Author : Chyad Abdul-Zahra, Narjes
Combination Therapy with Hydroquinone, Tretinoin and Steroid for Treatment of Melasma in Iraqi patients
karbala journal of pharmaceutical sciences,
Volume 2, Issue 2, Pages 218-227
Background: Melasma is one of the most frequently acquired hyperpigmentation disorders clinically characterized by symmetrical brown patches on sun exposed areas. The pathogenesis of melasma is not fully understood, but several hypotheses have been suggested. Patient treatment is particularly difficult and challenging, and necessitates using different modalities of treatment which is a burden on the patient.
Objectives: The aim of this study was to evaluate the efficacy of combination of retinoic acid, steroids and hydroquinone in reducing melasma.
Patients and Methods: The study was conducted at the private clinic, Kerbala city in the period July 2008- March 2009. One hundred & thirteen patients with melasma were included in this study, all of them were female (pregnant and nursing mothers were excluded), with an age range 25-40 years. Full clinical examination was done for all patients ,the severity of melasma was assessed by the melasma area severity index(MASI).The treatment include using of combination of retinoic acid 0.25,steroid (hydrocortisone cream ,Betamethasone cream and clobetasol propionate cream ) and hydroquinone in addition to use of sunblock SPF60 regularly for all patients .
The patients divided in to three groups according to primary cause of melasma and the treatment modules were as follow:
Group 1: (sun exposure ) the formula used was retinoic acid 0.25 ,hydroquinone 2% and hydrocortisone cream ,for group (2)(cosmetic ) the formula used was retinoic acid cream 0.25 ,hydroquinone cream 4%and betamethasone cream and for group (3) (pregnancy cause )we used retinoic acid cream 0.25 ,hydroquinone cream 4% and clobetasol propionate cream .The follow up and response to treatment recorded every week depending on the MASI until the desired response was achieved at the end of 4th week .follow-up was carried out for 6 months later to record any relapse.
Result: The results revealed marked improvement and significant decrease in MASI in all groups .The MASI for group (1) decrease from 10.6 to reach 3.18,MASI for group (2) was decreased from 15.5 to 3.88 while MASI for group (3) decreased from 22 to reach 4.4 .
No side or unwanted effect recorded or informed by the patients .
Conclusion: Combination of retinoic acid, steroids and hydroquinone was found to be effective in reducing and treating melasma if used in proper way.