Dihydroxyacetone (Monograph)

Drug class: Pigmenting Agents
VA class: DE900
Chemical name: 83-72-7
CAS number: 96-26-4

Medically reviewed by Drugs.com on Nov 21, 2024. Written by ASHP.

Introduction

Dihydroxyacetone is a pigmenting agent, which darkens the skin without the aid of ultraviolet (UV) light.

Uses for Dihydroxyacetone

Dihydroxyacetone is applied topically to cosmetically camouflage vitiliginous skin in patients with idiopathic vitiligo. The drug is rarely useful in darkly pigmented blacks with vitiligo.

Dihydroxyacetone is also used topically as a cosmetic to produce an artificial suntan, but patchy coloration of skin may result from uneven application and/or uneven thickness of the epidermis. Dihydroxyacetone alone provides no protection against UV light that causes sunburn (UVB). In some combination products containing dihydroxyacetone and a sunscreen, the sunscreen protection factor (SPF) may be too low to afford proper protection, especially during initial exposure to sunlight; therefore, sunlight exposure should be limited until a protective tan develops.

Sequential application of 3% dihydroxyacetone and 0.25% lawsone solutions is used as a sunscreen to protect against severe photosensitivity reactions of various etiologies (e.g., erythropoietic protoporphyria, exposure to photosensitizing drugs, allergic contact photodermatitis). Although there are no comparative studies, some clinicians prefer to treat erythropoietic protoporphyria with beta carotene.

Dihydroxyacetone Dosage and Administration

Solutions containing approximately 4–8% dihydroxyacetone are applied topically. To darken hypopigmented skin or to produce an artificial tan, a thin layer of dihydroxyacetone solution or suspension should be applied uniformly, without rubbing and as often as necessary, using an applicator or the fingers. If applied with the fingers, the hands should be washed immediately afterward to avoid staining. To obtain darker pigmentation, a second and third coat of the preparation may be applied after the prior coat has been allowed to dry for 1 hour, but the knees and elbows should be treated only once because they darken very easily. A single application of dihydroxyacetone may give a patchy appearance to the skin but repeated application may correct the uneven appearance. Following topical application of dihydroxyacetone, darkening of the skin occurs slowly, increasing with repeated application. After discontinuing the drug, pigmentation fades with the sloughing of the stratum corneum, usually beginning within 2 days and fading completely within 8–14 days. Rubbing, scraping or shaving of skin hastens fading of pigmentation. To maintain pigmentation once the desired skin color is obtained, the frequency of application may be reduced to once daily or every third day.

For sunscreen protection against photosensitivity reactions, sequential applications of 3% dihydroxyacetone solution, followed in 15 minutes with 0.25% lawsone solution, are repeated several times (at least 3 times) the first evening before sunlight exposure. On following evenings, 1 application of dihydroxyacetone and lawsone will suffice. Solutions of these drugs have been extemporaneously prepared using 50% isopropyl alcohol.

Cautions for Dihydroxyacetone

Adverse Effects

Skin irritation or sensitivity following topical application of dihydroxyacetone is rare but rashes with erythema, vesicles and wheals, and allergic dermatitis have been reported.

Precautions and Contraindications

If rash or irritation occurs, the drug should be discontinued and a physician consulted. Contact of the drug with the eyes should be avoided and dihydroxyacetone preparations should not be applied to the eyelids or abraded skin. Dihydroxyacetone stains clothing and hair; therefore, clothing should not be put over the treated area until the applied solution or suspension has dried. Although the color washes out of most fabrics, dihydroxyacetone will permanently stain wool and nylon fabrics.

Vitadye topical solutions contain the dye tartrazine (FD&C yellow No. 5), which may cause allergic reactions including bronchial asthma in susceptible individuals. Although the incidence of tartrazine sensitivity is low, it frequently occurs in patients who are sensitive to aspirin.

Commercially available formulations of Vitadye topical solutions contain sodium metabisulfite, a sulfite that may cause allergic-type reactions, including anaphylaxis and life-threatening or less severe asthmatic episodes, in certain susceptible individuals. The overall prevalence of sulfite sensitivity in the general population is unknown but probably low; such sensitivity appears to occur more frequently in asthmatic than in nonasthmatic individuals.

Acute Toxicity

Information on the acute toxicity of dihydroxyacetone is limited. Oral ingestion of up to 150 g of the drug reportedly has been tolerated well. Adults receiving 15 g of dihydroxyacetone orally 3 times daily for 2–3 weeks also have reported no toxic adverse effects.

Pharmacology

Following topical application, dihydroxyacetone slowly darkens the skin without the aid of ultraviolet (UV) light, producing a brown color similar to that caused by exposure to sunlight but rarely matching that of melanin. The intensity of pigmentation produced by dihydroxyacetone increases as the concentration of the drug increases; however, darkening of the skin continues to a maximum point and then progresses no further. Dihydroxyacetone often produces a yellow or orange pigmentation of the skin; addition of glyceraldehyde or iron oxide dyes to dihydroxyacetone preparations may prevent yellow pigmentation of the skin. Pigmentation is facilitated by the presence of surfactants. The mechanism of action of the drug has not been definitely established but may involve a reaction with amino acids in the stratum corneum. The pigmentation produced by dihydroxyacetone is of unknown composition but is not derived from melanin.

Dihydroxyacetone, in sequential combination with lawsone (a naphthoquinone-derivative dye present in henna), acts as a sunscreen. Dihydroxyacetone alone absorbs, to a limited extent, UVA light (320–400 nm). The sequential combination of dihydroxyacetone and lawsone absorbs light with wavelengths of 290–400 nm (UVA and UVB light). The mechanism of action of the sequential combination has not been fully defined but dihydroxyacetone appears to reduce sulfhydryl groups in keratin, allowing lawsone to react with the keratin and absorb UV light.

Dihydroxyacetone Pharmacokinetics

Information on the absorption, distribution, and elimination of dihydroxyacetone is not available.

Chemistry and Stability

Chemistry

Dihydroxyacetone occurs as a hygroscopic, dimeric, crystalline powder having a characteristic odor and a sweet, cooling taste. The drug is very soluble in water and soluble in alcohol.

Stability

Dihydroxyacetone is incompatible with amines and their derivatives.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

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