Treatment modalities for hyperpigmented skin lesions: A brief overview
Abstract
Skin hyperpigmentation involves a broad range of skin conditions, including epidermal pigmented lesions, dermal pigmented lesions, and mixed pigmented lesions. Treatment includes various modalities such as brightening cream, chemical peeling, and laser therapy. Responses to various treatment modalities can be quite varied depending on the type of treatment and the degree of pigmentation. Sometimes a lesion can lighten or even partially disappear, while other lesions may recur. This paper provides a brief overview of treatment modalities available for hyperpigmented skin lesions including the importance of photoprotection, various types of brightening creams, suitable types of chemical peels, specific laser therapies targeted for skin hyperpigmentation, and surgery.
References
Draelos ZD. Skin lightening preparations and the hydro-quinone controversy. Dermatol Ther 2007; 20(5): 308–313.
doi:10.1111/j.1529-8019.2007.00144.x.
Bentley R. From miso, sake and shoyu to cosmetics: A century of science for kojic acid. Nat Prod Rep 2006; 23(23): 1046–1062. doi: 10.1039/B603758P.
Badreshia-Bansal S, Draelos ZD. Insight into skin light-ening cosmeceuticals for women of color. J Drugs Der-matol 2007; 6(1): 32–39.
Licorice [Internet]. Merriam-Webster's Medical Dictionary: Merriam-Webster, Inc.; 2007 [cited 2015 Dec 1]. Available from: www.merriam-webster.com/dictionary/ licorice.
Halder RM, Nordlund JJ. Topical treatment of pigmentary disorders. 2nd ed. In: Nordlund JJ, Boissy RE, Hearing VJ, Hearing RA, King WS, et al., (editors). The pigmentary system: physiology and pathophysiology. Oxford: Blackwell Publishing Ltd; 2006. p. 1165–1174.
doi: 10.1002/9780470987100.ch59.
Picardo M, Carrera M. New and experimental treatments of cloasma and other hypermelanoses. Dermatol Clin 2007; 25(3): 353–362. doi: 10.1016/j.det.2007.04.012.
Yokota T, Nishio H, Kubota Y, Mizoguchi M. The inhibi-tory effect of glabridin from licorice extracts on melano-genesis and inflammation. Pigment Cell Res 1998; 11(6): 355–361. doi: 10.1111/j.1600-0749.1998.tb00494.x.
Pop C, Vlase L, Tamas M. Natural resources containing arbutin. Determination of arbutin in the leaves of Bergenia crassifolia (L.) Fritsch acclimated in Romania. Not Bot Hort Agrobot Cluj Napoca 2009; 37(1): 129–132.
Boissy RE, Visscher M, DeLong MA. DeoxyArbutin: A novel reversible tyrosinase inhibitor with effective in vivo skin lightening potency. Exp Dermatol 2005; 14(8): 601– 608. doi: 10.1111/j.0906-6705.2005.00337.x.
Hamed SH, Sriwiriyanont P, deLong MA, Visscher MO, Wickett RR, et al. Comparative efficacy and safety of deoxyarbutin, a new tyrosinase-inhibiting agent. J Cosmet Sci 2006; 57(4): 291–308.
Colby SI, Schwartzel EH, Huber FJ, Highton A, Altman DJ, et al. A promising new treatment for solar lentigines. J Drugs Dermatol 2003; 2(2): 147–152.
Briganti S, Camera E, Picardo M. Chemical and instru-mental approaches to treat hyperpigmentation. Pigment Cell Res 2003; 16(2): 101–110. doi: 10.1034/j.1600-0749. 2003.00029.x.
Hakozaki T, Takiwaki H, Miyamoto K, Sato Y, Arase S. Ultrasound enhanced skin-lightening effect of vitamin C and niacinamide. Skin Res Technol 2006; 12(2): 105–113. doi: 10.1111/j.0909-752X.2006.00186.x.
Zhu W, Zhang R. Skin lightening agents. In: Draelos ZD, Thaman LA, (editors). Cosmetic formulation of skin care products. New York: Taylor and Francis Group LLC; 2005. p. 205–218.
Zhu W, Gao J. The use of botanical extracts as topical skin-lightening agents for the improvement of skin pig-mentation disorders. J Investig Dermatol Symp Proc 2008; 13(1): 20–24. doi: 10.1038/jidsymp.2008.8.
