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Postinflammatory hyperpigmentation: try triple therapy.

MIAMI BEACH -- A three-ingredient topical combination therapy was more effective than dual combination therapy in the treatment of postinflammatory hyperpigmentation secondary to acne, according to the results of a phase III study reported at a symposium sponsored by the Florida Society of Dermatology and Dermatologic Surgery.

Maria I. Rendon, M.D., presented findings of the study that randomized 792 patients to one of four treatment groups. All participants had postinflammatory hyperpigmentation (PIH) secondary to acne and were treated for 8 weeks. The triple therapy group applied fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05% (TriLuma Cream, Galderma Laboratories). Dr. Rendon disclosed she is a consultant and is on the speakers' bureau for Galderma; she has also received research grants from the company.

The other groups received different combinations of two out of three of these agents at the same dosages. There were 297 patients in the triple therapy arm, 297 patients in the tretinoin/hydroquinone group, 99 in the fluocinolone acetonide/hydroquinone group, and 99 in the fluocinolone acetonide/tretinoin group, said Dr. Rendon, a physician in private practice in Boca Raton, Fla.

Mean age of participants was 34 years, and the majority (91%), were female. Participants were black (69%), Hispanic (15%), white (13%), Asian (1%), and other races (2%).

The depth of pigment in the skin generally dictates treatment success. Results show 45% of patients in the triple therapy group were clear or almost clear at 8 weeks, compared with 35% of the next closest group, the hydroquinone/tretinoin group. The most common adverse events were desquamation and erythema. Both these were higher in the tretinoin/hydroquinolone group, compared with the triple therapy group. Pigmentation changes, however, were higher in the triple therapy group (10%) than in the double combination groups (5% or less).

Triple therapy has a favorable tolerability profile with results similar to studies of patients with melasma. Continue using the triple therapy to maximal result unless hypersensitivity occurs, then consider switching to retinoids for maintenance, Dr. Rendon said. When using triple combination therapy for either condition, it is important to emphasize that patients should limit sun exposure and use a sunblock of SPF 30 or greater.

She suggested monitoring compliance because many patients with darker skin are unaccustomed to applying sunblock regularly.

Risk factors for PIH include Fitzpatrick skin type III-VI; reactions to cosmetic and other products; and inflammatory diseases, such as acne, psoriasis, and eczema. Chemical peels, laser skin resurfacing, waxing, and electrolysis can also increase risk.

PIH presents as hyperpigmented macules and/or patches that correspond to injured epidermal or dermal sites. Disfigurement can be severe.


Miami Bureau
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Author:McNamara, Damian
Publication:Internal Medicine News
Date:May 1, 2005
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