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| |  AAD: Microdermabrasion Plus Triple-Combination Therapy Successful in Treating Melasma By Maggie Schwarz NEW YORK, NY -- August 4, 2004 -- A small pilot study has shown excellent efficacy for microdermabrasion in treating melasma when a combination-depigmenting regimen is added, according to results of a study of 50 patients with the chronic condition. Wendy E. Roberts, MD, clinical assistant professor of medicine, Loma Linda University Medical Center, Rancho Mirage, California, presented the results of the study here July 28th to August 1st at the American Academy of Dermatology Annual Summer Scientific Meeting. An effective triple-combination cream containing hydroquinone, tretinoin, and a topical corticosteroid is available for treatment of melasma. Dr. Roberts said that to increase the penetration and effectiveness of the triple-combination cream, it is important to deliver it to the basal layer of the epidermis. Microdermabrasion is effective in enhancing penetration of topical medications, she said. Patients underwent a series of 6 microdermabrasion treatments spaced at 1 to 2-week intervals. During this period, they applied sunscreen SPF 30 UVA/UVB and topical vitamin C. Immediately following the last microdermabrasion session, they began using the triple-combination skin lightening cream, which contained hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.1%, administering it once each evening for 8 weeks. After 2 weeks, patients were evaluated using photographs and physician and patient assessments. If persistent hyperpigmentation was present, an additional microdermabrasion treatment was completed followed by 4 additional weeks of the triple-combination cream. At the 2-year follow-up, 20% of the patients reported greater than 95% clearing and 60% reported 60% to 95% clearing, while 20% of patients reported less than 60% clearing. Patients reported being extremely happy with the results of treatment. Microdermabrasion alone may be ineffective for melasma, Dr. Roberts said. The procedure removes melanin by exfoliating some melanophage-packed keratinocytes. However, there is no mechanism in the process of microdermabrasion for inhibiting melanin production by means of tyrosinase inhibition. Over time, maturing keratinocytes migrates from the basal layer with their melanophages, and the clinical picture does not alter. This explains the transient improvement, which has previously been reported with microdermabrasion as a treatment for melasma. Dr. Roberts concluded that once the majority of the melasma has been cleared, an appropriate maintenance regimen is essential to maintain melanocyte suppression and prevent repigmentation of treated areas. In addition to continued tyrosinase inhibition, the use of a sun-blocking cream is mandatory, she said.
[Presentation title: Long-Term Results of Microdermabrasion and Triple-Combination Melasma.]
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