Poster presentation, P109

Official XXIst International Pigment Cell Conference website - 21-24 Sept 2011, Bordeaux - France | updated: September 04 2011

Comparative efficacy and safety of mometasone based triple creams v/s fluocinolone based triple creams in melasma in Indian patients

Melasma (from the Greek word, 'melas' meaning black) is a common, acquired, circumscribed hypermelanosis of sun-exposed skin. It presents as symmetric, hyperpigmented macules having irregular, serrated, and geographic borders. The most common locations are the cheeks, upper lips, the chin, and the forehead, but other sun-exposed areas may also occasionally be involved. Melasma occurs in all skin types and in people of all racial and ethnic groups, but is more common in those with darker complexions living in areas of intense UV radiation, such as Latin Americans, Asians and blacks. Melasma is the most common pigmentary disorder among Indians. In India over the counter medications are often tried by patients before approaching a dermatologist. In 2004 a triple combination of hydroquinone (2%) with tretinoin (0.025%) and mometasone furoate (0.1%) was launched in India. This combination has a potent steroid mometasone furoate (0.1%) which induces local side effects like thinning of skin, persistent erythema and telangiectasia within few weeks of application. Patient keeps on applying this combination as it can be purchased without prescription in India. Now triple combination cream with fluocinolone acetonide (0.01%) as steroid is available in India. We tried these two combinations in 20 Indian patients (age group 18 to 40 years, mean age 23.4 years) with mild to moderate melasma with glycolic acid peels and sunscreens. First group of 10 patients (8 females and 2 males) were advised to use mometasone based triple creams along with physical sunscreen zinc oxide. Second group of 10 patients (7 Females and 3 Males) were advised to use fluocinolone based triple cream in the night along with sunscreen in the morning and glycolic acid peels. Those with a history of recurrent herpes, and nursing and pregnant women were not included in the study. All the patients were informed about the procedure and their consent was taken. All patients with melasma were put on a maintenance regimen of triple combination to be applied at night. The patients were instructed to apply medication all over the face. In the morning, physical sunscreen of SPF 19 (Micronized zinc oxide 15%) was used. Serial Glycolic acid peels were used at three weekly intervals, for two to six minutes, depending on tolerance and erythema. Glycolic acid of 57% with free acid of 55% and pH of 2.3 was used in gradually increasing duration of application on the face. Post peel care was in the form of calam---TRUNCATED!

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