Hydrocortisone 1% / Tretinoin 0.025% / Hydroquinone 4% in Aqueous cream

PurposeAs demand for nonsurgical aesthetic procedures increases, interest is also growing for desirable skin quality-radiant, healthy, and glowing skin-by patients seeking treatment to improve appearance. Although aesthetic medicine physicians are well positioned to advise on the role of basic skin care products in maintenance of results and healing, clear guidelines and protocols are currently lacking regarding the standard use of these products before and after aesthetic procedures.MethodsAn international panel of dermatologists (n = 6) and plastic surgeons (n = 2) convened virtually in March 2022 to discuss the role of skin care before and after nonsurgical aesthetic procedures (including injectables, energy-based devices, chemical peels, and microdermabrasion). As an outcome of that meeting, expert recommendations were developed for periprocedural skin care with the goal of improving recovery time or treatment outcomes for each procedure based on clinical evidence from a systematic literature review of relevant articles published through June 2022 combined with the authors' experience.ResultsOverall, 104 publications were identified and reviewed; publications could be counted more than once if they covered more than one topic (energy-based procedures, n = 70; injectable procedures including microneedling, n = 25; chemical peels, n = 21; microdermabrasion, n = 10). Common periprocedural skin care included daily routines utilizing cleansers, moisturizers, toners, hydroquinone, antioxidant serums, and sunscreens (as needed) across procedure types. Evidence supports pre/post-procedure routines (cleansers, moisturizers, toners, hydroquinone, antioxidants, sunscreens) across injectables (n = 25 studies), energy devices (n = 70), peels (n = 21), microdermabrasion (n = 10); high-evidence data limited, petrolatum/antioxidants show particular benefit post-laser.ConclusionPanel consensus endorses tailored regimens to optimize recovery/outcomes. However, very few studies were designed to evaluate a specific routine vs no skin care treatment. Further studies are needed to provide clinical evidence supporting the effectiveness of periprocedural skin care in reducing healing time and improving aesthetic outcomes. Herein, we provide evidence- and expert-based recommendations for incorporating daily skincare, including cleansers, moisturizers, antioxidant serums, depigmenting agents, and sunscreens, into periprocedural care for minimally invasive aesthetic treatments. These regimens should be adapted to procedure type and individual post-procedural responses and symptoms to optimize outcomes and address specific patient needs.

Abstract licence: CC BY-NC

Treatment with fluocinolone acetonide, hydroquinone, and tretinoin cream is the gold standard for melasma; however, the effects of this treatment in the Chinese population remain unclear. Due to the differences between Chinese and Caucasian subjects, further clinical trials in Chinese patients with melasma are needed.

Abstract licence: CC BY 4.0

Introduction: Ablative and nonablative lasers have been used to treat melasma. We aimed to assess and compare the combining Q-switched Nd:YAG laser (QSNYL) and fractional erbium:YAG laser (FEYL) with QSNYL alone in treatment of melasma. Methods: This randomized controlled clinical trial was performed in our Research Center during 2013-2014. Women with melasma and without a history of keloid formation, hypersensitivity to hydroquinone, or pigmentary changes due to laser therapy were randomly allocated to receive four sessions of either QSNYL-FEYL combination or QSNYL alone. All patients received topical treatment with Kligman's formula. Before laser therapy and 4 weeks after the last treatment session, patients' skin was assessed for changes in skin color, melanin content, and erythema intensity of melasma lesions quantitatively. Results: Finally, 21 patients in QSNYL-FEYL and 20 in QSNYL group (mean age, 38.57 [5.60] and 42.60 [8.44] years, respectively) completed study. The skin color had become lighter in both groups (mean [SD] percentage change of 56.95 [40.29] and 29.25 [13.20] in QSNYL-FEYL and QSNYL groups, respectively) with significantly better results in QSNYL-FEYL group (P = 0.006). Percentage of decrease of melanin content was significantly higher in QSNYL-FEYL group (22.01 [10.67] vs. 7.69 [4.75]; P P Conclusion: QSNYL-FEYL was significantly more effective in decreasing melanin content of lesions than QSNYL and led to a lighter skin.

