Safety and efficacy of topical metformin 30% cream versus triple combination cream (Kligman's formula) in treating melasma: A randomized controlled study

Abstract

Background Melasma is an acquired common pigmentary condition that mostly presents as pigmented macules on the face. Triple combination creams (TCC), commonly known as kligman's formula, had been regarded as the mainstay of treatment for years. Topical metformin was recently studied for its melanopenic effects and potential use in melasma. Aim of the work This study aimed to evaluate the efficacy and safety of using 30% metformin cream to that of triple combination creams (Kligman's formula) in treating melasma. Patients and Methods About 40 patients complaining of melasma were recruited for this controlled randomized trial and were divided into 2 groups. Group 1 (n = 20) subjects received 30% metformin cream whereas group 2 (n = 20) were treated with TCC for eight consecutive weeks. Pigmentation severity and improvements were assessed using the melasma area severity index (MASI) at baseline and after 8 weeks of using treatment. Results MASI score decreased dramatically from 12.18 ± 9.33 before treatment to 5.59 ± 4.61 at Week 8 with a mean decrease percentage of 55.97 ± 16.77 for group 1 (p = 0.001) and from 16.05 ± 8.73 to 7.54 ± 5.77 with a mean decrease percentage of 56.50 ± 19.44 for group 2 (p = 0.001). No significant difference was reported between the two treatment modalities regarding the reduction in melasma throughout the study period (p = 0.968). Conclusion Metformin cream is a safe, potential effective treatment for melasma, which needs to be verified by long‐term large scale studies in diffident populations.

Topical metformin 30% gel in the treatment of acne vulgaris in women, a split face, placebo‐controlled study

“…In the current work, patients did not report any adverse events with the 30% metformin formulation, nor with the placebo form. This was consistent with the previous studies on topical metformin 30% for melasma 21,25 and reflects the high safety profile of such formulations.…”

“…13 Hypothetically, metformin cellular effects might vary when used via different routes, 14 therefore, several indications have been studied using variable routes of administration and formulations of metformin. [15][16][17][18][19][20][21][22][23][24] Topical metformin treatment showed promising results in patients suffering from melasma 21,25 and recalcitrant central centrifugal cicatricial alopecia. 19 Other successful studies in experimental animals included treatment of wounds 26,27 skin cancer 15,24 and ultraviolet skin injury.…”

Is Topical Metformin Effective in Treatment of Melasma?

“…Mean MASI score significantly decreased from 7.84 (SD 5.32) to 6.71 (SD 5.04) following 8 weeks of therapy in Group 1 (P1 =0.017). Likewise, Abo Alsoud et al (27) assessed safety and effectiveness of topical metformin (30%) in melasma and compared its effectiveness with TCC (hydroquinone 2% + tretinoin 0.025% + fluocinolone acetonide 0.01%). They observed a reduction in melasma severity after metformin application in the majority of cases with different degrees of improvement.…”

Skin hyperpigmentation index in melasma: A complementary method to classic scoring systems

“…Melasma is a common acquired recurrent pigment disorder predominantly in women and darker skin types, accompanied with a high impact on quality of life and emotional stress. 2,3,10 Due to its high prevalence (up to 34% and 40% among women in Brazil and South Asia) and its treatment-resistant behavior and relapsing nature, it is one of the most frequent reasons for dermatologic consultations. 2,3 As no punching through treatment has been discovered so far, every year a huge number of studies are conducted to determine the most effective treatment option.…”