Journal of Clinical and Aesthetic Dermatology

FEB 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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30 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY Feburary 2018 • Volume 11 • Number 2 R E V I E W TABLE 1, continued. Summary of clinical studies evaluating the efficacy of natural ingredients as hypopigmenting agents NATURAL INGREDIENTS STUDY HYPOPIGMENTING MECHANISM COMPARISON PIGMENTATION DISORDER CONCLUSION LEVEL OF EVIDENCE* LIGNIN PEROXIDASE RCT (Mauricio et al) 18 Oxidizes and breaks down melanin Lignin peroxidase cream vs. placebo or 2% HQ Mottled hyperpigmentation According to Mexameter evaluation, lignin peroxidase had more rapid and observable skin-lightening effect compared to placebo or HQ IB RCT /Split-face (Draelos et al, 2015) 19 Lignin peroxidase cream vs. none, lignin peroxidase cream vs. 4% HQ Facial dyspigmentation Lignin peroxidase was more effective than applying nothing at all based on dermatospectrophotometer. Lignin peroxidase was superior to 4% HQ in aesthetics when including skin texture, lack of clarity and radiance, roughness, and overall appearance. Parity was demonstrated between both agents when evaluating skin lightening efficacy. IB KOJIC ACID (KA) Prospective controlled study (Monteiro et al) 21 ROS scavenger, tyrosinase inhibition 0.75% KA with 2.5% Vitamin C vs. 4% HQ Melasma Patients responded faster and better to HQ IIA RCT (Draelos et al, 2010) 63 Compound (KA, emblica extract, glycolic acid) vs. 4% HQ Facial dyschromia Both treatment equally efficacious IB RCT (Deo et al) 22 1% KA vs. KA with 2% HQ vs, KA with 0.1% betamethasone vs. combination of products Melasma KA with HQ was most effective combination IB NIACINAMIDE RCT (Lee et al) 23 Inhibits melanosome transfer to keratinocytes Cream containing 2% niacinamide with 2% tranexamic acid vs. vehicle control Irregular facial hyperpigmentation Niacinamide with TXA combination product showed efficacy IB RCT (Castanedo- Cazares et al) 24 Niacinamide 4% vs. desonide 0.05% vs. control Axillary hyperpigmentation 4% Niacinamide with 0.05% desonide emulsion showed significant colorimetric improvement, though desonide alone was more effective IB Open-label controlled trial (Farris et al)** None PIH Skin brightening compound containing retinol 0.5%, niacinamide 4.4%, resveratrol 1%, and hexylresorcinol 1.1% improved hyperpigmentation IIA *Level of evidence —IA: evidence from meta-analysis of randomized controlled trials; IB: evidence from at least one randomized controlled trial; IIA: evidence from at least one controlled study without randomization; IIB: evidence from at least one other type of clinical study; ** Farris PP. Efficacy and tolerability of a skin brightening/anti-aging cosmeceutical containing retinol 0.5%, niacinamide, hexylresorcinol, and resveratrol. J Drugs Dermatol. 2016;15(7):863–868;PIH: post-inflammatory hyperpigmentation; RCT: Randomized controlled trial; ROS: reactive oxygen species; HQ: hydroquinone; TXA: tranexamic acid

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