The Role of Topical Retinoids in the Treatment of Pigmentary Disorders An Evidence-Based Review

• Published in: American journal of clinical dermatology Vol. 10; no. 4; pp. 251 - 260
• Main Authors: Kang, Hee Young, Valerio, Laure, Bahadoran, Philippe, Ortonne, Jean-Paul
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-01-2009; Adis International; Wolters Kluwer Health, Inc; Springer Nature B.V
• Subjects: Administration, Cutaneous; Antioxidants - administration & dosage; Biological and medical sciences; Dermatologic Agents - administration & dosage; Dermatology; Drug Therapy, Combination; Evidence-Based Medicine; Fluocinolone Acetonide - administration & dosage; Glucocorticoids - administration & dosage; Health aspects; Humans; Hydroquinones - administration & dosage; Medical sciences; Medicine; Medicine & Public Health; Miscellaneous; Pharmacology/Toxicology; Pharmacotherapy; Pigmentary diseases of the skin; Pigmentation Disorders - drug therapy; Practice Guidelines as Topic; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retinoids; Retinoids - administration & dosage; Review Article; Treatment Outcome; France; Hydroquinone; Isotretinoin; Tazarotene; Adapalene; Tretinoin; Skin disease; Treatment; Pigmentation disorder; Dermatology; Evidence-based practice; Retinoid; Evidence-based medicine; Bibliographic review; Topical administration
• ISSN: 1175-0561; 1179-1888
• DOI: 10.2165/00128071-200910040-00005

Topical retinoids have been used in the treatment of pigmentary disorders such as melasma, actinic lentigines, and post-inflammatory hyperpigmentation. This article evaluates the clinical efficacy and tolerability of retinoid treatment for pigmentary disorders through an evidence-based approach.We searched the MEDLINE and The Cochrane Library databases using the keywords ‘retinoid’ combined with ‘melasma,’ ‘lentigines,’ or ‘postinflammatory hyperpigmentation.’ For each study, the methodology and outcomes were assessed according to specific criteria. There is fair evidence to support the use of topical tretinoin as a monotherapy in the treatment of melasma as well as in the treatment of lentigines (grade B). Adverse effects of topical retinoids are quite frequent, and include local skin irritation, erythema, and peeling, and their severity is mild to moderate. There is evidence to support the use of topical tretinoin in a fixed, triplecombination therapy (hydroquinone 4%/tretinoin 0.05%/fluocinolone acetonide 0.01%) for the treatment of melasma (grade B). There is poor evidence (grade C) to support the use of combination formulations for the treatment of lentigines, and large, randomized, double-blind, controlled trials are needed to further evaluate their use for this indication.
In conclusion, there is evidence to support the use of topical retinoids as monotherapy or in combination with other topical agents in the treatment of pigmentary disorders.