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Triple combination (TC) cream is a stable combination of fluocinolone acetonide 0.01%, hydroquinone 4% and tretinoin 0.05% and is currently the only FDA-approved drug for the treatment of melasma. Furthermore, it is the only FDA-approved agent containing hydroquinone. Case reports suggest that significant improvements in melasma can be achieved with a multifactor approach involving TC cream with a variety of procedures; however, data from larger studies have not previously been conducted to confirm these findings.
A study was designed to evaluate the efficacy and safety of daily application of TC cream and intermittent glycolic acid peels. Patients began daily treatment with TC cream and continued for 2 weeks prior to having the first of 5 glycolic acid peels. TC cream applications were stopped for the 2 days preceding each peel and for the 2 days immediately following each peel. Efficacy and safety evaluations were made at Weeks 6 and 12. Objective mexameter readings for melanin were used to determine the improvement in hyperpigmentation.
Twenty patients were enrolled. According to investigator global assessment (IGA) ratings, one patient (5%) achieved treatment success (clear/almost clear) as early as Week 6 and most patients achieved treatment success by Week 12 (n = 13, 65%, p < 001). Objective mexameter measurements of melanin confirmed that hyperpigmentation was significantly reduced in patients at Week 6 and Week 12 (p < .001) compared with baseline.
Investigator and patient evaluations revealed that most patients (>=90%) had good improvement (excellent improvement or much improved) by Week 12 with alternating, sequential treatments of TC cream and a series of glycolic acid peels. Furthermore the results of this study also indicated that sequential treatments of TC cream and glycolic acid peels were well tolerated.
Nurses in the specialized field of dermatology will gain insight into the disease state and treatment options, which will be useful information for patient consultations.
Abramovits, W., Barzin, S., & Arrazola, P. (2005). A practical comparison of hydroquinone-containing products for the treatment of melasma. Skinmed, 4(6), 371-376.
Gupta, A. K., Gover, M. D., Nouri, K., & Taylor, S. (2006). The treatment of melasma: A review of clinical trials. Journal of the American Academy of Dermatology, 55(6), 1048-1065.
Menter, A. (2004). Rationale for the use of topical corticosteroids in melasma. Journal of Drugs in Dermatology, 3(2), 169-174.
Pandya, A. G., & Guevara, I. L. (2000). Disorders of hyperpigmentation. Dermatologic Clinics, 18(1), 91-98, ix.
Rendon, M. I. (2004). Utilizing combination therapy to optimize melasma outcomes. Journal of Drugs in Dermatology, 3(5 Suppl.), S27-S34.
Rendon, M., Berneburg, M., Arellano, I., & Picardo, M. (2006). Treatment of melasma. Journal of the American Academy of Dermatology, 54(5 Suppl. 2), S272-S281.
Sarkar, R., Kaur, C., Bhalla, M., & Kanwar, A. J. (2002). The combination of glycolic acid peels with a topical regimen in the treatment of melasma in dark-skinned patients: A comparative study. Dermatologic Surgery, 28(9), 828-832; discussion 832.
Taylor, S. C., Torok, H., Jones, T., Lowe, N., Rich, P., Tschen, E., et al. (2003). Efficacy and safety of a new triple-combination agent for the treatment of facial melasma. Cutis, 72(1), 67-72.
Torok, H. M., Jones, T., Rich, P., Smith, S., & Tschen, E. (2005). Hydroquinone 4%, tretinoin 0.05%, fluocinolone acetonide 0.01%: A safe and efficacious 12-month treatment for melasma. Cutis, 75(1), 57-62.
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