Combination treatments (TC) for hyperpigmentary disorders are overused (Hydroquinone-Steroid-Retinoid) (For Professionals)

Poster:

A retrospective analysis of the topical preparations used by melasma patients of darker skin types – highlighting the rampant use of triple combination formulations

Kandhari R

• The authors sought to evaluate the use of Triple Combination (TC) creams by the population in India (Hydroquinone-Retinoid-Steroid)
• TCs consist of the combination of hydroquinone, a steroid, and a retinoid

Patients were evaluated in a retrospective analysis in 69 patients. The treatment duration was of at least 3 months. The following criteria were recorded:

• Preparation:

1. single agent
2. combination of agents

• How the product was obtained/ how follow up was made:

1. supervised (clinician)
2. unsupervised (self application)
3. both

• concentration
• duration of use
• regular or intermittent usage

Results

-Frequency of use:

• Over half of the patients used a triple combination (n=36)

-How the product was used and whether it was supervised:

• 10% (N=6) of patients self-applied the medication or were under the exclusive supervision of a clinician.
• More than a third (N=24) of patients self medicated after having been counseled by  a clinician

-Side effects:

• Erythema in almost half of patients (N=27)
• Hypertrichosis in almost a third of patients (N=21)
• Other recorded side effects:

1. acneiform eruptions
2. telangiectasia
3. rosaceaform eruptions

Conclusion

• There is a rampant use of triple combinations (TC)
• Patients use them in a prolonged and unsupervised manner

Comments

• Only Dermatologists or experimented physicians (doctors) should prescribe TC’s as they warrant a prolonged medical supervision of potentially serious side effects
• What is very alarming is that the study mentions no diagnosis. 
• Therefore it is worrying to note that while TC’s are classically prescribed for melasma (chloasma, pregnancy mask), their anarchical use has been widely extended to anything with pigmentation.

Source of Information: 2012 (09) – Sachdev M. .21st Annual Congress of the EADV (European Academy of Dermatology and Venerology) – Prague (Praha), Czech Republic (česká republika)

Original article: here