TY - CHAP M1 - Book, Section TI - Depigmenting Ingredients A1 - Baumann, Leslie S. A2 - Baumann, Leslie S. A2 - Rieder, Evan A. A2 - Sun, Mary D. PY - 2022 T2 - Baumann’s Cosmetic Dermatology, 3e AB - SUMMARY POINTSWhat’s Important?When using any type of skin lightener, it can take 12–16 weeks to see a visible decrease in skin pigmentation.Fatty acids in moisturizers can affect tyrosinase activity.Hydroquinone alone or in combination with a topical steroid and retinoid have the best efficacy.Triple combination creams containing a tyrosinase inhibitor, a retinoid, and a corticosteroid remain the best topical skincare product to lighten skin.Coenzyme Q10 is an antioxidant, increases ATP production, and inhibits tyrosinase activity by affecting gene transcription.What’s New?Oral tranexamic acid has been shown to be safe and very effective for melasma.Hydroquinone is no longer allowed in cosmetic products in the United States.What’s Coming?Studies and clinical experience will evaluate the efficacy, dosing, and optimal protocols for the use of tranexamic acid intradermally or with microneedling.More studies and clinical experience on oral tranexamic acid are needed to determine the most effective treatment and maintenance protocols and relapse rates.More studies on the use of cysteamine in pigmentation disorders and the mechanism by which it inhibits melanin formation are needed.Studies on the efficacy of oral melatonin will shed light on melatonin’s role in pigment production.New ingredients to replace hydroquinone and its derivatives are being developed.Glutathione is not recommended until stable topical forms that can penetrate the skin have been developed; oral forms have poor bioavailability; and IV forms need far more studies evaluating safety, efficacy, and optimal dosing. SN - PB - McGraw Hill LLC CY - New York, NY Y2 - 2024/03/28 UR - dermatology.mhmedical.com/content.aspx?aid=1190671085 ER -