Trichloroacetic acid model to accurately capture the efficacy of treatments for postinflammatory hyperpigmentation
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ORIGINAL PAPER
Trichloroacetic acid model to accurately capture the efficacy of treatments for postinflammatory hyperpigmentation Alexis B. Lyons1 · Indermeet Kohli1,2 · Amanda F. Nahhas3 · Taylor L. Braunberger1 · Tasneem F. Mohammad1 · Cynthia L. Nicholson4 · Nathan T. Nartker4 · Krishna Modi5 · Mary S. Matsui6 · Henry W. Lim1 · Iltefat H. Hamzavi1 Received: 15 January 2020 / Revised: 27 February 2020 / Accepted: 30 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Postinflammatory hyperpigmentation (PIH) occurs following cutaneous injury and is common following resolution of acne especially in patients with skin of color. The objective of this study was to further validate a trichloroacetic acid (TCA)induced PIH model and compare it to acne-induced PIH using topical bakuchiol, a botanical extract that has been shown to have antimicrobial, anti-inflammatory, antioxidant, and antiacne properties. A prospective, non-randomized clinical trial was conducted on subjects with skin phototypes IV–VI with a history of acne-induced PIH. Subjects applied bakuchiol or vehicle cream twice daily to 2 acne-induced and 2 TCA-induced PIH lesions for 28 days with a third lesion serving as a control in each group. Degree of improvement was defined as the change in the Investigator Global Assessment (IGA) score over 28 days of treatment. Twenty subjects (6 males, 14 females) completed the study. For TCA-induced PIH sites, there was a statistically significant (p 0.05). TCA-induced PIH sites were uniform in size and pigment intensity thereby allowing better comparison among sites. This emphasizes the relevance of using this model for PIH which may help reduce the barriers in clinical trials and help improve access to treatments for patients who suffer from PIH. The results suggest that topical bakuchiol may decrease the severity of PIH. Keywords Postinflammatory hyperpigmentation · Bakuchiol · Acne · Trichloroacetic acid · Hypermelanosis · Model
Introduction Alexis B. Lyons, Indermeet Kohli and Amanda F. Nahhas are cofirst authors. * Iltefat H. Hamzavi [email protected] 1
Department of Dermatology, Henry Ford Hospital, 3031 West Grand Blvd, Detroit, MI 48202, USA
2
Department of Physics and Astronomy, Wayne State University, Detroit, MI, USA
3
Department of Dermatology, Beaumont Hospital, Farmington, MI, USA
4
Department of Dermatology, Wayne State University, Detroit, MI, USA
5
Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
6
Independent Researcher, Englewood, NJ, USA
Postinflammatory hyperpigmentation (PIH) is an acquired hypermelanosis that presents after cutaneous inflammation or injury [1]. The severity of PIH is determined by Fitzpatrick skin phototype, degree and depth of inflammation, degree of dermal–epidermal junction disruption, inflammatory insult type, and melanocyte stability [2]. Though all skin types are susceptible to PIH, patients with darker skin phototypes, such as African-Americans, Hispanics, Asians, Native Americans, Pacific Island
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