From the Research
Tretinoin may be used as a treatment for exogenous ochronosis, typically applied as a 0.05-0.1% cream once daily at bedtime, as it increases cell turnover and promotes exfoliation of the hyperpigmented skin containing homogentisic acid deposits, although the most recent and highest quality study 1 suggests that treatment of this condition is often unsatisfactory. The treatment regimen should start with application every other night for 2-4 weeks to minimize irritation, then gradually increase to nightly use as tolerated. Patients should apply a pea-sized amount to affected areas after cleansing and drying the skin. Some key points to consider when treating exogenous ochronosis with tretinoin include:
- Treatment duration is typically several months, with improvements potentially seen after 3-6 months of consistent use.
- Strict sun protection is essential as tretinoin increases photosensitivity.
- Patients may experience side effects including redness, dryness, peeling, and irritation.
- For severe cases, combination therapy with other depigmenting agents like hydroquinone (under medical supervision), chemical peels, or laser therapy may be more effective than tretinoin alone.
- Results are generally gradual, and complete resolution of pigmentation may not be achievable in all cases, as noted in the study 1. It is also important to note that the use of hydroquinone in concentrations above 4% and in treatment courses longer than 3 months may be associated with new-onset ochronosis, as reported in the study 1. Some other key considerations include:
- The condition is often difficult to treat, and treatment options are limited, as noted in the studies 2, 3, and 4.
- Exogenous ochronosis is a rare condition, but it can be cosmetically disfiguring and troubling for patients, as reported in the study 4.
- The condition is often associated with the use of skin-lightening creams containing hydroquinone, as noted in the studies 2, 3, and 1.