC area. After obtaining sufficient improvement in NAC color, the application of tretinoin was discontinued and hydroquinone alone was continually applied in the healing phase until the reactive erythema was eliminated. Fifteen female patients were involved in this study.
  
  
  RESULTS
  The average treatment period was 16.6 weeks. Improvement of NAC color was obtained in 12 patients (80%) by the physician's estimation, and 11 patients (73%) satisfied with their final results. The treatment was repeated after a 1-month interval of tretinoin application in 4 patients: 2 desired further improvement in color, and 2 had the second course conducted to treat the postinflammatory hyperpigmentation on the surrounding mound induced by the first course.
  
  
  CONCLUSIONS
  This approach appeared to be most effective for cosmetic improvement of NAC color among treatments available so far.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Tokyo, Graduate School of Medicine, Japan. yoshimura-pla@h.u-tokyo.ac.jp
authors.forename: Kotaro
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Akira
authors.initials: A
authors.lastname: Momosawa
authors.forename: Asami
authors.initials: A
authors.lastname: Watanabe
authors.forename: Katsujiro
authors.initials: K
authors.lastname: Sato
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsumoto
authors.forename: Emiko
authors.initials: E
authors.lastname: Aiba
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Harii
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Takao
authors.initials: T
authors.lastname: Aoyama
authors.forename: Tatsuji
authors.initials: T
authors.lastname: Iga
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005782:Gels; D006801:Humans; D006873:Hydroquinones / Q000008:administration & dosage / Q000627:therapeutic use*; D017495:Hyperpigmentation / Q000188:drug therapy* / Q000473:pathology; D007641:Keratolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D009558:Nipples / Q000473:pathology; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D005782:Gels; D006873:Hydroquinones; D007641:Keratolytic Agents; D014212:Tretinoin; C031927:hydroquinone