Combined therapy is more effective than conventional therapy as Melasma treatmen 2010 

Dr. Bhuiyan Ma Yousuf MBBS, MSc ( Sweden), D.D (Singapore), PGCD( Kerolinska institute); 
email: ybhuia@yahoo.com  
 
Back ground: Melasma is an acquired symmetric hypermelanosis characterized by irregular

light-to gray-brown macules and patches on sun-exposed areas, mostly affecting women of

childbearing age. It is exacerbated by sun exposure, pregnancy, oral contraceptives, and certain

antiepilepsy drugs. Intense or chronic exposure to the sun worsens the condition and

precipitates recurrence. The type of hypermelanosis may be epidermal (brown), dermal (blue-

gray), or mixed (brown-gray). Wood's lamp examination distinguishes epidermal from dermal

hyperpigmentation in all but skin phototypes V and VI, in which the Wood's lamp is of no value.

Many therapeutic agents are available but are unsatisfactory. Successful treatment of Melasma

involves the triad of sun blocks, bleach, and time. Without daily use of sunscreens, treatment

will fail. Sunscreens should be opaque, broad-spectrum formulations with an SPF of at least 30.

Objective: To assess the efficacy of 0.28% hydroquinone cream combined with retinoid,
cortisone, lactic acid, glycol, stearic acid, palmic acid and so on as treatment for Melasma.

Methods:This was a prospective Single blind randomized clinical trials with once daily
application of Raeemo to be applied for 6 weeks only. Concomitant use of a broad-spectrum
sunscreen was also being mandatory. 56 Melasma patients (48 females, 8 males) with skin
phototypes I to IV and moderate-to-severe Melasma of the face, whose ages ranged from 21 to
50 years and who were not pregnant, nursing or on any concurrent therapy. Clinical evaluation,
photography and the overall response was assessed at 1, 2, 4 and 6 weeks. Pigmentation was
measured objectively using a Melasma Area and Severity Index and effectiveness to be
measured by Objective assessment tools. Duration of study was 6 months.

Results: Treatment with the combination of 0.28 % hydroquinone, retinoid, cortisone, lactic

acid, glycol, stearic acid, palmic acid and so on had a great effect of reducing skin pigmentation

compared with baseline (P<.001). There is no side effects has been observed.

Conclusions: Use of 0.28 % hydroquinone, with retinoid, cortisone, lactic acid, glycol, stearic

acid, palmic acid and so on is an effectiveness of reducing Melasma with use of daily
sunscreen.