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Research Article| Volume 19, ISSUE 4, P483-488, July 2001

Depigmenting and bleaching agents: coping with hyperpigmentation

  • Andreas D Katsambas
    Correspondence
    Address correspondence to Andreas Katsambas, MD, Department of Dermatology, Andreas Sygros Hospital for Skin and Venereal Diseases, 5 Dragoumi Street, Kesariani, Athens, Greece
    Affiliations
    Department of Dermatology, University of Athens, School of Medicine, Andreas Sygros Hospital for Skin and Venereal Diseases, Athens, Greece
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  • Alexander J Stratigos
    Affiliations
    Department of Dermatology, University of Athens, School of Medicine, Andreas Sygros Hospital for Skin and Venereal Diseases, Athens, Greece
    Search for articles by this author
      Since the introduction of hydroquinone as a skin-lightening agent in 1961, several products with bleaching properties have been used for the treatment of pigmentary disorders of the skin.
      • Spencer M.C
      Hydroquinone bleaching.
      The most important medical indications for the use of these agents are melasma and postinflammatory hyperpigmentation, although they have also been used as alternative options for the treatment of ephelides, solar lentigenes, nevi, and lentigo maligna. This article reviews the most commonly used bleaching agents, discusses their mechanism of action, and focuses on their efficacy and safety in treating unwanted skin pigmentation.
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      References

        • Spencer M.C
        Hydroquinone bleaching.
        Arch Dermatol. 1961; 84: 131-134
        • Palumb A
        • d’Ischia M
        • Misuraca G
        • Prota G
        Mechanism of inhibition of melaninogenesis by hydroquinone.
        Biochem Biophys Acra. 1991; 1073: 85-90
        • Fisher A.A
        Leukoderma from bleaching creams containing 2% hydroquinone.
        Contact Dermatitis. 1982; 8: 272-273
        • Jimbow K
        • Obata H
        • Pathak M.A
        • Fitzpatrick T.B
        Mechanism of depigmentation by hydroquinone.
        J Invest Dermatol. 1974; 62: 436-449
        • Pathak M.A
        • Fitzpatrick T.B
        • Kraus E.W
        Usefulness of retinoic acid in the treatment of melasma.
        J Am Acad Dermatol. 1986; 15: 894-899
      1. Glenn M, Grimes PE, Pitt E, et al. Evaluation of clinical and light microscopic effects of various concentrations of hydroquinone. Clin Res 1991 (abstract);39:83A.

        • Verallo-Rowell V.M
        • Verallo V
        • Graupe K
        • et al.
        Double blind comparison of azelaic acid and hydroquinone in the treatment of melasma.
        Acta Dermatol Venereol (Stockh). 1989; 143: 58-61
        • Gladstone H.B
        • Nguyen S.L
        • Williams R
        • et al.
        Efficacy of hydroquinone cream (USP 4%) used alone or in combination with salicylic acid peels in improving photodamage on the neck and upper chest.
        Dermatol Surg. 2000; 26: 333-337
        • Grimes P.E
        Melasma. Etiologic and therapeutic considerations.
        Arch Dermatol. 1995; 131: 1453-1457
        • Sanchez J.L
        • Vazques M
        A hydroquinone solution in the treatment of melasma.
        Int J Dermatol. 1982; 21: 55-58
        • Engasser P.E
        • Maibach H.I
        Cosmetics and dermatology.
        J AM Acad Dermatol. 1981; 5: 143-147
        • Snider R.I
        • Thiers B.H
        Exogenous ochronosis.
        J Am Acad Dermatol. 1993; 28: 662-664
        • Findley G.H
        • Morrison J.G.L
        • Simon I.W
        Exogenous ochronosis and pigmented millium from hydroquinone bleaching creams.
        Br J Dermatol. 1975; 93: 613-622
        • Frenk E
        • Ott F
        Evaluation of the toxicity of the monoethyl ether of hydroquinone for mammalian melanocytes and melanoma cells.
        J Invest Dermatol. 1971; 56: 287-293
        • Mosher D.B
        • Parrish J.A
        • Fitzpatrick T.B
        Monobenzylether of hydroquinone.
        Br J Dermatol. 1977; 9: 669-679
        • Njoo M.D
        • Vodegel R.M
        • Westerhof W
        Depigmentation therapy in vitiligo universalis with topical methoxyphenol and the Q-switched ruby laser.
        J Am Acad Dermatol. 2000; 42: 760-769
        • Bleehen S.S
        The treatment of hypermelanosis with 4-isopropylcatechol.
        Br J Dermatol. 1976; 94: 687-694
        • Fleischer A.B
        • Schwartzel E.H
        • Colby S.I
        • Altman D.J
        The combination of 2% 4-hydroxyanisole (Mequinol) and 0.01% tretinoin is effective in improving the appearance of solar lentigines and related hyperpigmented lesions in two phase double-blind multicenter clinical studies.
        J Am Acad Dermatol. 2000; 42: 459-467
      2. Jimbow K. N-acetyl-4-S-cystaminylphenol as new type of depigmenting agent for the melanoderma of patients with melasma. Arch Dermatol 1991;127:1528–4.

