Pigmentary Disorders Editorials
Cost Trends of Hydroquinone and Other Dyschromia Treatments in the United States
Skin dyspigmentation is a common dermatologic concern, particularly in patients with skin of color.1 Hydroquinone is often used as a first-line therapy for dyschromia, and is approved for treatment of melasma, chloasma, freckles, senile lentigines, and hyperpigmentation.2 Hydroquinone 4% cream is available only by prescription in the United States (US). Hydroquinone formulations with concentrations less than 4% were previously available over-the-counter (OTC), however sales were prohibited by the US Food and Drug Administration (FDA) as of September 25, 2020.
The Use of Fibrinolytic Agent that has Antiplasmin Properties to Prevent and Treat Post-Inflammatory Hyperpigmentation
he risk of post-inflammatory hyperpigmentation (PIH) in patients undergoing dermatologic procedures is well known. It is especially common after laser procedures and chemical peels but can be seen with any procedure. PIH is also a sequela of acne, burns, and other trauma. High-risk patients are thought to have excessive production and abnormal distribution of melanin within the skin that triggers PIH, but the exact pathophysiology is unknown.1 We define high-risk patients as Fitzpatrick skin types 3–5, those with existing PIH, or a history of PIH.1,2
An antifibrinolytic medication prescribed to treat bleeding and is also used off-label to treat melasma. It is contraindicated in patients with hypercoagulable conditions, renal impairment, vision impairment disorders, pregnancy, breast-feeding, or on hormone therapies.3,4,5
From 2015–2020, we have used this medication off-label to successfully treat and/or prevent PIH in approximately 82 high-risk patients after injuries or prior to procedures that disrupt the epidermis. We also have used this to prevent PIH after acute injuries such as irritant dermatitis, thermal burns, and abrasions. We now consider it a treatment for all at risk patients prophylactically before undergoing microneedling, cryotherapy, cryolipolysis, chemical peels, and laser treatments.
Approach to Skin Lightening in Patients With Melasma
I read with interest the informative article by Spencer et al1 that describes the efficacious use as a novel skin lightening agent (LumaPro-C) for the treatment of patients with melasma. The topical preparation contains not only a resurfacing peptide with stabilized vitamin C and botanicals (including resveratrol, daisy and pine extracts, and ginger extract), but also an encapsulated plankton extract and a probiotic regulator. The components of the researchers’ preparation promoted skin lightening by exfoliation, impeding melanogenesis, and reducing inflammation.