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Background Melasma is an acquired pigmentary disorder characterized by symmetrical hyperpigmentation of the face. Treatment of melasma is unsatisfactory most of the times and comes with various side effects such as contact dermatitis, irritation and scarring.   Objective To compare efficacy of hydroquinone versus hydroquinone plus tretinoin plus topical steroids in patients with melasma.   Methods This randomized Controlled Trial was conducted in Department of Dermatology, Nishtar Medical University, Multan from 15th February 2019 to 15th August 2019. A total of 114 patients were divided in two groups, Group A, having 57 patients, was treated with hydroquinone cream once daily at bed time while group B, having 57 patients, was treated with combination therapy. Baseline and post-treatment MASI scores were calculated and patients were assessed weekly till 12 weeks and the efficacy of the treatment was documented. Efficacy was measured in terms of at least 50% reduction of MASI score after 12 weeks of therapy, compared with baseline MASI score.   Results This study comprised of a total of 114 patients meeting our inclusion criteria. Of these 114, 37 (32.5%) were male patients while 77 (67.5%) were female patients. Mean age in this study was 27.22±5.08 years. Mean age of the male patients was noted to be 27.89±4.53 years while that female patients was 26.90±5.32 years (p=0.330). Majority of the study cases i.e. 81 (71.1%) were aged up to 30 years. Of these 114 study cases, 43 (37.7%) belonged to rural areas and 71 (62.3%) belonged to urban areas. Fitzpatrick skin type III was noted in 78 (68.4%) and type IV in 36 (31.6%). Mean body mass index of our study cases was 25.68±2.59 kg/m2 and obesity was present in 11 (9.6 %) of our study cases. Mean disease duration was 10.29±8.23 months and 82 (71.9%) had duration of illness up to 1 year. Of these 114 study cases, 46 (40.6%) were illiterate and 68 (59.6%) were literate. Efficacy was noted in 75 (65.8%) of our study cases, Efficacy in group A was 49.1% while in group B, efficacy was noted in 82.5%.   Conclusion Combination therapy with hydroquinone plus tretinoin plus topical steroids is more effective, reliable and safe in treatment of melasma as compared with hydroquinone alone and it provides rapid and sustained clinical improvement in the treatment of melasma.  

Abstract licence: CC BY 4.0

IntroductionMelasma is one of the most common pigmentary disorders seen by dermatologists and often occurs among women with darker complexion (Fitzpatrick skin type IV-VI). Even though melasma is a widely recognized cause of significant cosmetic disfigurement worldwide and in India, there is a lack of systematic and clinically usable treatment algorithms and guidelines for melasma management. The present article outlines the epidemiology of melasma, reviews the various treatment options along with their mode of action, underscores the diagnostic dilemmas and quantification of illness, and weighs the evidence of currently available therapies.MethodsA panel of eminent dermatologists was created and their expert opinion was sought to address lacunae in information to arrive at a working algorithm for optimizing outcome in Indian patients. A thorough literature search from recognized medical databases preceded the panel discussions. The discussions and consensus from the panel discussions were drafted and refined as evidence-based treatment for melasma. The deployment of this algorithm is expected to act as a basis for guiding and refining therapy in the future.ResultsIt is recommended that photoprotection and modified Kligman's formula can be used as a first-line therapy for up to 12 weeks. In most patients, maintenance therapy will be necessary with non-hydroquinone (HQ) products or fixed triple combination intermittently, twice a week or less often. Concomitant camouflage should be offered to the patient at any stage during therapy. Monthly follow-ups are recommended to assess the compliance, tolerance, and efficacy of therapy.ConclusionThe key therapy recommended is fluorinated steroid containing 2-4% HQ-based triple combination for first line, with additional selective peels if required in second line. Lasers are a last resort.

Abstract licence: CC BY-NC