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

Authors

  • Abeer Aslam Nishtar Hospital Multan District headquarter Hospital, Multan
  • Leena Hafeez Nishtar Hospital Multan Khawaja Fareed Social security hospital, Multan.
  • Aymon Shafi Nishtar Hospital Multan
  • Asiah Yousaf Nishtar Hospital Multan Tehsil Headquarter hospital, Shujaabad
  • Aamina Noureen Khan Nishtar Hospital Multan
  • Raheel Tahir Nishtar Hospital Multan

Keywords:

Keywords Melasma, Hydroquinone, Tretinoin, Triple Therapy, Steroids

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.  

References

References:

Lee MC1, Chang CS, Huang YL, Chang SL, Chang CH, Lin YF, et al. Treatment of melasma with mixed parameters of 1,064-nm Q-switched Nd:YAG laser toning and an enhanced effect of ultrasonic application of vitamin C: a split-face study. Lasers Med Sci. 2015 Jan;30(1):159-63.

Lima Ede A1. Microneedling in facial recalcitrant melasma: report of a series of 22 cases. An Bras Dermatol. 2015 Nov-Dec;90(6):919-21.

Choi CP1, Yim SM, Seo SH, Ahn HH, Kye YC, Choi JE. Retrospective analysis of melasma treatment using a dual mode of low-fluence Q-switched and long-pulse Nd:YAG laser vs. low-fluence Q-switched Nd:YAG laser monotherapy. J Cosmet Laser Ther. 2015 Feb;17(1):2-8.

Hsiao CY, Sung HC, Hu S, Huang CH. Fractional CO2 Laser Treatment to Enhance Skin Permeation of Tranexamic Acid with Minimal Skin Disruption. Dermatology. 2015;230(3):269–275. [PubMed]

Vachiramon V, Sahawatwong S, Sirithanabadeekul P. Treatment of melasma in men with low-fluence q-switched neodymium-doped yttrium-aluminum-garnet laser versus combined laser and glycolic Acid peeling. Dermatol Surg. 2015;41:457–465

Sardesai VR, Kolte JN, Srinivas BN. A clinical study of melasma and a comparison of the therapeutic effect of certain currently available topical modalities for its treatment. Indian J Dermatol. 2013;58(3):239.

Rivas S, Pandya AG. Treatment of melasma with topical agents, peels and lasers: an evidence-based review. Am J Clin Dermatol. 2013;14(5):359–376.

Jutley GS, Rajaratnam R, Halpern J, Salim A, Emmett C. Systematic review of randomized controlled trials on interventions for melasma: an abridged Cochrane review. J Am Acad Dermatol. 2014;70(2):369–373

Adalatkhah H1, Sadeghi-Bazargani H2. The first clinical experience on efficacy of topical flutamide on melasma compared with topical hydroquinone: a randomized clinical trial. Drug Des Devel Ther. 2015 Aug 4;9:4219-25.

Udare S, Borade D, Narayanan V, Mahajan S. Sequential use of hydroquinone based (without steroid and tretinoin) formulation followed by non-HQ based formulation in the treatment of melasma in Indian patients; prospective non-randomized study. J Bio Innov. 2017;6(6):896-907.

Guevara IL1, Pandya AG. Melasma treated with hydroquinone, tretinoin, and a fluorinated steroid. Int J Dermatol. 2001 Mar;40(3):212-5.

Miot LD, Miot HA, Silva MG, Marques ME. Physiopathology of melasma. An Bras Dermatol. 2009;84:623–635.

Handel AC, Miot LDB, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol.2014;89(5):771–82.

Puri N1. Comparative study of 15% TCA peel versus 35% glycolic acid peel for the treatment of melasma. Indian Dermatol Online J. 2012 May;3(2):109-13. doi: 10.4103/2229-5178.96702.

Ali R, Aman S, Nadeem M, Kazmi AH. Quality of life in patients of melasma. J Pak Assoc Derma.2013;23:143-8.

Ejaz A1, Raza N, Iftikhar N, Muzzafar F. Comparison of 30% salicylic acid with Jessner's solution for superficial chemical peeling in epidermal melasma. J Coll Physicians Surg Pak. 2008 Apr;18(4):205-8. doi:04.2008/JCPSP.205208.

Ali R, Aman S, Nadeem M, Kazmi AH. Quality of life in patients of melasma. J Pak Assoc Derma.2013;23:143-8.

Halder S, Halder A, Nag SC, Sarkar RP. Melasma in the people of Sub-Himalayan region of Eastern India. J Pak Assoc Derma. 2013;23(2):139-42.

Udare S, Borade D, Narayanan V, Mahajan S. Sequential use of hydroquinone based (without steroid and tretinoin) formulation followed by non-HQ based formulation in the treatment of melasma in Indian patients; prospective non-randomized study. J Bio Innov. 2017;6(6):896-907.

Guevara IL1, Pandya AG. Melasma treated with hydroquinone, tretinoin, and a fluorinated steroid. Int J Dermatol. 2001 Mar;40(3):212-5.

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Published

2021-08-06

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