Triple Combination Creams in Melasma (Steroid – Vitamin A – Hydroquinone) Don’t Always Work

• Triple Combination Creams (Triluma) In Melasma (Hydroquinone, Fluocinolone, Tretinoin) Don’t Always Work.
• Triple combination creams are considered to be the gold standard in the treatment of melasma (chloasma, pregnancy mask).
• As a general rule, topical treatments work best when the location of the pigment is superficial. On the other hand,  treatment with light sources are used when the depth of the pigmentation has a dermal component.
• Nearly thirty percent of patients with Melasma (Chloasma, Pregnancy Mask) do not show any response to conventional treatment with Hydroquinone. This might be due to due to atypical melanin arrangement and concentration.

• The purpose of this study is to use Raman spectroscopy and Diffuse Reflectance Spectroscopy to investigate abnormal molecular structure and concentration of melanin:

1. 31 patients (27 females, median age of 38.7 years old) with recalcitrant melasma lesions were enrolled
2. A questionnaire was given (to record history, sunlight exposure, treatments used as well as cosmetics used)
3. Raman and diffuse reflectance spectroscopy measurements were taken from melasma lesions, non lesional facial photoexposed skin area, and non photoexposed skin area before and after treatment with Triluma (Hydroquinone, Fluocinolone and Tretinoin)

• Results show that Raman spectroscopy results show that patients non responsive to treatment demonstrate differences in the molecular structure of their skin compared to people that showed improvement with treatment.
• There are higher melanin concentrations in patients unresponsive to treatment.
• Alternative treatments should then be tried and topicals should be used, especially if the pigmentation is superficial.

Contributors: Dr Christophe HSU – dermatologist. Geneva, Switzerland

Source of Information: E Arenas-Velazquez,1 FJ González,2 MG Ramirez-Elias,2 C Castillo-Martínez1 and B Moncada1 1Dermatology, Hospital Central “Dr. Ignacio Morones Prieto”/Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico and 2CIACYT, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico Lack of clinical response of recalcitrant melasma to triple combination cream (Tretinoin, Fluocinolona and Hidroquinone) due to abnormal concentration of melanin.  International Investigative Dermatology (IID) 2013 – Edinburgh, United Kingdom.