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.

A DEPIGMENTATION TOPICAL TREATMENT PROGRAM ENHANCES A PREVIOUS CHEMICAL PEELING OF THE FACE 395 action, thanks to its glycolic acid content, and a mechanical action, thanks to the presence of squalene and scrubbing beads, specifi cally formulated to help uniform the skin pig- mentation. The glycolic acid contained in the night cream is considered the safest and the most versatile peeling agent among all the alpha hydroxy acids used as chemical peels for the treatment of melasma because it has the smallest molecule and penetrates the epider- mis the best (23). The kojic acid contained in the day and night creams is widely used for melasma treatment as well (24), and its clinically effective antimelanogenic activity on hyperpigmented skin is associated with the induction of Interleukin-6 (IL-6) production in keratinocytes (25), other than with its tyrosinase inhibition and scavenging activity of reactive oxygen species (16). Our dat a revealed no statistically signifi cant change for pigment uniformity and skin texture in the study we performed. Additional investigations with a longer study period and larger sample size will be performed to further verify an effect of the chemical peeling/ depigmentation treatment we tested also on these parameters. This st udy took advantage of the Antera 3D system, which proved to be a valuable, objective, easy, and reproducible method to assess the effects of a dermocosmetic treatment on hy- perpigmentation, excluding any need for clinical scores (26) or self-assessment. The area selected in each patient for the study purposes showed a regular surface, without excessive concavities or convexities, potentially affecting the measurements of the selected skin parameters. Of note, a recent study compared the Antera 3D-based system with other methods (Mexameter® MX-18 and Colorimeter® CL-400, Courage+Khazaka electronic GmbH, Köln, Germany) for the skin color analysis in healthy volunteers. The Antera 3D system sho wed a better sensitivity and specifi city and a higher repeatability versus other methods for all the parameters analyzed (22). The only intrinsic limitation of the Antera 3D system was the fi xed size of the skin areas analyzed (56 × 56 mm). Because th e study product was a home-based treatment, not only its effi cacy but also its safety, tolerability, ease of use, and level of patients’ and physicians’ satisfaction have been considered as parameters of major importance in the assessment of the hyperpigmenta- tion topical treatment program. The treatment was safe and well-tolerated, and the satis- faction rate of investigators and patients with the overall results at study completion was very high. Of interest, a previous multicenter, prospective study performed on 100 women affected by melasma and treated for 45 and 90 d with the same home-based depigmentation pro- gram tested in our study indicated its effectiveness on melasma even in the absence of a prestudy chemical peeling (27). Figure 4. Pie charts sh o wing the distribution of subjects’ opinions on the pleasantness of the study products included in the depigmentation topical treatment program (including the cleanser, day cream, and night cream).