Combination treatments (TC) for hyperpigmentary disorders are overused (Hydroquinone-Steroid-Retinoid) (For Professionals)

Poster:

A retrospective analysis of the topical preparations used by melasma patients of darker skin types – highlighting the rampant use of triple combination formulations

Kandhari R

• The authors sought to evaluate the use of Triple Combination (TC) creams by the population in India (Hydroquinone-Retinoid-Steroid)
• TCs consist of the combination of hydroquinone, a steroid, and a retinoid

Patients were evaluated in a retrospective analysis in 69 patients. The treatment duration was of at least 3 months. The following criteria were recorded:

• Preparation:

1. single agent
2. combination of agents

• How the product was obtained/ how follow up was made:

1. supervised (clinician)
2. unsupervised (self application)
3. both

• concentration
• duration of use
• regular or intermittent usage

Results

Frequency of use:

• Over half of the patients used a triple combination (n=36)

How the product was used and whether it was supervised:

• 10% (N=6) of patients self-applied the medication or were under the exclusive supervision of a clinician.
• More than a third (N=24) of patients self medicated after having been counseled by  a clinician

Side effects:

• Erythema in almost half of patients (N=27)
• Hypertrichosis in almost a third of patients (N=21)
• Other recorded side effects:

1. acneiform eruptions
2. telangiectasia
3. rosaceaform eruptions

Conclusion

• There is a rampant use of triple combinations (TC)
• Patients use them in a prolonged and unsupervised manner

Comments

• Only Dermatologists or experimented physicians (doctors) should prescribe TC’s as they warrant a prolonged medical supervision of potentially serious side effects
• What is very alarming is that the study mentions no diagnosis. 
• Therefore it is worrying to note that while TC’s are classically prescribed for melasma (chloasma, pregnancy mask), their anarchical use has been widely extended to anything with pigmentation.

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

Source of Information: 2012 (09) – Sachdev M. .21st Annual Congress of the EADV (European Academy of Dermatology and Venerology) – Prague (Praha), Czech Republic (česká republika)