A comparative study of the efficacy of 4% hydroquinone vs 0.75% Kojic acid cream in the treatment of facial melasma

Abstract

Background:Melasma is a common acquired cause of facial hyperpigmentation seen predominantly among females with significant psychological and social impact. It is often recalcitrant to treatment. Several topical hypopigmenting agents have been used to combat melasma. Hydroquinone and Kojic Acid are well established monotherapeutic agents for treating melasma.Objectives:This study focuses mainly on the efficacy of once daily application of 4% Hydroquinone and 0.75% Kojic Acid cream (containing 0.75% Kojic acid and 2.5% vitamin C) so as to determine an effective modality of treatment for facial melasma.Materials and Methods:A total number of 60 patients with facial melasma attending the Out-patient department of Dermatology, Venerology and Leprosy, Fr. Muller Medical College Hospital, Mangalore from Oct 2008-April 2010 were studied. Patients were allocated alternately to group A and group B. Group A patients received 4% Hydroquinone cream and group B patient received a Kojic Acid cream (which contained 0.75% Kojic acid and 2.5% vitamin C) and were advised to apply topically once daily at night. Patients were followed up on 4th, 8th and 12th week. At each visit side effects were noted and clinical response to treatment was calculated using the MASI score.Statistical Methods:Chi square test, student ‘t’ test.Results:At the 4th week post treatment evaluation, facial hyperpigmentation responded early to 4% Hydroquinone cream than to 0.75% Kojic Acid cream. At the end of 12 week treatment period, 4% Hydroquinone cream had an overall superiority to 0.75% Kojic Acid cream as a topical hypopigmenting agent.Conclusion:The results of the study show that 4% Hydroquinone cream is a better topical hypopigmenting agent with rapid rate of clinical improvement when compared to 0.75% Kojic Acid cream.

Topical silymarin versus hydroquinone in the treatment of melasma: A comparative study

“…Hydroquinone has been proven as an effective treatment for melasma in a large number of previous studies . This came in agreement with the results of the present study that revealed significant reduction of the severity of melasma after treatment with hydroquinone for 3 months.…”

“…On the contrary, adverse effects including erythema, burning, and scaling were detected in 71.4% of the patients treated with hydroquinone 4% cream (group 3). This was in accordance with the findings demonstrated by many studies, which reported that hydroquinone is associated with frequent side effects such as skin irritation, erythema, burning sensation, desquamation, and exogenous ochronosis . These undesirable side effects arouse the need of an alternative safer modality, but with comparable efficacy to hydroquinone.…”

Discovery of new depigmenting compounds and their efficacy to treat hyperpigmentation: Evidence from in vitro study

“…Previously known depigmenting compounds such as azelaic acid (C 9 H 16 O 4 ) selectively reduce hyperpigmentation in abnormal melanocytes, and it has minimum effect to normal melanocytes . On the other hand, hydroquinone (C 6 H 6 O 2 ) possesses intracellular cytotoxic effect that reduces pigmentation level by nonselectively destroying the epidermal melanocytes and keratinocytes . Due to aggressive mode of action of hydroquinone in reducing level of pigmentation, it is associated with skin cancer .…”

“…In recent years, cosmetic products containing hydroquinone have been banned in most countries, but its usage for medical purpose can be compromised under strict regulation . Other depigmenting compounds such as kojic acid (C 6 H 6 O 4 ) caused irritant contact dermatitis especially to human skin treated with very high concentrations (3%, w/w) . Depigmenting compounds such as α‐arbutin (C 12 H 16 O 7 ), ascorbic acid (C 6 H 8 O 6 ), and thioctic acid (C 8 H 14 O 2 S 2 ) reduced pigmentation by various different ways, such as chelation of copper ions (Cu 2+ ), at the catalytic active site of TYR, which deactivates TYR activity or prevention of TYR maturation by hindering incorporation of Cu 2+ into TYR as well as inhibition to TYR‐related protein (TRP) activity .…”

New Aspects of Melasma/Novi aspekti melazme

“…Although kojic acid alone is less effective than HQ 2%, (36) in combination with glycolic acid 10% and HQ 2%, it seems to have a synergistic action (37).…”