Rolfe HM. A review of nicotinamide: Treatment of skin diseases and potential side effects. J Cosmet Dermatol 2014; 13(4): 324–328. doi: 10.1111/jocd.12119.
Niren NM. Pharmacologic doses of nicotinamide in the treatment of inflammatory skin conditions: A review. Cutis 2006; 77(1 Suppl): 11–6.
Greatens A, Hakozaki T, Koshoffer A, Epstein H, Schwemberger S, et al. Effective inhibition of melanosome transfer to keratinocytes by lectins and niacinamide is reversible. Exp Dermatol 2005; 14(7): 498–508. doi: 10.1111/j.0906-6705.2005.00309.x.
Hakozaki T, Minwalla L, Zhuang J, Chhoa M, Matsubara A, et al. The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer. Br J Dermatol 2002; 147(1): 20–31. doi: 10.1046/j.1365-213 3.2002.04834.x.
Navarrete-Solís J, Castanedo-Cázares JP, Torres-Álvarez B, Oros-Ovalle C, Fuentes-Ahumada C, et al. A dou-ble-blind, randomized clinical trial of niacinamide 4% versus hydroquinone 4% in the treatment of melasma. Dermatol Res Pract 2011; 379173. doi: 10.1155/2011/ 379173.
Breathnach AS. Melanin hyperpigmentation of skin: Me-lasma, topical treatment with azelaic acid, and other therapies. Cutis 1996; 57(1 Suppl): 36–45.
Baliña LM, Graupe K. The treatment of melasma 20% azelaic acid versus 4% hydroquinone cream. Int J Der-matol 1991; 30(12): 893–895. doi: 10.1111/j.1365-4362.1 991.tb04362.x.
Saurat JH. Retinoids and psoriasis: Novel issues in retin-oid pharmacology and implications for psoriasis treatment. J Am Acad Dermatol 1999; 41(Suppl 3): S2–S6. doi: 10.1016/S0190-9622(99)70358-0.
Thielitz A, Gollnick H. Topical retinoids in acne vulgaris. Am J Clin Dermatol 2008; 9(6): 369–381. doi: 10.2165/01 28071-200809060-00003.
Stefanaki C, Stratigos A, Katsambas A. Topical retinoids in the treatment of photoaging. J Cosmet Dermatol 2005; 4(2): 130–134. doi: 10.1111/j.1473-2165.2005.40215.x.
Mukherjee S, Date A, Patravale V, Korting HC, Roeder A, et al. Retinoids in the treatment of skin aging: An overview of clinical efficacy and safety. Clin Interv Aging 2006; 1(4): 327–348.
Nair X, Parah P, Suhr L, Tramposch KM. Combination of 4-hydroxyanisole and all-trans retinoic acid produces synergistic skin depigmentation in swine. J Invest Der-matol 1993; 101(2): 145–149.
Solano F, Briganti S, Picardo M, Ghanem G. Hypopig-menting agents: An updated review on biological, chemical and clinical aspects. Pigment Cell Melanoma Res 2006; 19(6): 550–571. doi: 10.1111/j.1600-0749.200 6.00334.x.
Pathak MA, Fizpatrick TB, Kraus EW. Usefulness of retinoic acid in the treatment of melasma. J Am Acad Dermatol 1986; 15(4): 894–899. doi: 10.1016/S0190-962 2(86)70247-8.
Glogau RG. Chemical peeling and aging skin. J Geriatr Dermatol 1994; 2: 30–35.
Branham GH, Thomas JR. Rejuvenation of the skin surface: Chemical peel and dermabrasion. Facial Plast Surg 1996; 12(2): 125–133. doi: 10.1055/s-0028-1082404.
Joshi SS, Boone SL, Alam M, Yoo S, White L, et al. Effectiveness, safety, and effect on quality of life of topical salicylic acid peels for treatment of postinflammatory hyperpigmentation in dark skin. Dermatol Surg 2009; 35(4): 638–644. doi: 10.1111/j.1524-4725.2009.01103.x.
Kligman D, Kligman AM. Salicylic acid peels for the treatment of photoaging. Dermatol Surg 1998; 24(3): 325–328. doi: 10.1111/j.1524-4725.1998.tb04162.x.
