A novel triple combination in treatment of melasma: Significant outcome with far less actives

Abstract

Summary Background Melasma is an acquired hyperpigmentation, often involving the face, and a source of distress for the affected individuals. Although treatment is challenging and frequently a multimodality approach, topical applications are the mainstay of therapy. Objective Due to the frequent relapses, a therapy both acting rapidly and suitable for long‐term use, with fewer adverse effects should be administered. In our outpatient clinic, we treated the melasma patients with a previously unreported triple combination which was empirically formulated with lesser amount of active components, regarding the balance between long‐term use and safety. Methods Sixty‐eight female patients with melasma who referred to our hospital dermatology clinic in the years 2016‐2017 were retrospectively recruited. They all had completed 6‐month treatment with a prescribed cream mixture comprised of azelaic acid (4%), hydroquinone (1.6%), methylprednisolone aceponate (0.04%), and salicylic acid (2%). The outcomes were evaluated both instrumentally (Melanin Index/MI) and by patients (Patient Self‐Assessment Scale/PSAS). Results Adverse effects declared by the patients were transient irritation in three and mild hypertrichosis in two. Both the MI and PSAS values were found extremely significant at the end of 6th month, compared with initial values. Approximately 62% of total decrease in MI was realized in the first 3 months. Conclusion The triple combination containing active ingredients with lesser concentrations than proposed, and with the addition of 2% salicylic acid, may be promising as a quite effective and safe protocol in treatment of melasma for longer durations.

Efficacy of intradermal injection of tranexamic acid and ascorbic acid versus tranexamic acid and placebo in the treatment of melasma: A split‐face comparative trial

“…In contrast, combination therapies (e.g., tretinoin plus corticosteroids plus hydroquinone) appear to be more beneficial than monotherapy. 22 , 23 Ali Balvei et al, in a clinical trial in Australia, evaluated the effect of a combination of mesotherapy with ascorbic acid and salicylic acid (as a peeling agent) in one group and salicylic acid alone in the other group. After 2 months of therapy with 2‐week intervals between sessions, those who received ascorbic acid mesotherapy experienced a greater decrease in MASI scores than those who received only the peeling agent.…”

“…To date, no single therapy has been proven to be effective in treating melasma. In contrast, combination therapies (e.g., tretinoin plus corticosteroids plus hydroquinone) appear to be more beneficial than monotherapy 22,23. Ali Balvei et al, in a clinical trial in Australia, evaluated the effect of a combination of mesotherapy with ascorbic acid and salicylic acid (as a peeling agent) in one group and salicylic acid alone in the other group.…”

Systematic review of melasma treatments: advantages and disadvantages

“…Irritation or erythema was an adverse effect that might occur. 25 A contrasting result by Fragoso et al found that combination (4% azelaic acid, 0.04% methylprednisolone aceponate, 1.6% HQ, and 2% salicylic acid) had the same effect as 4% HQ in melasma treatment with the adverse effect more occurs than 4% HQ cream. 26 Based on previous studies, the most recommend formula in triple combination cream is Kligman and Willis formula (5% HQ, 0.1% dexamethasone, and 0.1% tretinoin) because it can decrease MASI score significantly, increase and maximize the efficacy and performance of every topical agent in that combination, shorter duration of treatment, and minimalize the side effects of regimen usage.…”

Different therapeutic approaches in melasma: advances and limitations

“…Despite the promising therapeutic potential of azelaic acid in melasma, however due to limited water solubility and poor skin permeability, its conventional topical formulations have been fabricated in higher doses (10%–20%) to achieve the desired clinical outcome ( Sieber and Hegel, 2014 ; Sobhan et al, 2023 ). The most common adverse reactions that have been reported with topical azelaic acid formulations are burning, itching, stinging, dryness, and erythema which are temporary and mild ( Kirsch et al, 2019 ; Malik et al, 2019 ; Pekmezci, 2019 ; Searle et al, 2022 ).…”