P2615

Case studies of combination treatment with a solution of mequinol 2%/tretinoin 0.01% with chemical peels for mild-to-moderate postinammatory hyperpigmentation Susan C. Taylor, MD, Society Hill Dermatology, Philadelphia, PA, United States Skin of color, which encompasses the pigmented skin of those of African-American and Hispanic descent, is susceptible to several unique and cosmetically disguring problems. Postinammatory hyperpigmentation (PIH) is among the diseases that commonly necessitate visits to the dermatologist and are of major cosmetic concern for these populations. The number of agents available for the treatment of PIH is limited, and some agents are minimally effective. While mequinol 2%/tretinoin 0.01% topical solution (Solage) is indicated for the treatment of solar lentigines, previous clinical work suggests clinical efcacy for the treatment of PIH. Although there is a lack of published data regarding chemical peels in patients with skin of color, data suggest that supercial salicylic acid peels are safe and effective for treatment of PIH in patients with darker skin types. The goal of these case studies is to observe and document the results of a dual modality regimen of the combination of a solution of mequinol 2%/tretinoin 0.01% in conjunction with salicylic acid chemical peels in the treatment of PIH. Approximately 3 patients (male or female), ages 18 years and over, with Fitzpatrick skin types III to VI, and mild-to-moderate PIH on the face resulting from acne as rated by the investigator at baseline will be studied for a 12-week period. Patients will continue their regular skin care regimen and follow a sun avoidance/protection program. Treatment/peel cycles will include use of mequinol 2%/tretinoin 0.01% solution (applied twice daily, 8 hours apart), which will be discontinued for 3 days prior to the application of a 20% or 30% salicylic acid peel. Treatment with mequinol 2%/tretinoin 0.01% solution will resume the day following the peel. Peels will be applied approximately every 2-3 weeks as tolerated. Primary efcacy variables will be: (1) Physician Global Assessment, (2) Subject Global Assessment, and (3) mexameter evaluation readings of each hyperpigmented target site (as compared to adjacent normal skin). In addition to clinical evaluations of PIH, photography will be used to document the results achieved with this regimen. Any adverse events will be monitored throughout the course of the case studies. Results are expected in early 2007. 100% is sponsored by Barrier Therapeutics.

P2617
Diltiazem-induced photodistributed hyperpigmentation Sima Torabian, MD, Department of Dermatology, University of California-Davis, School of Medicine, Sacramento, CA, United States; Maxwell Fung, MD, Department of Dermatology, University of California-Davis, School of Medicine, Sacramento, CA, United States; Philina Lamb, MD, Department of Dermatology, University of California-Davis, School of Medicine, Sacramento, CA, United States Diltiazem hydrochloride, a benzothiazepine calcium-channel blocker, is often prescribed for the treatment of cardiovascular diseases. Adverse cutaneous reactions associated with diltiazem are infrequent, but variable ranging from photosensitivity and maculopapular eruptions to vasculitis, Stevens-Johonson syndrome, and toxic epidermal necrolysis. Over the past few years, diltiazem induced photodistributed hyperpigmentation has been described in 12 patients most of whom were African-American females. We describe the second reported case of diltiazem induced photodistributed hyperpigmentation in a 68-year-old Hispanic female who developed reticular brown patches on her face and neck a few months after starting Diltiazem. Histopathological studies revealed interface vacuolar alterations and dermal melanin-laden macrophages. Hyperpigmentation is reversible upon discontinuation. Avoidance of sun exposure as well as use of broadspectrum sunscreens and sun-protective clothing are indicated for patients undergoing treatment with diltiazem. Commercial support: None identified.

P2616
Melasma and its impact on quality of life in Latino women Rajesh Balkrishnan, PhD, Ohio State University College of Pharmacy, Columbus, OH, United States; Amy McMichael, MD, Wake Forest University Health Sciences, Winston Salem, NC, United States; Steven Feldman, MD, PhD, Wake Forest University Health Sciences, Winston Salem, NC, United States Background: Melasma has been shown to have a signicant emotional and psychologic effect on affected patients. Although this pigmentary disorder is thought to be more prevalent among Latinos, the effect of melasma on quality of life (QOL) in this population is unknown. Objective: We examined the impact of melasma on the quality of life in women of Hispanic origin (Mexican and Central American), using data from 2 instrument development prospective studies and one large clinical trial (PIGMENT). Methodology: Objective data on melasma related QOL was obtained from 316 Latina patients and compared to 885 White women with melasma. QOL was measured using the MELASQOL intrument and the Spanish version of the MELASQOL, both of which have been validated. General health status was measured using the SF-12 instrument. Results: We found in all comparisons that QOL in Latina patients (both on the MELASQOL as well as SF-12) was signicantly lower than White women with the same condition (average burden 25% higher in Latinas compared to White women). Additional difculties with Latino women not identied in White women was the economic toll melasma had on their lives. Conclusion: Melasma has a signicant impact on the QOL of women of Hispanic origin. The translation and validation of the MELASQOL, a condition-specic instrument in Spanish will enable researchers to document this impact in greater detail. This study was supported by a grant from Galderma Laboratories, L.P.

P2618
Techniques of assessing skin hyper-pigmentation and dark lesions Iqbal Sadiq, MS, S.K.I.N. Inc, Conshohocken, PA, United States; Tracy Stoudemayer, S.K.I.N. Inc., Conshohocken, PA, United States Recent advances in bioengineering technology have made it possible to study skin hyper-pigmentation more closely. Since melanin absorbs light strongly in the ultraviolet and blue region of the spectrum, we have used spectroscopic methods to assess the increase in melanin content of skin. Due to the high refractive index of melanin compared to other components of skin, confocal scanning laser microscopy was used to visualize the microstructure of hyper-pigmented lesions. Imaging techniques using selected wavelengths were used to see the spatial distribution of pigment. Digital dermatoscopy with oil or gel optical coupling show clear boundaries of the pigmented lesion. UVA photography and UVA-blue light photographic techniques were used to enhance the appearance of pigment. The appearance of common hyper-pigmented lesions is due to the increase in melanin content. There are a variety of stimuli for hyper-pigmentation. Post inammatory hyper-pigmentation is a common observation. Ultraviolet light causes darkening of skin in a variety of ways. Acute exposure to solar ultraviolet light triggers melanogenesis, the darkening appears after 3 to 7 days and may last for weeks or months. Chronic exposure results in the appearance of freckles, solar lentigos, and blotchy hyperpigmentation. A different type of pigment appears in some cases of seborrheic keratosis, showing gray-brown or gray-yellow color with a distinct morphology. Commercial support: None identified.

FEBRUARY 2007

J AM ACAD DERMATOL

AB173