Effectiveness and safety of a combination of sun protection and depigmentation agent in the treatment of epidermal hyperpigmentation

B. S. Chandrashekar, Vinay N.


Background: Medication adherence is recognized as a worldwide public health problem. As a multi-modality approach with sun protection and depigmentation is quintessential in patients with epidermal hyperpigmentation, a combination of day and night cream may be prudent for long-term improvement and compliance. Aim of the current investigation was to assess treatment outcomes and medication compliance in patients with epidermal hyperpigmentation using day and night cream in a combi-kit packaging (Melaglow day and nightTM combi-kit).

Methods: Sixty patients (18-45 years) with epidermal pigmentation were enrolled in this 12-week study. Treatment effectiveness was determined by melanin index/erythema measure (dermacatch), extent, depth and density of pigmentation (fotofinder), and clinical/dermoscopic aspects (grade-1: <25%; grade-2: 25%-50%; grade-3: 50%-75%; grade-4: >75% reduction in the amount of epidermal pigment), safety, satisfaction, and compliance were assessed.

Results: Out of 60 patients, 52 completed the study. The overall percentage of melanin and erythema improvement was 22.51% and 13.85%, respectively. Based on fotofinder images, 36.54% had grade-2, 34.62% had grade-3, 15.38% had grade-1, and 13.46% patients had grade-4 improvement. Based on the photographic images, 40.38% had grade-2, 32.69% had grade-3, 17.31% had a grade-1, and 9.62% had grade-4 improvement in skin color. All patients agreed that combi-kit helped in remembering and adhering to treatment. Most patients were satisfied with the treatment (84.62%), with compliance rate of 97.72%. No adverse events were reported.

Conclusions: Combi-kit containing day and night cream (Melaglow day and nightTM combi-kit) was safe and effective in the treatment of epidermal pigmentation, ensuing treatment compliance, and patient satisfaction.


Dermacatch, Epidermal pigmentation, Erythema, Fotofinder, Melanin

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Nouveau S, Agrawal D, Kohli M, Bernerd F, Misra N, Nayak CS. Skin hyperpigmentation in indian population: insights and best practice. Indian J Dermatol. 2016;61(5):487-95.

Del Bino S, Duval C, Bernerd F. Clinical and biological characterization of skin pigmentation diversity and its consequences on UV impact. Int J Mol Sci. 2018;19(9):2668.

Zhu W, Gao J. The use of botanical extracts as topical skin-lightening agents for the improvement of skin pigmentation disorders. J Investig Dermatol Symp Proc. 2008;13(1):20-24.

Katiyar KS, Sanjeev KS, Rai M. Botanical study of skin lightening agents. IJP. 2014;1(4):243-49.

Sheth VM, Pandya AG. Melasma: a comprehensive update: part II. J Am Acad Dermatol. 2011;65(4): 699-714.

Hexsel D, Soirefmann M, Fernandes JD, Siega C. Objective assessment of erythema and pigmentation of melasma lesions and surrounding areas in long-term management regimens with triple combination. J Drugs Dermatol. 2014;13(4):444-8.

Smit N, Vicanova J, Pavel S. The hunt for natural skin whitening agents. Int J Mol Sci. 2009;10(12): 5326-49.

Costa E, Giardini A, Savin M. Interventional tools to improve medication adherence: review of literature. Patient Prefer Adherence. 2015;9:1303-14.

Nayak CS, Ansari SMM, Salve V, Patil S. Effectiveness of a combination of anti-pigmentary products in facial post-inflammatory hyper-pigmentation. Int J Res Dermatol. 2020;6(1):1-8.

Stoebner PE, Poosti R, Djoukelfit K, Martinez J, Meunier L. Decreased human epidermal antigen-presenting cell activity after ultraviolet A exposure: dose-response effects and protection by sunscreens. Br J Dermatol. 2007;156(6):1315-20.

Latha MS, Martis J, Shobha V, et al. Sunscreening agents: a review. J Clin Aesthet Dermatol. 2013;6(1): 16-26.

