Dermatologic Therapy, Vol. 21, 2008, S18–S19 Printed in the United States · All rights reserved Copyright © Blackwell Publishing, Inc., 2008 DERMATOLOGIC THERAPY ISSN 1396-0296 Melasma: Successful treatment with pidobenzone 4% (K5®lipogel) Blackwell Publishing Inc FABIO ZANIERI*,†, GELAREH BANI ASSAD*, PIERO CAMPOLMI† & TORELLO LOTTI*,† *Centro Interuniversitario di Dermatologia Biologica e Psicosomatica, Università Consorziate, Firenze-Milano-Siena, and †Department of Dermatological Science, University of Florence, Florence, Italy ABSTRACT: Melasma (a term derived from the Greek word “melas” meaning black) is an acquired blotchy, irregularly patterned, brown or sometimes gray brown hypermelanosis of the face and occasionally the neck. Its etiology is poorly understood but mainly related to sunlight and genetic predisposition. Melasma seems to be more frequent in darker skinned people, especially women. Its treatment is always difficult and the condition usually relapses. The treatment with pidobenzone 4% (K5® lipogel), twice per day for 16 weeks has proved to be safe and effective. Pidobenzone 4% lipogel, according to the present study, seems also to represent a useful, reliable, and safe treatment of the different types of melasma. KEYWORDS: melasma, pigmentation disorders, therapy Materials and methods Introduction Melasma is an acquired blotchy, irregularly patterned, brown, or sometimes gray brown hypermelanosis of the face and occasionally the neck. Its etiology is poorly understood but mainly related to sunlight and genetic predisposition. According to the distribution of the lesions, three main clinical patterns of melasma are recognized: the centrofacial, the malar, and the mandibular pattern. Histologically, melasma can be classified into three types: epidermal, dermal, and mixed. The histologic type of melasma can be detected with Wood’s light examination easily. In this paper we describe the successful treatment of pidobenzone 4% gel in melasma. Address correspondence and reprint requests to: Torello Lotti, MD, Unit of Dermatology and Physiotherapy, School of Medicine, Department of Dermatological Science, University of Florence, University Via Lorenzo il Magnifico, 104, 50129 Florence, Italy, or email: torello.lotti@unifi.it S18 We enrolled 20 female patients (aged from 20 to 46 years) who were visited in our outpatient consultation for cosmetic dermatology; their phototype was from II to VI according to Fitzpatrick scale. They had centrofacial and malar melasma. For the evaluation of the severity of melasma we used the melasma area and severity index (MASI) score and Wood’s lamp. To calculate MASI, the face was divided into four areas: forehead (30%), right malar (30%), left malar (30%), and chin area (10%), according to MASI standard. The examination with Wood’s lamp, used to determine depth of pigmentation, showed an epidermic melasma in eight patients (clinically, melasma is light brown and its appearance is enhanced by Wood’s light), a dermal melasma in eight patients (clinically melasma is dark-brown to gray and its appearance is not enhanced by Wood’s light), and a mixed-depth melasma in four patients (clinically melasma is dark-brown and its appearance is not enhanced by Wood’s light). We treated all the 20 patients with pidobenzone 4% lipogel twice per day for 16 weeks. Patients Melasma treatment with pidobenzone 4% were treated from October to May, to avoid the risk of the sun exposure in summer. Results Results were evaluated 3 months after the beginning of the treatment. The response in each patient was graded as: • No response (no change in MASI score at the end of the treatment) • Mild response (less than 25%) • Moderate response (from 25 to 50%) • Good response (from 50 to 75%) • Very good response (more than 75% decrease in MASI score) All eight patients (100%) with epidermic melasma obtained a very good response with complete regression of the skin hyperpigmentation. Only two of these eight patients with dermal melasma had complete clearing, the remaining 6 patients only obtained a mild response (less than 25%). All four patients with mixed melasma (100%) had a good response (50–75%) with a significant reduction of the hyperpigmentation. All the patients with total resolution and with mild or good response were examined every month for 3 months. No relapses or worsening were observed. No side effects were observed either during or after the treatment. Discussion Melasma is a cosmetic problem that may cause great emotional suffering. Epidemiologic studies regarding incidence of melasma have not been published yet. The exact cause of melasma is unknown. Natural and synthetic estrogen and progesterone hormones have been implicated in the pathogenesis. Thus pregnancy, oral contraception, and ovarian tumors are often related to the presentation of the disorder. Extensive endocrinologic measurements in female patients with melasma have revealed increased levels of luteinizing hormone and lower levels of serum estradiol abnormalities suggesting subclinical evidence of mild ovarian dysfunction. Although the mechanism of estrogen in precipitating melasma is unknown, it has been reported that the melanocytes are provided with estrogen receptors. Nowadays, there is no pharmacologic agent universally recognized as effective for the treatment of melasma. The majority of the existing treatments may temporarily depigment the melasma but the condition usually relapses. The targets of therapeutic approach for melasma should be (i) the delay in melanocyte proliferation rates, (ii) the inhibition of melanosome formation, and (iii) the enhancement of melanosome degradation. Research is in progress in our laboratories to evaluate if and how pidobenzone 4% lipogel has effects on the above points. Avoidance of solar exposure is mandatory. Broad-spectrum sunscreens should be used, as the melanocytes in melasma are easily stimulated not only by ultraviolet B but also by ultraviolet B and visible radiation. The formulation of K5® lipogel contains appropriate broad spectrum sunscreen. The treatment of melasma is always difficult, and both patients and dermatologist may feel discouraged even when treated with well-established formulations. Nevertheless, the new treatment with pidobenzone 4% lipogel has proved to be safe, well tolerated, and effective, and the patient’s compliance is excellent. References 1. Pazeshky S, Bell FE, Grummer S, McMichael AJ. 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