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A randomized, double-blind trial conducted by Yoritaka et al

The ingredients could act through two possible ways: (a) biological mechanism-oriented by exerting anti-photodamage actions, namely the products resulting of the direct and oxidative damage of DNA, downregulation the expression of MMPs, and pro-inflammatory cytokines confirmed in in vitro studies in keratinocytes and fibroblasts and in vivo and ex vivo studies, and/or (b) clinical effects-oriented by softening the visible effects of the skin sun damage, by providing moisturizing effect and refreshing properties, mainly corroborated by clinical trials

A modified triple combination cream consisting of hydroquinone, a retinoid, and a low-potency steroid have been considered as a therapeutic regimen for melasma management

Vinayagamoorthi R, Bobby Z, Sridhar MG