Ngoc LTN, Tran VV, Moon JY, Chae M, Park D, Lee YC. Recent trends of sunscreen cosmetic: an update review. Cosmetics. 2019;6(4):64.

Donglikar M, Deore S. Sunscreens: A review. Pharmacog J. 2016;8:171-9.

Chandrashekar BS, Shenoy C, Narayana LN. Effectiveness and safety of a novel topical depigmenting agent in epidermal pigmentation: an open-label, non-comparative study. Int J Res Dermatol. 2018;4(4):489-94.

Maeda K, Fukuda M. Arbutin: mechanism of its depigmenting action in human melanocyte culture. J Pharmacol Exp Ther. 1996;276(2):765-9.

Hori I, Nihei K, Kubo I. Structural criteria for depigmenting mechanism of arbutin. Phytother Res. 2004;18(6):475-9.

Nordlund JJ, Grimes PE, Ortonne JP. The safety of hydroquinone. J Eur Acad Dermatol Venereol. 2006; 20(7):781-7.

Sccs, Degen GH. Opinion of the scientific committee on consumer safety (sccs)-opinion on the safety of the use of α-arbutin in cosmetic products. Regul Toxicol Pharmacol. 2016;74:75-6.

Sugimoto K, Nishimura T, Nomura K, Sugimoto K, Kuriki T. Inhibitory effects of alpha-arbutin on melanin synthesis in cultured human melanoma cells and a three-dimensional human skin model. Biol Pharm Bull. 2004;27(4):510-4.

Draelos ZD, Yatskayer M, Bhushan P, Pillai S, Oresajo C. Evaluation of a kojic acid, emblica extract, and glycolic acid formulation compared with hydroquinone 4% for skin lightening. Cutis. 2010; 86(3):153-8.

Lim JT. Treatment of melasma using kojic acid in a gel containing hydroquinone and glycolic acid. Dermatol Surg. 1999;25(4):282-4.

Chaowattanapanit S, Silpa-Archa N, Kohli I, Lim HW, Hamzavi I. Postinflammatory hyperpigmentation: A comprehensive overview: Treatment options and prevention. J Am Acad Dermatol. 2017;77(4):607-21.

Yokota T, Nishio H, Kubota Y, Mizoguchi M. The inhibitory effect of glabridin from licorice extracts on melanogenesis and inflammation. Pigment Cell Res. 1998;11(6):355-61.

Jutley GS, Rajaratnam R, Halpern J, Salim A, Emmett C. Systematic review of randomized controlled trials on interventions for melasma: an abridged Cochrane review. J Am Acad Dermatol. 2014;70(2):369-73.

Stamford NP. Stability, transdermal penetration, and cutaneous effects of ascorbic acid and its derivatives. J Cosmet Dermatol. 2012;11(4):310-7.

Al-Niaimi F, Chiang NYZ. Topical Vitamin C and the skin: mechanisms of action and clinical applications. J Clin Aesthet Dermatol. 2017;10(7): 14-7.

Badreshia-Bansal S, Draelos ZD. Insight into skin lightening cosmeceuticals for women of color. J Drugs Dermatol. 2007;6(1):32-9.

Hayakawa R, Ueda H, Nozaki T. Effects of combination treatment with vitamins E and C on chloasma and pigmented contact dermatitis. A double blind controlled clinical trial. Acta Vitaminol Enzymol. 1981;3(1):31-8.

Wallo W, Nebus J, Leyden JJ. Efficacy of a soy moisturizer in photoaging: a double-blind, vehicle-controlled, 12-week study. J Drugs Dermatol. 2007; 6(9):917-22.

Hakozaki T, Minwalla L, Zhuang J, et al. The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer. Br J Dermatol. 2002;147(1):20-31.

Tetali B, Fahs FM, Mehregan D. Popular over-the-counter cosmeceutical ingredients and their clinical efficacy. Int J Dermatol. 2020;59(4):393-405.

Mekas M, Chwalek J, MacGregor J, Chapas A. An evaluation of efficacy and tolerability of novel enzyme exfoliation versus glycolic acid in photodamage treatment. J Drugs Dermatol. 2015; 14(11):1306-19.