Quiz: a therapeutic challenge in dermatology

Quiz: a therapeutic challenge in dermatology

that’s right

Answer: a) Hydroquinone is still a well-established drug.

Melasma is a common hypermelanosis that affects the quality of life of many individuals, especially women. It is characterized by asymmetric brownish spots on photoexposed areas, usually on the face. Its etiology has not yet been fully elucidated, but chronic sun exposure, hormonal and genetic factors play an important role.

Treating the condition remains a challenge, as exacerbations are common even after successful cleansing. Photoprotection is the first measure to be adopted, with color photoprotectors being preferred for additional protection from visible light.

Topical depigmentation agents are the first therapeutic option, and hydroquinone is still the most successful agent. The triple formula combines hydroquinone, tretinoin and flucinolone, enhancing its whitening due to its associated anti-aging and anti-inflammatory effect. However, exogenous chronosis and permanent depigmentation are potential side effects of continued hydroquinone use, and alternating use with alternative topical agents (such as niacinamide, azelaic acid, tranexamic acid, cysteamine, and chic acid) has been shown to be safer.

Oral agents are also widely used, such as tranexamic acid, which inhibits vascularization and skin inflammation (factors involved in the pathogenesis of melasma). Oral antioxidants such as lutein and Polypodium leucotomos are aids in photoprotection and brightening stains.

Procedures such as surface chemical peels and lasers are options for patients who do not respond only to local remedies. Picosecond lasers transfer the same energy with less heat transfer to neighboring tissues, offering greater safety and less risk of post-inflammatory hyperpigmentation.

References:

  • Passeron T. Melasma, photoaging disorder. Pigment Cell Melanoma Res. July 2018, 31 (4): 461-465.
  • Kwon SH. Melasma: updates and perspectives.
  • Sarkar R. Future melasma therapies: What lies ahead? Indian J Dermatol Venereol Leprol. 2020 Jan-Feb; 86 (1): 8-17.

Incorrect

Answer: a) Hydroquinone is still a well-established drug.

Melasma is a common hypermelanosis that affects the quality of life of many individuals, especially women. It is characterized by asymmetric brownish spots on photoexposed areas, usually on the face. Its etiology has not yet been fully elucidated, but chronic sun exposure, hormonal and genetic factors play an important role.

Treating the condition remains a challenge, as exacerbations are common even after successful cleansing. Photoprotection is the first measure to be adopted, with color photoprotectors being preferred for additional protection from visible light.

Topical depigmentation agents are the first therapeutic option, and hydroquinone is still the most successful agent. The triple formula combines hydroquinone, tretinoin and flucinolone, enhancing its whitening due to its associated anti-aging and anti-inflammatory effect. However, exogenous chronosis and permanent depigmentation are potential side effects of continued hydroquinone use, and alternating use with alternative topical agents (such as niacinamide, azelaic acid, tranexamic acid, cysteamine, and chic acid) has been shown to be safer.

Oral agents are also widely used, such as tranexamic acid, which inhibits vascularization and skin inflammation (factors involved in the pathogenesis of melasma). Oral antioxidants such as lutein and Polypodium leucotomos are aids in photoprotection and brightening stains.

Procedures such as surface chemical peels and lasers are options for patients who do not respond only to local remedies. Picosecond lasers transfer the same energy with less heat transfer to neighboring tissues, offering greater safety and less risk of post-inflammatory hyperpigmentation.

References:

  • Passeron T. Melasma, photoaging disorder. Pigment Cell Melanoma Res. July 2018, 31 (4): 461-465.
  • Kwon SH. Melasma: updates and perspectives.
  • Sarkar R. Future melasma therapies: What lies ahead? Indian J Dermatol Venereol Leprol. 2020 Jan-Feb; 86 (1): 8-17.

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