Comparison of the efficacy of cysteamine 5% cream and hydroquinone 4%/ascorbic acid 3% combination cream in the treatment of epidermal melasma

Abstract

Background: Few safe and effective treatments are available for melasma. Cysteamine, a non-melanocytotoxic molecule is a safer alternative to hydroquinone and usable for long-term use. Aim:To evaluate the effect of cysteamine 5% cream in the treatment of melasma.Methods: Sixty-five of 80 patients completed this single-blind, randomized, controlled trial. The patients received cysteamine 5% or hydroquinone 4%/ascorbic acid 3% (HC) cream. The therapeutic response was evaluated by modified MASI (mMASI) and melanin index (SkinColorCatch) after 2 and 4 months of treatment. The effect of treatment on the quality of life was also assessed. Results:The decrease in mMASI score was from 6.69 ± 2.96 to 4.47 ± 2.16 in the cysteamine group and from 6.26 ± 3.25 to 3.87 ± 2.00 in the HC group after 4 months (p values < 0.001). The melanin index decreased from 37.72 ± 10.17 to 31.47 ± 11.90 in the cysteamine group and from 36.37 ± 10.80 to 23.16 ± 8.83 in the HC group after 4 months (p-value = 0.003 and <0.001, respectively). The difference between mMASI score at baseline and month 4 was not significant between both groups (pvalue > 0.05). The difference between the melanin index at baseline and month 4 was significantly more pronounced in the HC group (p-value = 0.002). Quality of life improved in both groups (p-value < 0.05), but was not significantly different between groups (p-value > 0.05). Conclusion:Cysteamine was confirmed to be an effective treatment for melasma, with equivalent results to HC in reducing mMASI score and improving quality of life, despite lesser melanin index reduction observed. Cysteamine and HC efficacy was confirmed in patients recalcitrant to previous treatments, by a significant reduction of mMASI and melanin index.

The Impact of Antioxidants on Vitiligo and Melasma: A Scoping Review and Meta-Analysis

“…Sepaskhah et al, in 2022, reported similar non-significant findings when comparing topical 5% cysteamine with hydroquinone 4% and ascorbic acid 3%. Again, the mMASI decreased most in the hydroquinone group without significant difference compared to 5% cysteamine, comparable to another small RCT [63,64]. Finally, a similar improvement was observed with 5% cysteamine compared to tranexamic acid and mesotherapy [65].…”

The efficacy of extracted Tanshinone compounds for infantile hemangiomas of the skin: results from a pilot study

“…The main goal of the treatment is to decrease cosmetic impairment caused by IHs. Therefore, response to treatment was mainly assessed according to cosmetic improvement by the skin erythema index using SkinColorCatch (previously named Dermacatch; Delfin, Kuopio, Finland) ( 14 ) before and after treatment. The Achauer score ( 15 ) was evaluated by another two independent physicians after reviewing all clinical photographs of IHs at baseline and after the full course of treatment.…”

An Update on New and Existing Treatments for the Management of Melasma

“…Combination treatments with hydroquinone have also been developed for melasma, including with sunscreen, retinoids, traditional and novel agents, chemical peels, or as triple combination therapy (TCC), discussed in their respective sections [11,18,[22][23][24][25]. Importantly, sunscreen with VL protection further augments the depigmenting efficacy of hydroquinone, as described in the aforementioned study by Castanedo-Cazares et al [11].…”

“…A prospective, single-arm study in patients with a MASI score under 10.5 at baseline found that 4% niacinamide, 3% arbutin, 1% bisabolol, and 0.05% retinaldehyde reduced MASI scores and melasma surface area on medical imaging [42]. A randomised controlled trial of 4% hydroquinone + 3% ascorbic acid demonstrated equal effectiveness after 4 months to 5% cysteamine cream in terms of mMASI reduction and quality-of-life improvement, and produced a greater melanin index reduction [25].…”