title: Successful short-term and long-term treatment of melasma and postinflammatory hyperpigmentation using vitamin C with a full-face iontophoresis mask and a mandelic/malic acid skin care regimen.
abstract: BACKGROUND
  Treatment of melasma and postinflammatory hyperpigmentation is often challenging. No ideal short-term and long-term treatment is available. Vitamin C alone and in combination with iontophoresis has been studied and found to be useful; however, no long-term studies have been published.
  
  
  METHODS
  In this study, 35 patients (34 female, 1 male) were treated with a novel full-face iontophoresis mask (FFIM) and a proprietary vitamin C (ascorbyl glucoside) preparation. Patients received one in-office treatment and 12 to 24 at-home treatments over 1 to 2 months in conjunction with a strict maintenance regimen consisting of a mandelic/malic acid skin care regimen, broad-spectrum ultraviolet A/ultraviolet B sunblock, a wide-brimmed hat, and sun-avoidance behavior. Follow-up after the initial in-office treatment ranged from 1 to 54 months (mean, 26 months). Four independent observers graded improvement of melasma and PIH using a 4-point scale. Before the study, high-performance liquid chromatography was used to verify iontophoretic penetration of vitamin C into the skin to a level of 0.2 cm in healthy volunteers (2 male, 2 female).
  
  
  RESULTS
  A mean 73% improvement in abnormal pigmentation was observed at the end of FFIM/vitamin C treatment. Greater than 25% improvement was observed in 32 of 35 patients, and greater than 50% improvement in 22 of 35 patients. Melasma Area and Severity Index scores demonstrated substantial improvement from baseline for all patients, with a mean improvement of 15.7.
  
  
  CONCLUSIONS
  Full-face iontophoresis of vitamin C appears to be an effective short-term treatment for melasma and postinflammatory hyperpigmentation. A protocol of strict sun avoidance in combination with a mandelic/malic acid skin care regimen appears to be useful in maintaining the improvement.
authors: Gateway Aesthetic Institute, Salt Lake City, UT, USA. gateway@xmission.com
authors: Mark B
authors: MB
authors: Taylor
authors: Jamal S
authors: JS
authors: Yanaki
authors: David O
authors: DO
authors: Draper
authors: Joe C
authors: JC
authors: Shurtz
authors: Mark
authors: M
authors: Coglianese
mesh_terms: D000328:Adult; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002851:Chromatography, High Pressure Liquid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017495:Hyperpigmentation / Q000150:complications / Q000188:drug therapy*; D007478:Iontophoresis; D008293:Malates / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008333:Mandelic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D008397:Masks; D008548:Melanosis / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D012867:Skin / Q000737:chemistry; D012869:Skin Absorption; D013473:Sunscreening Agents / Q000627:therapeutic use; D016896:Treatment Outcome; D014815:Vitamins / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D008293:Malates; D008333:Mandelic Acids; D013473:Sunscreening Agents; D014815:Vitamins; C030298:malic acid; C037938:mandelic acid; D001205:Ascorbic Acid