title: Combined use of two formulations containing diacetyl boldine, TGF-β1 biomimetic oligopeptide-68 with other hypopigmenting/exfoliating agents and sunscreen provides effective and convenient treatment for facial melasma. Either is equal to or is better than 4% hydroquinone on normal skin.
abstract: BACKGROUND
  Treatment of melasma remains a challenge and involves multistep approach. Diacetyl boldine (DAB) stabilizes tyrosinase in its inactive form while TGF-β1 biomimetic oligopeptide-68 inhibits tyrosinase activity.
  
  
  OBJECTIVE
  (1) to study the efficacy and safety of the combination use of two formulae containing two principal ingredients: DAB and TGF-β1 biomimetic oligopeptide-68 on facial melasma, and (2) to compare their efficacy with 2% and 4% hydroquinone cream (HQ) on sun-protected normal skin.
  
  
  METHODS
  A randomized, double-blind, 12-week comparative study of pre-/post-treatment was conducted in 40 females. Melasma was evaluated by manual MASI score and MASI score with instrumentally graded darkness at baseline, 6th week, and 12th week. The author also compared their effect with HQ on the arms, assessed their safety profile throughout the study.
  
  
  RESULTS
  Thirty-eight subjects have completed the study. Their melasma showed improvement at the 6th week and 12th week as compared with baseline (P < 0.05). None developed severe reaction. Most subjects had temporary, mild skin reaction. About 2.6% of subjects graded themselves markedly improved, 76.3% moderately improved, and 21.1% slightly improved. Each formula showed either more efficacy or exerted faster action on pigment reduction than HQ.
  
  
  CONCLUSIONS
  Combination of DAB serum at night and DAB/TGF-β1 biomimetic oligopeptide-68/sunscreen cream in the morning and at noon was effective and safe for facial melasma. They were superior to HQ in pigment reduction.
authors.affiliation: Department of Medical Services, Institute of Dermatology, Rajathevi, Bangkok, Thailand.
authors.forename: Walai-Orn
authors.initials: WO
authors.lastname: Pratchyapurit
mesh_terms: D000287:Administration, Topical; D000328:Adult; D001060:Aporphines; D032701:Biomimetics; D003931:Diacetyl / Q000008:administration & dosage*; D004311:Double-Blind Method; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004954:Esthetics; D005148:Facial Dermatoses / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007641:Keratolytic Agents / Q000008:administration & dosage; D008297:Male; D008548:Melanosis / Q000175:diagnosis / Q000188:drug therapy*; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012016:Reference Values; D012720:Severity of Illness Index; D013473:Sunscreening Agents / Q000008:administration & dosage*; D053773:Transforming Growth Factor beta1 / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D001060:Aporphines; D004338:Drug Combinations; D007641:Keratolytic Agents; D013473:Sunscreening Agents; D053773:Transforming Growth Factor beta1; C011686:boldine; D003931:Diacetyl
keywords: MASI score; TGF-beta-1 biomimetic oligopeptide-68; diacetyl boldine; hydroquinone; melasma