Combination of Topical Actives: A choice in Melasma Management
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Introduction
Melasma also known as hyper melanotic disorder affects the facial skin and nearby areas. The management of melasma is challenging and requires a long-term treatment plan. In reference to treatment topical therapy has remained the mainstay. Multiple options for topical treatment are available of which clinical efficacy of azelaic acid, kojic acid, arbutin etc is well known. Combinational therapy is the preferred mode of treatment for the synergism and reduction of untoward effects.
Benefits
Melasma is classified into three types on the basis of depth of pigmentation.
Epidermal: Pigmentation appears more intense as melanin is distributed throughout the epidermis. Topical treatment may work best in this type of melasma.
Dermal: Pigmentation is not intensified as plenty of melanophages distributed in the dermis.
Mixed: Pigmentation is due to increased epidermal melanin as well as dermal melanophages.
Topical Actives for Melasma Management
Kojic acid, a naturally occurring, hydrophilic fungal product derived from certain species of Acetobacter, Aspergillus and Penicillium. It acts by inhibiting the production of free tyrosinase and a potent antioxidant.
Azelaic acid, a naturally occurring, nonphenolic, saturated, nine-carbon dicarboxylic acid that inhibits tyrosinase. Its mechanism of action includes the inhibition of DNA synthesis and mitochondrial enzymes, thereby inducing direct cytotoxic effects toward the melanocyte.
Arbutin, the beta-D-glucopyranoside derivative of hydroquinone, is a naturally occurring plant product which has been used successfully in the treatment of hyper pigmentary disorders. Arbutin acts by inhibiting tyrosinase thereby decreasing melanin formation.
Conclusion
Melasma management is a challenging process as it requires long-term treatment with topical actives. A triple combination of actives like kojic acid, azelaic acid, tranexamic acid and alpha-arbutin inhibit melanogenesis and play hence suggested as a first line of treatment for melasma or pigmentation related skin concerns.
References
- Topical treatment of Melasma. Indian Journal of Dermatology. 2009, Oct-Dec.