Usage
- This topical medication is primarily prescribed for the treatment of melasma, also known as chloasma or “mask of pregnancy.” Melasma presents as symmetrical, grey-brown or brown patches on sun-exposed areas, especially the face. It’s more common in women, particularly during pregnancy or menopause.
- Pharmacological Classification: This is a combination product containing a depigmenting agent (hydroquinone), a retinoid (tretinoin), and a skin protectant (allantoin). It can be considered a skin-lightening or bleaching agent.
- Mechanism of Action: Hydroquinone decreases melanin production by inhibiting tyrosinase, the enzyme responsible for melanin synthesis. Tretinoin increases skin cell turnover, promoting the shedding of hyperpigmented cells. Allantoin moisturizes and softens the skin, reducing irritation caused by tretinoin and hydroquinone, while promoting the breakdown of keratin and removing dead skin cells.
Alternate Names
- No official alternate names exist for this specific combination, though individual ingredients have other names (e.g., tretinoin is also retinoic acid).
- Brand Names: Several brand names exist, such as Melapik Ever New, Lumadip, and Skinlite Ever, among others. Availability and specific brand names may vary by region.
How It Works
- Pharmacodynamics: Hydroquinone’s depigmenting effect results from tyrosinase inhibition. Tretinoin modulates cell proliferation and differentiation, leading to increased epidermal cell turnover and shedding of pigmented cells. Allantoin acts as an emollient and keratolytic agent, moisturizing, softening, and promoting exfoliation of the skin.
- Pharmacokinetics: Following topical application, systemic absorption is minimal for all three components.
- Mode of Action: Hydroquinone acts by inhibiting tyrosinase, which reduces melanin formation within melanocytes. Tretinoin binds to retinoic acid receptors within the skin, increasing cell turnover rate. Allantoin promotes cell proliferation and tissue repair.
- Elimination Pathways: Topical application, Minimal systemic absorption.
Dosage
Standard Dosage
Adults:
- A thin layer is applied to the affected areas once daily, typically at night or at least 30 minutes before bedtime, or as prescribed. Application should typically be made to melasma-affected skin, including roughly a 1.25cm border of unaffected skin, surrounding the visibly affected skin.
Children:
- Not recommended for children under 12 years old.
Special Cases:
- Elderly Patients: Use with caution. May need a lower dose.
- Patients with Renal Impairment: Minimal systemic absorption; dose adjustment is generally unnecessary.
- Patients with Hepatic Dysfunction: Minimal systemic absorption; dose adjustment is generally unnecessary.
- Patients with Comorbid Conditions: Caution is advised, especially for patients with inflammatory skin disorders. A dermatologist should be consulted.
Clinical Use Cases
This combination is not typically used in the clinical settings you mentioned (intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations). It is specifically for topical treatment of melasma.
Dosage Adjustments:
Dose adjustments might be needed based on individual tolerance and response. A dermatologist should assess and titrate the dose accordingly.
Side Effects
Common Side Effects:
- Dryness
- Redness
- Peeling
- Burning
- Itching
- Stinging
Rare but Serious Side Effects:
- Allergic reactions (rash, itching, swelling, difficulty breathing)
- Exogenous ochronosis (blue-black skin discoloration)
- Worsening of melasma
- Increased sensitivity to sunlight, cold, and wind
- Severe skin irritation
Long-Term Effects:
- Exogenous ochronosis
- Skin atrophy
Adverse Drug Reactions (ADR):
- Allergic contact dermatitis
- Exogenous ochronosis
Contraindications
- Hypersensitivity to any of the components
- Open wounds, burns, or infected skin
- Eczema, psoriasis, or rosacea
- Sunburned skin
- Concurrent use of certain topical medications, including those containing benzoyl peroxide, resorcinol, salicylic acid or other retinoids.
- Pregnancy and breastfeeding, unless deemed absolutely necessary by a physician.
Drug Interactions
- Photosensitizing agents: Increased risk of sunburn.
- Topical antibiotics (e.g., benzoyl peroxide): May cause skin discoloration.
- Other retinoids (e.g., isotretinoin): Increased irritation.
- Antiseptics (e.g., resorcinol): Increased irritation.
- Keratolytic agents (e.g., salicylic acid, sulfur): Increased irritation.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: Contraindicated.
- Fetal Risks: Tretinoin is teratogenic.
- Breastfeeding: This combination is contraindicated.
- Safer alternatives should be considered.
Drug Profile Summary
- Mechanism of Action: Decreases melanin production (hydroquinone), increases skin cell turnover (tretinoin), moisturizes (allantoin).
- Side Effects: Dryness, redness, peeling, burning, itching. Rarely: exogenous ochronosis, allergic reactions.
- Contraindications: Hypersensitivity, open wounds, skin infections, eczema, psoriasis, sunburn, pregnancy, breastfeeding.
- Drug Interactions: Photosensitizers, topical antibiotics, other retinoids, antiseptics, keratolytic agents.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Apply a thin layer to affected areas once daily at night.
- Monitoring Parameters: Skin irritation, allergic reactions, signs of exogenous ochronosis.
Popular Combinations
- Glycolic acid peels are sometimes used in conjunction with this combination to enhance the depigmenting effect.
Precautions
- General Precautions: Patch test recommended before applying to large areas.
- Specific Populations: Contraindicated in pregnancy and breastfeeding. Use with caution in the elderly. Not recommended for children under 12 years old.
- Lifestyle Considerations: Avoid sun exposure, use sunscreen, and protective clothing. Avoid using other potentially irritating topical products.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Allantoin + Hydroquinone + Tretinoin?
A: Apply a thin layer to the affected skin once daily, usually at night.
Q2: What are the common side effects?
A: Dryness, redness, peeling, burning, and itching are common.
Q3: Can this cream be used during pregnancy or breastfeeding?
A: No, it is contraindicated.
Q4: How long does it take to see results?
A: Improvement may be seen after several weeks, but significant improvement can take several months.
Q5: What should I do if I experience severe irritation?
A: Discontinue use and consult a dermatologist.
Q6: Can I use other skincare products with this combination?
A: Use cautiously, after discussing other products with the prescribing dermatologist.
Q7: Does this cream permanently cure melasma?
A: It can significantly improve the appearance of melasma, but recurrence is possible, especially with sun exposure.
Q8: What happens if I miss a dose?
A: Apply the missed dose as soon as remembered, unless it is almost time for the next dose. Do not apply extra to make up for missed doses.
Q9: Should I apply sunscreen when using this cream?
A: Yes, daily sunscreen use is essential, as this cream can increase skin sensitivity to the sun.
