Assessing the Effectiveness of Stabilized Cysteamine 5% Cream Compared to Hydroquinone 4%/Ascorbic Acid 3% Combination Cream in Treating Acne-induced Post-inflammatory Hyperpigmentation: A Randomized, Controlled Study

Koorosh Ahmadi; Amir Miri; Zeinab Bizaval; Mozhdeh Sepaskhah; Sara Ranjbar; Zahra Bagheri; Behrooz Kasraee

Assessing the Effectiveness of Stabilized Cysteamine 5% Cream Compared to Hydroquinone 4%/Ascorbic Acid 3% Combination Cream in Treating Acne-induced Post-inflammatory Hyperpigmentation: A Randomized, Controlled Study

J Clin Aesthet Dermatol. 2024 Apr;17(4):37-41.

Authors

Koorosh Ahmadi¹, Amir Miri¹, Zeinab Bizaval¹, Mozhdeh Sepaskhah², Sara Ranjbar³, Zahra Bagheri⁴, Behrooz Kasraee⁵

Affiliations

¹ Drs. Ahmadi, Miri, and Bizaval are with the Department of Dermatology and School of Medicine at Shiraz University of Medical Sciences in Shiraz, Iran.
² Dr. Sepaskhah is with the Department of Dermatology, School of Medicine, and Molecular Dermatology Research Center at Shiraz University of Medical Sciences in Shiraz, Iran.
³ Ms. Ranjbar is with the Molecular Dermatology Research Center at Shiraz University of Medical Sciences in Shiraz, Iran.
⁴ Dr. Bagheri is with the Department of Biostatistics and School of Medicine at Shiraz University of Medical Sciences in Shiraz, Iran.
⁵ Dr. Kasraee is with Scientis SA in Geneva, Switzerland.

PMID: 38638185
PMCID: PMC11022844

Abstract

Objective: Postinflammatory hyperpigmentation (PIH) is a common sequela of acne vulgaris. Topical treatment with hydroquinone is the standard treatment, but may be associated with complications. Cysteamine is a relatively safe depigmenting agent with an observed depigmenting effect. We designed this study to assess the efficacy of a cysteamine 5% cream in treating acne-induced PIH.

Methods: Twenty-eight out of 32 participants finalized this investigator-blind, randomized, and controlled trial (registered in Iranian Registry of Clinical Trials [IRCTID: IRCT20140212016557N5]). We randomized the patients to apply either cysteamine 5% or hydroquinone 4%/ascorbic acid 3% (HC) cream. Postacne hyperpigmentation index (PAHPI) and melanin index were the assessment measures after four months of treatment. We evaluated the quality of life by the Dermatology Life Quality Index (DLQI) questionnaire.

Results: Both cysteamine and HC cream significantly decreased the PAHPI score and melanin index of acne-induced PIH patients (p<0.05). The decrease in PAHPI score and melanin index were not significantly different in treatment groups after four months (p>0.05). Quality of life ameliorated significantly only with cysteamine treatment. However, no significant change in quality of life was observed between groups.

Limitations: Limitations of our study include the relatively small sample size and absence of follow-up.

Conclusion: Cysteamine cream is an effective treatment of post-acne PIH, with similar efficacy to the accepted treatment of PIH, i.e., hydroquinone cream.

Keywords: Acne vulgaris; administration; ascorbic acid; cysteamine; drug therapy; hydroquinone; hyperpigmentation; topical.