Objectives: Melasma and post-inflammatory hyperpigmentation (PIH) are frequent skin hyperpigmentary disorders which can present therapeutic challenges for the clinician. The therapeutic armamentarium against melasma and PIH is being significantly changed during the past years mainly due to the safety issues regarding the gold standard treatment, hydroquinone followed by its ban in several countries and on the other hand the emerge of depigmenting molecules with a better safety profile into the market.
Introduction: In this presentation, new therapeutic options for melasma and PIH as well as their safety and efficacy profiles will be presented. Some oral and parenteral skin depigmenting agents (e.g. tranexamic acid) as well as biogenic depigmenting compounds (e.g. L-cysteamine) will be discussed.
Results: Cysteamine hydrochloride is known for its potent depigmenting effect since 1960's when Chavin tested it through injecting cysteamine into the black goldfish skin (1). A few years later, different in vivo studies showed the higher depigmenting efficacy of this molecule compared to hydroquinone (2). Superiority to hydroquinone was recently confirmed in vitro (3). However, cysteamine has never been utilizable in human mainly due to the very offensive odor it produced in topical products. Results for a comparative study with Kligman formula will be presented.
Conclusion: Cysteamine is biologically produced in mammalian cells and serves as an intracellular anti-oxidant. This molecule is FDA approved as eye-drops and as an oral medication and has a long history of safety for human use. The anti-mutagenic and anti-carcinogenic effects of cysteamine are previously shown in numerous studies. With its high efficacy and safety profiles, topical cysteamine has a higher benefit/risk ratio compared to hydroquinone and might serve as a new safe and effective skin depigmenting agent for the treatment of hyperpigmentary disorders such as melasma.
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