Comparison of efficacy of hydroquinone versus hydroquinone plus tretinoin plus topical steroids in patients with melasma

Abstract

Background Melasma is an acquired pigmentary disorder characterized by symmetrical hyperpigmentation of the face. Treatment of melasma is unsatisfactory most of the times and comes with various side effects such as contact dermatitis, irritation and scarring.   Objective To compare efficacy of hydroquinone versus hydroquinone plus tretinoin plus topical steroids in patients with melasma.   Methods This randomized Controlled Trial was conducted in Department of Dermatology, Nishtar Medical University, Multan from 15th February 2019 to 15th August 2019. A total of 114 patients were divided in two groups, Group A, having 57 patients, was treated with hydroquinone cream once daily at bed time while group B, having 57 patients, was treated with combination therapy. Baseline and post-treatment MASI scores were calculated and patients were assessed weekly till 12 weeks and the efficacy of the treatment was documented. Efficacy was measured in terms of at least 50% reduction of MASI score after 12 weeks of therapy, compared with baseline MASI score.   Results This study comprised of a total of 114 patients meeting our inclusion criteria. Of these 114, 37 (32.5%) were male patients while 77 (67.5%) were female patients. Mean age in this study was 27.22±5.08 years. Mean age of the male patients was noted to be 27.89±4.53 years while that female patients was 26.90±5.32 years (p=0.330). Majority of the study cases i.e. 81 (71.1%) were aged up to 30 years. Of these 114 study cases, 43 (37.7%) belonged to rural areas and 71 (62.3%) belonged to urban areas. Fitzpatrick skin type III was noted in 78 (68.4%) and type IV in 36 (31.6%). Mean body mass index of our study cases was 25.68±2.59 kg/m2 and obesity was present in 11 (9.6 %) of our study cases. Mean disease duration was 10.29±8.23 months and 82 (71.9%) had duration of illness up to 1 year. Of these 114 study cases, 46 (40.6%) were illiterate and 68 (59.6%) were literate. Efficacy was noted in 75 (65.8%) of our study cases, Efficacy in group A was 49.1% while in group B, efficacy was noted in 82.5%.   Conclusion Combination therapy with hydroquinone plus tretinoin plus topical steroids is more effective, reliable and safe in treatment of melasma as compared with hydroquinone alone and it provides rapid and sustained clinical improvement in the treatment of melasma.