A DEPIGMENTATION TOPICAL TREATMENT PROGRAM ENHANCES A PREVIOUS CHEMICAL PEELING OF THE FACE 393 as “unpleasant.” The majority of patients evaluated the cleanser as “pleasant” (43.75%) and “very pleasant” (12.50%) (Figure 4). The o verall satisfaction of investigators and patients with the results obtained after the study treatment was assessed through two fi ve-point questionnaires (one for the investi- gator and one for the patient), completed at study visit 2. The results were reported as number and percentage of patients for each point of each questionnaire. The study inves- tigator declared to be “satisfi ed” (68.75%) and “very satisfi ed” (25%) with treatment re- sults in the large majority of cases, with the exception of a single subject (6.25%) declaring “neither satisfi ed nor dissatisfi ed.” Finally, the majority of the patients declared to be satisfi ed and very satisfi ed with the treatment results (68.75%), with the only fi ve patients (31.25%) declaring neutral perspective as “neither satisfi ed nor dissatisfi ed” and no patients (0%) declaring dissatisfi ed toward the treatment result. DISCU SSION The s ubjects enrolled in this clinical study had previously received a chemical peeling/ depigmentation treatment of the superfi cial layers of the epidermis with a product con- taining a fi xed-dose combination of salicylic acid, pyruvic acid, and retinoic acid, with the integration of depigmentation agents able to inhibit melanin biosynthesis. Pyruvic Figure 1. Assessment of the primary end point melanin concentration (%) at study visits 1 and 2, deter- mined through the Antera 3D camera and its associated software on selected skin areas for each patient. The individual measurement of melanin concentration at study visits 1 and 2 and the individual changes between the study visits are shown. Different kinds of lines have been used in addition to different colors to help distinguish among individual changes. A p value 0.05 was considered statistically signifi cant.

JOURNAL OF COSMETIC SCIENCE 394 acid peels have been shown to be safe and effective in treating melasma, allowing the patients to preserve their working and social life (2). Overall, our study revealed that the daily administration of the home-based hyperpigmentation topical treatment program not only maintained but also enhanced the benefi cial lightening effect achieved from the previous chemical peeling, as supported by the statistically signifi cant reduction in indi- vidual melanin concentration at study visit 2 versus visit 1 (Figure 1), and by the 2.6-fold higher melanin percent change at study visit 2 versus the prepeel period (from -3.0% to -7.8% p 0.0001) (Figure 2). These results are presumably related to the formulations of the products included in the depigmentation topical treatment program. In particular, the day cream has an adjuvant triple action: (i) promotes cell renewal, thanks to its vita- min A content (ii) plays a lightening action and supports the inhibition of the synthesis of new melanin , thanks to kojic acid (iii) hydrates and restructures the skin, protecting it from external agents and promotes the reduction of transepidermal water loss, thanks to the AQUAXYL complex. Of major interest, the night cream included in the depigmen- tation topical treatment program has a double peeling effect: it exerts both a chemical Figure 3. Antera 3D di g ital images showing a representative hyperpigmented patch on the skin at three dif- ferent time points of the study: prepeel period visit 1 (postpeel and study enrollment) visit 2 (end of the study). Figure 2. Reduction i n melanin concentration (%) across the study steps (prestudy period, study period, prestudy + study period), determined through the Antera 3D camera and its associated software on selected skin areas for each patient. A p value 0.05 was considered statistically signifi cant.