        • Nazzaro-Porro M
        Azelaic acid.
        J Am Acad Dermatol. 1987; 17: 1033-1041
        • Schallreuter K.U
        • Wood J.M
        Azelaic acid as a competitive inhibitor of thioredoxin reductase in human melanoma cells.
        Cancer Lett. 1987; 36: 297-305
        • Robins E.J
        • Breathnach A.S
        • Bennet D
        • et al.
        Ultrastructural observations on the effect of azelaic acid on normal human melanocytes and human melanoma cells.
        Br J Dermatol. 1985; 113: 687-697
        • Fitton A
        • Goa K.L
        Azelaic acid.
        Drugs. 1991; 41: 780-798
        • Nazzaro-Porro M
        • Passi S
        • Balus L
        • et al.
        Effect of dicarboxylic acids on lentigo maligna.
        J Invest Dermatol. 1979; 72: 296-305
        • Breathnach A.S
        • Nazzaro-Porro M
        • Passi S
        • Zina G
        Azelaic acid therapy in disorders of hyperpigmentation.
        Clin Dermatol. 1989; 7: 106-119
        • Balina L.M
        • Graupe K
        The treatment of melasma 20% azelaic acid versus 4% hydroquinone cream.
        Int J Dermatol. 1991; 30: 893-895
        • Verallo-Rowell V.M
        • Verallo V
        • Zaumseil R.P
        • Graupe K
        Combined use of 20% azelaic acid cream and 0.05% tretinoin in topical treatment of melasma.
        J Dermatol Treat. 1996; 7: 235-237
        • Kakita L.S
        • Lowe N.J
        Azelaic acid and glycolic acid combination therapy for facial hyperpigmentation in darker-skinned individuals.
        Clin Ther. 1998; 20: 960-970
        • Kligman A.M
        • Willis I
        A new formula for depigmenting human skin.
        Arch Dermatol. 1975; 111: 40-48
        • Ortonne J.P
        Retinoic acid and pigment cells.
        Br J Dermatol. 1992; 41: 43-47
        • Griffiths C.E
        • Finkel L.T
        • Ditre C.M
        • et al.
        Topical tretinoin (retinoic acid) improves melasma.
        Br J Dermatol. 1993; 129: 415-421
        • Kimbrough-Green C.K
        • Griffiths C.E
        • Finkel L.J
        • et al.
        Topical retinoic acid (tretinoin) for melasma in black patients.
        Arch Dermatol. 1994; 130: 727-733
        • Tadaki T
        • Watanabe M
        • Kumasaki K
        • et al.
        The effect of topical tretinoin on the photodamaged skin of the Japanese.
        Tohoku J Exp Med. 1993; 169: 131-139
        • Tomita Y
        • Hariu A
        • Mizuno C
        • Seiji M
        Inactivation of tyrosinase by dopa.
        J Invest Dermatol. 1980; 75: 379-382
        • Kameyama K
        • Sakai C
        • Kondoh S
        • et al.
        Inhibitory effect of magnesium L-ascorbyl-2-phosphate (VC-PMG) on melanogenesis in vitro and in vivo.
        J Am Acad Dermatol. 1996; 34: 29-33
        • Niwa Y
        • Akamatsu H
        Kojic acid scavenges free radicals while potentiating leukocyte functions including free radical generation.
        Inflammation. 1991; 15: 303-315
        • Kahn V
        Effect of kojic acid on the oxidation of DL-DOPA, norepinephrine, and dopamine by mushroom tyrosinase.
        Pigment Cell Res. 1995; 8: 234-240
        • Lim J.T
        Treatment of melasma using kojic acid in a gel containing hydroquinone and glycolic acid.
        Dermatol Surg. 1999; 25: 282-284
        • Nakagawa M
        • Kawai K
        • Kawai K
        Contact allergy to kojic acid in skin care products.
        Contact Dermatitis. 1995; 32: 9-13
        • Westerhof W
        • Njoo M.D
        Bleaching agents.
        in: Katsambas A.D Lotti T.M European handbook of dermatological treatments. Springer, Berlin1999: 766-777
        • Katsambas A
        • Antoniou C
        Melasma. Classification and treatment.
        J Eur Acad Dermatol. 1995; 4: 217-223
      3. Katsambas A. Melasma. A combined treatment with trichloroacetic acid 35% chemical peeling and a hydroquinone treatment scheme. 3rd Congress of the European Academy of Dermatology and Venereology, 1993:(abstract);230.