TOPICAL FORMULATION TO IMPROVE HYPERPIGMENTATION 269 0.0–25.6%) reported less redness with the HQ4%-treated side. Differences in pair-wise scores did not reach statistical signifi cance (p = 0.19). Tole rability. Aft er 1 mo of SKNB19 treatment, 100.0% of patients reported no tolerabil- ity issues. After 1 mo of HQ4%, of the 18 patients, 13 (72.2%) reported no tolerability issues, four (22.2%) reported mild tolerability issues and one (5.6%) reported severe in- tolerability (Figure 5). On p air-wise comparison, of the 18 patients, fi ve (27.8%, CI: 7.1–48.5%) reported better tolerability to treatment with the SKNB19-treated side than the HQ4%-treated side, whereas none reported better tolerability to treatment with the HQ4%-treated side. Dif- ferences in pair-wise scores were mildly statistically signifi cant (p = 0.048). Figure 3. Patient self-assessment: Distribution of irritation scores. After 1 mo of HQ4% treatment, 27.8% of skin sections had mild or signifi cant irritation compared with 0% with SKNB19. Figure 4. Patient self-assessment: Distribution of redness scores. After 1 mo of HQ4% treatment, 27.8% of skin sections had mild, moderate, or signifi cant redness compared with 11.1% with SKNB19.

JOURNAL OF COSMETIC SCIENCE 270 INDE PENDENT REVIEWER ASSESSMENT Seve nteen patients (15 females and two males) were included in the independent reviewer assessment. The mean age of the patients was 39.7 ± 9.1 (range: 27–61) years. One pa- tient dropped out of the study because of intolerability to HQ4%. Five independent evaluators reviewed 17 patients, for a total of 85 ratings that were taken into analysis. After 1 mo of treatment, evaluators reported an improvement (whether mild, moderate, or signifi cant) in the overall appearance in 70 of 85 cases (82.4%) on the SKNB19-treated side and in 55 of 85 cases (64.7%) on the HQ4%-treated side (Figure 6, Table IV). Rela- tive to HQ4%, this is a 27% improvement. Figure 5. Patient self-assessment: Distribution of tolerability scores. After 1 mo of HQ4% treatment, 27.8% of skin sections had mild or signifi cant tolerability issues compared with 0% with SKNB19. Figure 6. Independent reviewer assessment: Distribution of scores.