Kang Hee Young, Valerio Laure, Bahadoran Philippe, Ortonne Jean-Paul
Department of Dermatology, Ajou University School of Medicine, Suwon, Korea.
Am J Clin Dermatol. 2009;10(4):251-60. doi: 10.2165/00128071-200910040-00005.
Topical retinoids have been used in the treatment of pigmentary disorders such as melasma, actinic lentigines, and postinflammatory 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, triple-combination 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.
局部用维甲酸类药物已用于治疗色素沉着性疾病，如黄褐斑、光化性雀斑样痣和炎症后色素沉着。本文通过循证医学方法评估维甲酸类药物治疗色素沉着性疾病的临床疗效和耐受性。我们使用关键词“维甲酸类药物”与“黄褐斑”、“雀斑样痣”或“炎症后色素沉着”组合检索了MEDLINE和考克兰图书馆数据库。对于每项研究，根据特定标准评估其方法和结果。有充分证据支持局部用维甲酸作为单一疗法治疗黄褐斑以及雀斑样痣（B级）。局部用维甲酸类药物的不良反应相当常见，包括局部皮肤刺激、红斑和脱屑，其严重程度为轻至中度。有证据支持局部用维甲酸用于固定三联组合疗法（4%氢醌/0.05%维甲酸/0.01%醋酸氟轻松）治疗黄褐斑（B级）。支持联合制剂治疗雀斑样痣的证据不足（C级），需要进行大型随机双盲对照试验来进一步评估其在该适应症中的应用。总之，有证据支持局部用维甲酸作为单一疗法或与其他局部用药联合用于治疗色素沉着性疾病。
