COSMELAN® OR LASERS?

COSMELAN® OR LASER TREATMENT FOR MELASMA AND LENTIGENES?

Abstract: The medical literature confirms that the preferred initial treatment of melasma, is sun protection, removal of causative factors, and treatment with topical creams such as hydroquinone. In the USA, hydroquinone has been the gold-standard and stood the test of time, and is cost effective, but local application may be needed over many months. This topical application is not approved in Europe. Other local treatments and lightening-agents for facial hypermelanosis include retinoic acid, azelaic acid, kojic acid, Amelan M®, Cosmelan®, Dermamelan and Melanogel anti-spot cream®. Compared to monotherapy, combinations of hydroquinone, tretinoin and corticosteroids are thought to increase efficacy. Care must be taken to avoid excessive application, skin-atrophy and allergic- contact dermatitis that is common. Epidermal melasma is responsive to glycolic acid facial peels and sunscreens. IPL and hydroquinone have also proved effective in persons with melasma. LASERS have been used to treat melasma in specialised units, but the results have remained controversial over 20-years. Skin scarification and PIH are major drawbacks. In the salon, provided the doctors and therapists are properly trained, Cosmelan® and Dermamelan® depigmentation mask-therapy is effective and offer more advantages over laser therapy.

MELASMA: A COMMON AGING SKIN CONDITION

Melasma presents as symmetrical pigmented macules affecting the forehead, central-face, cheeks, upper-lip, and chin. Genetic, solar damage, contraceptive pills and hormonal factors are important causative agents. Pigmentation may be epidermal or dermal. The condition is benign in nature almost always, and sun spots are often present on the scalp, back of the hands, forehead, cheeks, and décolleté in persons older than 100-years. Most have had the spots for decades. Epidermal melasma is responsive to topical treatment. Dermal or mixed melasma is difficult to treat and recurrence is common. This poses challenges to the therapist. Harsh treatment can lead to excessive pigmentation. Sun-protection and screens is important, and if ignored, means rapid return of the sun lentigenes and melasma.

TREATMENT MODALITIES SHOWING RESPONSE IN MELASMA: Including Cosmelan® and Dermamelan®.

1. Removal of precipitating causes: sun-light, birth-control pills, scented cosmetic products, photoxic drugs
2. Appropriate broad-spectrum sunscreens : UVA and UVB blocking( SPF> 30)
3. Hydroquinone ( 1-4%): see references
4. Tretinoin
5. Steroids ( only prescribed by dermatologists)
6. Combination therapy: HQ,  tretinoin, and a steroid ( Tri-Luma®)
7. Azelaic acid, kojic acid
8. Dermamelan® and Cosmelan®, non-hydroquinone anti-melanin treatment of hypermelanosis (Distributors: Leenyx Technologies™ in Cape Town.)
9. TMT System treatment™ (electroporation: Melanogel Complex System Treatment®, with Anti-spot and Melanogel Touch® after-care treatment at home): Grupo Body_esthetic Laboratories (Barcelona Spain)®.
10. Chemical peels ( Glycolic acid, TCA)
11. Intense pulsed light-therapy (IPL): Pigmentation clearance is possible with superficial lesions. The modality has been used as an adjuvant to topical-therapy.
12. Lasers: Based on the theory of selective photo-thermolysis (see refs).Not all cases with melasma respond to all lasers. Hyperpigmentation resulting from treatment needs identification and can be problematical. Capital and running costs preclude the use in salons, especially in the current global financial recession. From a cost-effective point of view, topical-cream application would be considered first line-therapy for melasma, before lasers and this view is supported by the literature.

BOLANDCELL REFERENCES: TOPICAL CREAMS, AMELAN®,LASERS.

1. Barret-Hill F. Advanced  Skin Analysis 2004, Auckland, New Zealand.
2. Luc Levy J et al. A double-blind controlled study of a non-hydroquinone bleaching cream in the treatment of melasma. Jnl of Cosmetic Dermatology, 4,272-276 2005
3. Gupta AK et al. The treatment of melasma: A review of clinical trials. J Am Acad Dermatol , 55: 1048-1065, 2006.
4. Manaloto RM et al. Erbium:Yag laser resurfacing for refractory melasma. Dermatol Surg 1999: 25;121-3
5. Angsuwarangsee S et al. Combined ultrapulse CO2 laser and Q-switched Alexandrite laser compared with Q-switched alexandrite alone for refractory melasma: split face design. Dermatol Surg 2003: 29;59-64
6. Nouri K et al. Combination treatment of melasma with pulsed CO2 laser followed by Q-switched alexandrite laser: a pilot study. Dermatol Surg 1999: 25;494-7
7. Taylor CR et al. Ineffective treatment of refractory melasma and post-inflammatory hyper-pigmentation by Q-switched ruby laser. J Dermatol Oncol 1994: 29;20’ 592-7.
8. Goldberg DJ. Benign pigmented lesions of the skin: treatment with the Q-switched ruby laser. J Dermatol Surg Oncol 1993: 19;376-9
9. Tse Y et al. A comparative study. J Dermatol Surg Oncol 1994: 20;795-800.
10. Chan HH et al. Laser treatment of facial lentigenes in Oriental patients. Dermatol Surg 2000: 26;743-9.
11. Torok HM et al. Hydroquinone 4%. A safe and efficacious treatment for melasma. Cutis. 2005: 75: 57-62.
12. Taylor SC et al. Efficacy and safety of a new triple-combination agent for the treatment of facial melasma. Cutis 2003: 72, 67-72
13. Gano SE et al. Topical tretinoin, hydroquinone, and betamethasone valerate in the therapy of melasma. Cutis 1979: 23; 239-41
14. Pathak MA et al. Usefulness of retinoic acid in the treatment of melasma. J Am Acad Dematol 1986: 15; 894-9
15. Palumbo A et al. Mechanism of inhibition of melanogenesis by hydroquinone. Biochem Biophys Acta 1991: 1073;85-90.

DISTRIBUTORS OF COSMELAN® AND DERMAMELAN®: LEENYX TECHNOLOGIES, CAPE TOWN.

DISCLAIMER: This site does not provide treatment strategies for patients presenting with skin discoloration or pigmentation. It is their right and duty to visit a plastic surgeon, aesthetic physician or dermatologist if they need information , counselling and treatment options. The contents have been reviewed  by an International  Biomed Expert for correctness.
POSTED: 17 September 2009