Obagi ZE, Obagi S, Alaiti S, Stevens MB. TCA-based blue peel: A standardized procedure with depth control. Dermatol Surg 1999; 25(10): 773–780. doi: 10.1046/j.1524- 4725.1999.98178.x.
Low DW, Percec I. Lasers in plastic surgery. In: Thorne CH, Chung KC, Gosain AK, Gurtner GC, Mehrara BJ, et al. (editors). Grabb and Smith’s plastic surgery. Phila-delphia: Lippincott Williams & Wilkins; 2013. p.163–172
Goldberg DJ. Laser treatment of pigmented lesions. Dermatol Clin 1997; 15(3): 397–407. doi: 10.1046/j.152 4-4725.1999.98178.x.
Chung JH, Koh WS, Lee DY, Lee YS, Eun HC, et al. Copper vapour laser treatment of port-wine stains in brown skin. Australas J Dermatol 1997; 38(1): 15–21. doi: 10.1111/j.1440-0960.1997.tb01092.x.
Lee MWC. Combination 532-nm and 1064-nm lasers for noninvasive skin rejuvenation and toning. Arch Dermatol 2003; 139(10): 1265–1276. doi: 10.1001/archderm.139.1 0.1265.
Fitzpatrick RE, Goldman MP, Satur NM, Tope WD. Pulsed carbon dioxide laser resurfacing of photoaged facial skin. Arch Dermatol 1996; 132(4): 395–402. doi: 10.1001/archderm.1996.03890280047007.
Reid WH, McLeod PJ, Ritchie A, Ferguson-Pell M. Q-switched ruby laser treatment of black tattoos. Br J Plast Surg 1980; 36(4): 455–459. doi: 10.1016/0007-1226(83)9 0128-5.
Laub DR, Yules RB, Arras M, Murray DE, Crowley L, et al. Preliminary histopathological observation of Q- swit¬ched ruby laser radiation on dermal tattoo pigment in man. J Surg Res 1968; 8(5): 220–224. doi: 10.1016/0022-4804 (68)90090-5.
Taylor CR, Gange RW, Dover JS, Flotte TJ, Gonzalez E, et al. Treatment of tattoos by Q-switched ruby laser: A dose-response study. Arch Dermatol 1990; 126(7): 893– 899. doi: 10.1001/archderm.1990.01670310055007.
Tse Y, Levine VJ, Mcclain SA, Ashinoff R. The removal of cutaneous pigmented lesions with the Q-switched ruby laser and the Q-switched neodymium: yttrium-aluminum- garnet laser. J Dermatol Surg Oncol 1994; 20(12): 795–800.
doi: 10.1111/j.1524-4725.1994.tb03707.x.
Jang KA, Chung EC, Choi JH, Sung KJ, Moon KC, et al. Successful removal of freckles in Asian skin with a Q-switched alexandrite laser. Dermatol Surg 2000; 26(3): 231–234. doi: 10.1046/j.1524-4725.2000.09243.x.
Ross EV, Naseef G, Lin C, Kelly M, Michaud N, et al. Comparison of responses of tattoos to picosecond and nanosecond Q-switched neodymium: YAG lasers. Arch Dermatol 1998; 134(2): 167–171. doi: 10.1001/archderm. 134.2.167.
Suzuki H. Treatment of traumatic tattoos with the Q- switched neodymium: YAG laser. Arch Dermatol 1996; 132(10): 1226–1229. doi: 10.1001/archderm.1996.038903 40090014.
Stratigos AJ, Dover JS, Arndt KA. Laser treatment of pigmented lesions-2000: How far have we gone? Arch Dermatol 2000; 136(7): 915–921. doi: 10.1001/archderm. 136.7.915.
Citron BS. Laser treatment of pigmented lesions. Clin Plast Surg 2000; 27(2): 193–198.
Kilmer SL. Laser eradication of pigmented lesions and tattoos. Dermatol Clin 2002; 20(1): 37–53. doi: 10.1016/S0733-8635(03)00057-3.
Griffiths CEM, Goldfarb MT, Finkel LJ, Roulia V, Bona-witz M, et al. Topical tretinoin (retinoid acid) treatment of hyperpigmented lesions associated with photoa¬ging in Chinese and Japanese patients: A vehicle- contr¬olled trial. J Am Acad Dermatol 1994; 30(1): 76–84. doi: 10.1016/S0190-9622(94)70011-7.
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