Melanin hyperpigmentation: effective and lasting treatment of melasma in patients with a multi-ethnic profile using cosmelan®

INTRODUCTION Melasma is a type of hyperpigmentation characterized by the appearance of generally symmetrical pigmented stains on the face, particularly on the cheeks, dorsal surface of the nose, forehead and upper. It is common in women of all ethnic groups and skin phototypes, but it is most frequent in Asian, African, and Latin American individuals

Numerous treatment options have been consolidated in the last decades. In this regard, a distinction can be made between treatments that seek to eliminate the melanin deposits and those that seek to regulate melanin synthesis within the melanocyte. In relation to the elimination of melanin, laser therapy and intense pulsed light (IPL) are popular and widely used solutions, but they are expensive and invasive, have demonstrated heterogeneous efficacy in multi-ethnic profiles and even pose a high risk of post-inflammatory hyperpigmentation

Furthermore, there are many topical treatment alternatives: chemical peelings, creams containing acids to accelerate epidermal turnover, and even medical topical formulations based on hydroquinone, to regulate melanocyte activity. All these therapies represent a partial solution to a complex problem that requires a multi-focal approach capable of securing melanin elimination and regulation with the purpose of affording a short- and long-term solution, with maximum patient safety regardless of ethnic group or phototype.

OBJECTIVE To evaluate the efficacy and safety of the cosmelan® method in treating facial melasma among patients with a multi-ethnic profile and differentiated skin phototypes (according to the Fitzpatrick scale). cosmelan® offers a multi-focal approach to melasma treatment and control, thanks to its corrective and regulatory effects that modulates melanin synthesis, reduces transfer of the pigment from the melanosomes to the keratinocytes, while also eliminates melanin accumulation at epidermal level.

METHODS A retrospective analysis was made of 33 cases of mixed melasma corresponding to Caucasian, Asian, African, and Latin American ethnic groups with skin phototypes II-V, treated with the cosmelan® method between October 2013 and May 2016. The treatment protocol comprised a clinic session for renewal of the dermis and reversible inhibition of melanogenesis, combined with home treatment to complete epidermal turnover and regulate melanogenesis. STEP 1: AT THE CLINIC Application of the full 10 grams of cosmelan® 1 as a thick layer on the entire face, with increased thickness over the hyperpigmentation zones. The product was allowed to act upon the skin for the recommended time according to the skin phototype involved*:

Phototypes I and II: 8 hours

Phototypes III and IV: 10 hours

Phototypes V and VI: 12 hours

STEP 2: AT HOME Application of the cosmelan® 2 maintenance cream, based on the following scheme: * The product application times can be modulated according to medical criterion and considering the individual characteristics of the patient and skin ethnic group. In Asian patients with a thinner skin horny layer may experience increased sensitivity and it is advisable to limit the application time to a maximum of 8 hours4,6. 1st month 2nd and 3rd month 4th to 7th month cosmelan® 2 hydra-vital factor k moisturizing sun protection SPF 50+ Prize awarded to the best oral communication SEME 2017 Simultaneous hydration and solar protection is essential, applying hydra-vital factor k and moisturizing sun protection SPF 50+.