What is cysteamine cream?

Cysteamine 5% cream (Cysteamine Cream®, ScientisPharma) is a skin-lightening agent used in the treatment of hyperpigmentation disorders such as melasma, postinflammatory hyperpigmentation and lentigines. It has also been used to lighten skin colour overall. It is available as a 50-g tube.

A randomised, double-blind, placebo-controlled clinical trial confirmed the efficacy of cysteamine cream in the treatment of epidermal melasma [1].

Note: oral cysteamine is used to reduce cystine levels in the treatment of a rare genetic lysosomal storage disorder, nephropathic cystinosis. It is a complex medicine with multiple side effects and risks.

How does it work?

The cream contains cysteamine hydrochloride, a metabolite of L-cysteine and a natural cellular component. L-cysteamine inhibits melanin synthesis. Cysteamine has an unpleasant sulfur odour, but the manufacturers of the cream claim to have reduced this by new technology. Theories how it reduces skin pigment include:

• Inhibition of tyrosinase and peroxidase
• Scavenging of dopaquinone
• Chelation of iron and copper ions 
• Increasing intracellular glutathione.

Contraindication to the use of cysteamine cream

Cysteamine cream should not be used by anyone with a personal or family history of the depigmenting disorder, vitiligo.

No study has been performed during pregnancy or breast-feeding, so it should not be used by pregnant or breast-feeding women. 

How to use cysteamine cream

Cysteamine cream can be applied at any time of year regardless of the intensity of sunlight. It is suitable all skin phototypes.

The cream is applied to the darkened skin of face and neck once daily. It is washed off after 15 minutes using soap and tepid water. After gently drying the skin, a moisturising cream is applied.

• To reduce irritation, it should be applied at least an hour after washing the skin
• After 6 weeks of application, the exposure time can be increased gradually if there are no signs of skin irritation such as redness or dryness.
• A reduction in pigmentation can be visible after 6 weeks.
• Optimal results can be obtained after 8 to 12 weeks.

To maintain its effects, cysteamine cream should be continued twice weekly indefinitely.

Sunscreens should continue to be used year-round.

What are the side effects and risks of cysteamine cream?

Local side effects at the site of application may include:

• Temporary heating up or burning sensation and redness that clears within 30 minutes
• More persistent irritation and dryness, which should be treated with emollient.

To date (April 2017), no serious adverse events have been reported.