title: Successful treatment of moderate to severe melasma with triple-combination cream and glycolic acid peels: a pilot study.
abstract: Triple-combination (TC) cream is a stable combination of fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%, and currently is the only US Food and Drug Administration-approved drug for the topical treatment of melasma. Furthermore, it is the only US Food and Drug Administration-approved product containing hydroquinone. Anecdotal evidence suggests that improvements in melasma can be achieved with a multifactor approach involving TC cream with a variety of procedures. A pilot study was designed to evaluate the efficacy and safety of sequential treatment with TC cream and a series of glycolic acid (GA) peels in participants with moderate to severe melasma. Participants were treated with TC cream for 2 weeks before the alternating sequential treatment cycles with TC cream and GA peels began. A total of six 2-week cycles of TC cream and 5 GA peels were used. Efficacy and safety evaluations were conducted at weeks 6 and 12. Investigator global assessment (IGA) ratings indicated that 1 of 20 participants (5%) had achieved treatment success (clear/almost clear) as early as week 6 and most participants had achieved treatment success by week 12 (65% [13/20]; P < .001 vs baseline). Objective absorption spectrometry measurements of the difference in melanin for involved versus uninvolved skin confirmed that hyperpigmentation was significantly reduced in participants at weeks 6 and 12 compared with baseline (P < .001 for both). Investigator and participant evaluations revealed that most participants (> or = 90%) showed improvement (excellent improvement, much improved, improved) by week 12 with alternating sequential treatment with TC cream and GA peels. Furthermore, the results of this study indicated that sequential treatment with TC cream and GA peels was well-tolerated.
authors.affiliation: The Dermatology and Aesthetic Center, Boca Raton 33486, USA.
authors.forename: Marta
authors.initials: M
authors.lastname: Rendon
authors.forename: Lina M
authors.initials: LM
authors.lastname: Cardona
authors.forename: Eric W
authors.initials: EW
authors.lastname: Bussear
authors.forename: Adolfo L
authors.initials: AL
authors.lastname: Benitez
authors.forename: Luz E
authors.initials: LE
authors.lastname: Colón
authors.forename: Lori A
authors.initials: LA
authors.lastname: Johnson
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D002615:Chemexfoliation / Q000379:methods*; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005446:Fluocinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects; D005500:Follow-Up Studies; D006016:Glycolates / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006873:Hydroquinones / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008548:Melanosis / Q000188:drug therapy*; D008875:Middle Aged; D009824:Ointments; D010865:Pilot Projects; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D003879:Dermatologic Agents; D004338:Drug Combinations; D006016:Glycolates; D006873:Hydroquinones; D009824:Ointments; D005446:Fluocinolone Acetonide; C031149:glycolic acid; D014212:Tretinoin; C031927:hydroquinone