Comparative Efficacy of Topical 20% Azelaic Acid alone versus 4% Hydroquinone 4% as an Adjuvant to Oral Tranexamic Acid in Melasma
DOI:
https://doi.org/10.51253/pafmj.v75i3.10788Keywords:
Azelaic Acid, Melasma, Tranexamic Acid.Abstract
Objective: To compare the efficacy of 4% hydroquinone cream as an adjuvant to oral tranexamic acid versus topical 20% azelaic acid alone in the treatment of melasma.
Study Design: Randomized Controlled Trial (ClinicalTrials.gov: NCT05887219).
Place and Duration of Study: Department of Dermatology, Combined Military Hospital, Abbottabad Pakistan, from Nov 2022 to Apr 2023.
Methodology: Fifty females diagnosed with melasma were included. After randomization, they were allocated into two distinct groups. Group-A was administered with a 4% hydroquinone cream in conjunction with oral tranexamic acid at a dosage of 250mg twice daily, while Group-B received topical application of a 20% azelaic acid cream once daily, for a duration of six months. The clinical evaluation was conducted at the onset of therapy, as well as at the second, fourth-, and sixth-month intervals, utilizing the Melasma Area and Severity Index (MASI) score and assessing the patient's response. The assessment of efficacy was conducted in both groups following the completion of therapy, specifically after a duration of six months.
Results: Mean MASI score achieved with 4% hydroquinone cream adjuvant to oral tranexamic acid was significantly superior to topical 20% azelaic acid alone (4.99+0.69 vs 6.80+1.98, p=0.004) with “Excellent” patient response (66.7% vs 33.3%, p=0.03) at the end of therapy after six months of treatment.
Conclusion: The combination of 4% hydroquinone cream with oral tranexamic acid demonstrated superior efficacy compared to topical 20% azelaic acid after six months of therapy.
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Copyright (c) 2025 Zahra Nigar, Bushra Muzaffar, Muhammad Adeel Siddiqui, Majid Hussain, Sana Aslam, Misbah Malik
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