What is the role of tretinoin in the treatment of melasma?

Updated: Apr 27, 2020
  • Author: Willis Hughes Lyford, MD; Chief Editor: William D James, MD  more...
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Owing to tretinoin’s ability to increase the effectiveness of other therapies, combinations of tretinoin with HQ, with or without a topical corticosteroid, have been promoted. [24] In fact, the only topical ointment currently approved by the US Food and Drug Administration (FDA) for the treatment of melasma is a triple-combination cream, a composite of hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01% (Tri-Luma). Comparative studies of the effectiveness of the triple-combination cream versus topical HQ suggest that the combination cream is faster and more effective at reducing melasma pigmentation, but it does carry a slightly increased risk of an adverse reaction. [26] A 2010 study found that the triple-combination cream is safe and effective when used intermittently or continuously for up to 24 weeks. [27]

The major adverse effect of tretinoin is mild skin irritation, especially when the more effective, higher concentrations are used. Temporary photosensitivity and paradoxical hyperpigmentation can also occur. Tretinoin is believed to work by increasing keratinocyte turnover, thus limiting the transfer of melanosomes to keratinocytes. Adapalene is a synthetic retinoid analog that may be an alternative to tretinoin. A study in Asian Indian patients compared adapalene 0.1% topical to 0.05% tretinoin. After 14 weeks, reduction in MASI scores were equivalent between the two therapies, while the adapalene group developed fewer adverse effects and reported better tolerance to the therapy. [28]

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