What is afamelanotide?

Afamelanotide (SCENESSE®, Clinuvel Pharmaceuticals) is a potent alpha-melanocyte-stimulating hormone. Melanotan I was the original name for this injectable synthetic melanotropic peptide.

Eumelanin is a kind of melanin, the skin’s tanning pigment. Exposure to the ultraviolet (UV) radiation component of sunlight normally stimulates the production of melanin.

• UV radiation causes cellular damage, which increases the chance of developing skin cancer.
• By absorbing UV rays, a tan protects the skin from additional damage.
• Melanin also filters out longer wavelengths, protecting persons who are photosensitive to visible light.
• Melanin also protects the skin from free radicals by acting as an antioxidant. Free radicals are to blame for the signs and symptoms of erythropoietic protoporphyria.

How does afamelanotide work with vitiligo?

Vitiligo is a skin condition marked by white spots caused by the loss of epidermal melanocytes. UVB phototherapy is an important part of vitiligo treatment, but it has been proven that when combined with afamelanotide, repigmentation is faster and more effective.

Does afamelanotide work as a sunscreen?

The use of afamelanotide has been linked to a 50% reduction in epidermal sunburn cells, as well as a considerable reduction in the creation of thymine dimers (part of the process by which UVB damages DNA). Afamelanotide’s manufacturers, on the other hand, do not advocate it as a sunscreen or treatment for sunburn.

Contraindications to afamelanotide

Due to lack of data, contradictions to afamelanotide include:

• Liver or kidney impairment: the metabolism of this drug is not completely understood.
• Children: the safety and efficacy of this drug in people aged 0 to 17 years has not yet been established.
• The elderly: it is also recommended that patients over 70 do not take afamelanotide.
• Pregnancy: it is recommended that women who are pregnant or breastfeeding should not take it.

How to take afamelanotide

Afamelanotide (Scenesse®) is a white rod with a diameter of 1.5 mm and a length of 1.7 cm. It is implanted beneath the skin, generally around the hip, and contains 16 mg of afamelanotide. It should be administered every two months by a specialist physician, prior to and during increased sun exposure (eg, summer). Three implants per year are recommended, with a maximum of four per year.

In the event of an allergic reaction, the patient must wait 30 minutes.

Tests before/after starting afamelanotide

Tests before starting afamelanotide may include:

• Liver and kidney function
• Pregnancy test

If you have heart or lung issues, diabetes, Cushing disease, Addison disease, Peutz-Jeghers syndrome, epilepsy, anemia, or skin cancer, you may need additional tests.

Prior to treatment and every six months during treatment, full-body skin examinations are indicated to assess and monitor pigmented lesions and other skin abnormalities, especially in those with a personal history of skin cancer.

Side effects of afamelanotide

Few major side effects have been reported thus far.

• One-third of patients experience hyperpigmentation at the implant site
• There is a low risk of darkening moles anywhere on the body
• Mild tiredness, headache, dizziness and nausea are common after administration of the implant usually clears by 72 hours.

Afamelanotide does not appear to raise the risk of melanoma. UVB exposure is the most important risk factor for melanoma. Eumelanin synthesis protects the skin by reducing UVB skin penetration and scavenging free radicals.

Drug interactions with afamelanotide

Patients taking blood thinners may have bruising or bleeding at the implantation site due to the route of administration.

No specific medication interactions have been discovered yet (2015).

Safety measures

• Women of childbearing potential should use effective contraception during treatment with afamelanotide, and for a period of three months after.
• Patients are recommended not to drive or use heavy machinery within 72 hours of administration of afamelanotide due to the risk of tiredness and dizziness.