TriLuma combination effective for PIH

Kissimmee, Fla. - With recent developments in the treatment of hyperpigmentation, Dr. Roger Ceilley, clinical professor of dermatology at the University of Iowa and past president of the American Academy of Dermatology and the American Society for Dermatologic Surgery, provided further insight into the management of post-inflammatory hyperpigmentation.

"The most common types of hyperpigmentation include melasma, solar lentigines and post-inflammatory hyperpigmentation," he says.

Post-inflammatory hyperpigmentation can develop from many conditions, including acne, eczema, contact dermatitis, burn injury and psoriasis. It is most often seen in patients with darker skin types and is more common in women.

"Post-inflammatory hyperpigmentation occurs after the skin has been inflamed for some reason," Dr. Ceilley tells Dermatology Times. "It can develop if a patient had acne, especially in patients with darker skin types. Also, if a patient develops a burn or scrape they can develop hyperpigmentation.

"Sometimes if a patient has an allergic reaction to something - contact dermatitis - hyperpigmentation may develop. Overall, anything that causes inflammation, especially in patients with darker skin types, can lead to persistent hyperpigmentation," he says.

Management

Treatment remains individualized to the patient's underlying condition.

"First of all, you have to see if there is anything that is causing the inflammation and/or ongoing cause of inflammation," Dr. Ceilley advises. "For example, if a patient has acne, then you really need to get the acne under control. If they have another condition that may lead to hyperpigmentation, then you need to access and treat that first and then look into other approaches to treat the hyperpigmentation problem.

"In the past, there has been some use of drugs called hydroquinones. We have tried chemical peeling and we have tried a variety of different bleaching agents, but more recently there was a drug that was approved for the treatment of melasma - a combination of components that include hydroquinone, tretinoin and fluocinolone - that has demonstrated efficacy in the treatment of post-inflammatory hyperpigmentation. This fixed combination is called TriLuma," Dr. Ceilley says.

Dr. Ceilley presented results of a clinical study demonstrating increased efficacy and limited toxicity of TriLuma.

"The study I discussed was preliminary data on an eight-week study where we used this combination product on patients who had post-inflammatory hyperpigmentation from acne," he says. "The majority of individuals in the study had darker skin types. This approach worked well without any significant irritation, and we had very few patients drop out of the study. The preliminary results look very promising; at least half of the patients were clear or almost clear at eight weeks' time, and they seem to tolerate treatment quite well. Some of the patients, I would expect, would improve further with continuation of treatment, because the type of pigment you get with post-inflammatory hyperpigmentation is much deeper than you see in melasma or in freckles, so it takes longer for surface treatments to help fade them out," Dr. Ceilley says.

Existing treatments

Dr. Ceilley explains that existing treatments used to target other types of hyperpigmentation may also be used to treat post-inflammatory hyperpigmentation. However, TriLuma seems to be more effective than the other agents that have been used in the past.

"The study that was done also compared TriLuma to the combination of hydroquinone and tretinoin as well as the combination of tretinoin and fluocinolone. Results demonstrated TriLuma to be more effective at a faster rate with similar toxicity to these other combinations," he says.

The practicing dermatologist

As for the practicing dermatologist, Dr. Ceilley emphasizes that doctors need to recognize the significance of this problem.