Hello skintellectuals. It’s May! In Australia it’s a whole heap colder. And in the UK, where we spent the start of May, Spring has sprung. We were in the UK for the Aesthetic Medicine conference, where I was a guest speaker. This time I was speaking about uneven pigmentation and the role of skincare in managing it. We were also meeting some of our beautiful clinics and co-hosting some amazing events. This month in our science wrap we are unpacking two studies on pigmentation- one about rehashing a cheap-as-chips drug that seems to be flavour of the month (or year/ decade) for everything from diabetes to dementia and even cancer prevention- it seems to work for pigmentation too. We also do a deep dive into Bakuchiol (hint- STILL no evidence) and then some new hope for rosacea sufferers repurposing a migraine drug to prevent those nasty flares! Enjoy!!

A diabetes drug to combat excess pigmentation?

This caught my eye because I take metformin and have for years for insulin resistance. I also have melasma. It turns out, my metformin might be doing more for me than stabilizing my blood sugar levels. A new study published in the journal, Dermatologic Surgery included 60 melasma patients. The patients were divided into 3 groups: Group A received systemic metformin (1000 mg/d), Group B received systemic metformin (500 mg/d) and Group C received a placebo. The 3 treatment groups were also given a series of AHA peels over the whole face twice each month for a total of 6 sessions. All 3 groups saw improvements in their pigmentation, but the greatest improvements were seen were in those taking the higher metformin dose. Why? Well, it seems to reduce the ability of pigment producing cells AKA melanocytes to actually make pigment. And in fact quite a few studies have shown that popping a solution of metformin onto the skin also reduces pigmentation.

Looking into skincare with bakuchiol? There is no evidence for it, says a major review

Huge on TikTok and Reddit, Bakuchiol is all the range for pigmentation and collagen building. So a major review of studies of the skincare favourite published in one of our fav journals, The Journal of Drugs in Dermatology was truly welcome. Following a comprehensive search, fifteen clinical trials were analysed where bakuchiol was used for skin aging, acne, and post-inflammatory hyperpigmentation. The authors pretty much gave up because the trials were so bad, they were useless. Ten of the trials used a combination of different skincare actives- only one of which was bakuchiol. This means any benefits can’t be attributed to bakuchiol. Twelve of the trials had no control group (so any assessed changes could not be compared to anything else eg. a plane moisturiser). Four trials did not specify the dose or concentration of bakuchiol in treatment regimens. Their conclusion: “Trials lack methodological rigor which introduces a high risk of bias in reported outcomes”. For people not familiar with the balanced and considered wording of scientific papers, this is about as derisive as it gets. They called for more trials before we can say anything at all about whether bakuchiol works.

A brand new treatment for flushing rosacea?

If you suffer from burning red cheeks with rosacea, this might be exciting news. Doctors have invented an injection given monthly that reduces redness and flushing. It’s early days, but in a brand new Danish study, people with moderate to severe flushing rosacea received a monthly injection of Erenumab. This drug is actually an antibody against a protein called calcitonin gene-related peptide (CGRP). If it sounds vaguely familiar, that’s because it is EXACTLY the same protein and injection used to help people with chronic migraine. It was a pretty big success, with days of flushing reduced by 7 over the 12 week duration of the trial. But one in 4 managed to reduce their flushing by as much as 50%. Stand by for more trials! You’ll read it here first!