5% cysteamine cream for melasma: worth the hype and the price tag?

@emmaharrington brought this product to my attention the same week that a new clinical trial of it landed in my inbox – so I knew it was a ‘hot topic’ that needed my urgent attention.

Lots of cosmetic skincare ingredients/products have one or two ‘token’ clinical trials done as a marketing/sales technique so I generally don’t pay much attention to those – but when more start appearing and the product is claiming to treat a serious skin disease (in this case – melasma) and costs a lot of money, it is my responsibility to have a closer look at the evidence. Cysteamine cream has been known to be a depigmenting agent since 1966 when it was found to cause depigmentation via injection into the skin of black goldfish and, later, as a topical treatment depigmenting the skin of black guinea pigs. However, it is very unstable in a cream form and, when oxidised, produces an offensive odour.

In 2010, new technology was used to reduce this odour, allowing it to be used as an ingredient in cosmetic skincare. There are two randomised placebo-controlled trials looking at the efficacy of 5% cysteamine cream in the treatment of melasma (Farshi 2015 and Farshi 2018). Yes, they were done by the same group of researchers, are virtually identical and tested the effect of 5% cysteamine cream vs placebo in a total of 90 patients with facial melasma over 4 months of daily treatment.

Though there are some issues with these trials (namely blinding, the fact that the placebo response was basically zero, the big difference in baseline group mMASI scores and the way the power calculation was performed), they are otherwise decent pilot studies that do indeed show a significant improvement with the cysteamine cream vs placebo. So would I recommend this cream???

It is interesting that Scientis SA (they make the cream) has a disclaimer on their website stating that this product ‘is not intended to…diagnose, treat, cure or prevent any disease or condition.’ This, of course, contradicts how it is being marketed – as a treatment for melasma and pigmentation (or pigment ‘correction’). Would I recommend this cream over hydroquinone (HQ) for my melasma patients?

No – for a number of reasons, including cost, efficacy, ease of use, personalisation, not to mention decades worth of data supporting the use of HQ. If a patient is unresponsive to HQ then I would consider advising use of this topical – but fortunately I have yet to have a patient in that situation! Anyone used 5% cysteamine cream for melasma? Let me know your experiences!