The efficacy of combination of 20% azelaic acid with 0.05% tretinoin cream in the treatment of melasma
Keywords:
20% azelaic acid, 0.05% tretinoin, melasmaAbstract
Background Melasma is a common acquired macular hyperpigmentation which involves mostly the sun exposed areas of face and neck. Objective To assess the efficacy of the combination of 20% azelaic acid with 0.05% tretinoin cream in the treatment of melasma. Patients and methods 30 patients of melasma were treated with daily night application of 20% azelaic acid and 0.05% tretinoin. Patients were assessed at 4, 8 and 12 weeks of treatment using melasma area severity index. Side effects during therapy were also noted. Results Majority i.e. 43% cases were between 26 to 30 years, 73.3% of patients were females and 56.7% were housewives, 70% were married and 86.7% were in middle class. Family history of melasma was positive in 66.7% cases. 93.3% patients had no history of systemic drug and 73.3% had no history of use of cosmetics. 93.3% of patients had malar area involvement and 6.7% had centrofacial area involvement. After treatment, the average MASI score decreased by 38.66% indicating moderate reduction of the severity of melasma. Burning sensation, itching and erythema developed in 50%, 30% and 16%, respectively. Conclusion The combination of 20% azelaic acid and 0.05% tretinoin cream in the treatment of melasma has a moderate lightening effect with some remarkable side effects.References
Bandyobadhyay D. Topical treatment of melasma. Indian J Dermatol 2009; 54: 303-9.
Vazquez M, Maldonado H, Benmaman C, Sanchez JL. Melasma in men. A clinical and histologic study. Int J Dermatol 1988; 27: 25-7.
Management of pigmentary disorders - A report from the Pigmentary Disorders Academy. J Am Acad Dermatol 2006; 54: 272-81.
Pasricha JS, Khaitan BK, Dash S. Pigmentary disorder in India. Dermatol Clin 2007; 25: 243-522.
Rigopoulos D, Gregoriou S, Katasambas A. Hyperpigmentation and melasma. J Cosmet Dermatol 2007; 6: 195-202.
Kauh YC, Zachian TF. Melasma. Adv Exp Med Biol. 1999; 455: 491-9.
Taylor SC, Torok H, Jones T et al. Efficacy and safety of a new triple-combination agent for the treatment of facial melasma. Cutis 2003; 72: 67-72.
Prignano F, Ortonne JP, Buggiani G, Lotti T. Therapeutic approaches to melasma, Dermatol Clin 2007; 25: 337-42.
Rendon M, Berneburg M, Arellano I, Picardo M. Treatment of melasma. J Am Acad Dermatol 2006); 54 (5 Suppl): S272-81.
Pérez-Bernal A, Muñoz-Pérez MA, Camacho F. Management of facial hyperpigmentation. Am J Clin Dermatol 2000; 1: 261-68.
Pathak MA, Fitzpatrick TB, Parish JA. Treatment of melasma with hydroquinone. J Invest Dermatol 1993; 76: 324-9.
Sanchez NP. Melasma: a clinical, light microscopic, ultrastructural and immunofluorescence study. J Am Acad Dermatol 1981; 4: 698-710.
Lim JTE, Tham SN. GA peels in the treatment of melasma among Asian women. Dermatol Surg 1997; 23: 177- 9.
Cotellessa C, Peris K, Onorati MT et al. The use of chemical peelings in the treatment of different cutaneous hyperpigmentations. Dermatol Surg 1999; 25: 450-4.
Garcia A, Fulton JE. The combination of glycolic acid and hydroquinone or kojic acid for the treatment of melasma and related conditions. Dermatol Surg 1996; 22: 443-7.
Kimbrough-Green CK, Griffiths CE, Finkel LJ et.al. Topical retinoic acid for melasma in black patient. A vehicle controlled clinical trial. Arch Dermatol 1994; 130: 727-33.
Sarkar R, Bhalla M, Kaur C, Kanwar AG. The combination of glycolic acid peels with a topical regiment in the treatment of melasma in dark skinned patients: A comparative study. Dermatol Surg 2002; 28: 828-32.
Pandya A, Berneburg M, Ortonne JP, Picardo M. Guidelines for clinical trials in melasma. Br J Dermatol 2007; 156 (suppl. 1): 21-8.
