Hydrocortisone 2.5% / Tretinoin 0.1% / Hydroquinone 5% cream

This study aimed to investigate, through a systematic literature review, the efficacy of hydroquinone (HQ) as a primary depigmenting agent in the treatment of facial melasma, evaluating its clinical effectiveness, tolerability, recurrence rates, and therapeutic potential in combination therapies. Twenty studies published between 2020 and 2025 were analyzed, selected from the PubMed and Google Scholar databases, in Portuguese and English. The methodology involved the selection of articles within a defined temporal and thematic scope, prioritizing randomized clinical trials, systematic reviews, and comparative studies addressing HQ alone or in combination with other depigmenting agents or adjuvant technologies. The results indicated that hydroquinone, particularly in concentrations of 2% to 4%, remains the gold standard for melasma treatment, showing a significant reduction in pigmentation scores (MASI/mMASI) within 60 to 90 days of use. Recent studies emphasize the combined use of HQ with tranexamic acid, tretinoin, lasers, and platelet-rich plasma, resulting in greater efficacy and faster clinical response. However, erythema, desquamation, and post-treatment recurrence remain common limitations, especially in higher skin phototypes. It is concluded that, although new molecules and technologies demonstrate comparable efficacy, hydroquinone continues to be the most effective treatment for melasma, particularly when used in combined and supervised regimens, reaffirming its importance in evidence-based dermatological practice.  

Abstract licence: CC BY

ABSTRACT Background Treatment with fluocinolone acetonide, hydroquinone, and tretinoin cream is the gold standard for melasma; however, the effects of this treatment in the Chinese population remain unclear. Due to the differences between Chinese and Caucasian subjects, further clinical trials in Chinese patients with melasma are needed. Aim To evaluate the efficacy and safety of fluocinolone acetonide, hydroquinone, and tretinoin creams in Chinese patients with moderate‐to‐severe melasma. Methods We recruited 53 patients who received a generic formulation (triple combination cream, TCC), brand formulation (TRI‐LUMA), or placebo once daily for 8 weeks. In weeks 4 and 8, efficacy was evaluated based on the Melasma Severity Scale and Melasma Area and Severity Index. In addition, safety was assessed based on the incidence and severity of treatment‐emergent adverse events. Results The generic TCC group achieved 52.2% efficacy compared to 57.1% in the TRI‐LUMA group. There was no significant difference in the incidence of adverse effects between the TCC and TRI‐LUMA groups (69.6% and 90.5%, respectively; p  > 0.05). The incidence of adverse events in the placebo group was 0%. Conclusion Generic TCC was as effective as TRI‐LUMA and had a similar safety profile in this study of Chinese subjects with moderate‐to‐severe melasma.

Abstract licence: CC BY 4.0

Objective: To compare the efficacy of Tranexamic acid mesotherapy versus combination of hydroquinone, tretinoin, and fluocinolone cream (Triple cream) for melisma. Study Design: Randomized controlled trial (Iranian Registry of Clinical Trials = 20210823052264N1) Place and Duration of Study: Department of Dermatology, PNS Shifa Hospital Karachi, Pakistan from Mar 2022 to Aug 2022. Methodology: A total of 58 patients were divided randomly into two groups, A (29 patients) and B (29 patients). Group A patients received sessions of intalesional tranexamic acid 50mg/ml every 2 weeks. Group B patients were treated once nightly with Triple combination cream. Total Period of treatment was for twelve weeks for each patient. Measurement of Melasma Area Severity Index (MASI) Scores for both groups were calculated at 0, 4, 8, and 12 weeks. Final response was labelled at 12 weeks by comparing mean MASI reduction in both groups. SPSS, version 28 was used for data analysis and p<0.05 was considered significant. Results: At the end of study comparison was made of Mean reduction of MASI Score for both groups, significant reduction was noted in mean score from 7.73±1.43 to 4.30±1.34 (44.37%) in group A Tranexamic acid as compared to decrease in scores in group B Triple combination cream from 7.90±1.11 to 5.20±1.39 (34.18%) p-value 0.081. Conclusion: Tranexamic acid mesotherapy can be safe, effective and promising treatment option for melasma. It leads to better results, and lesser side effects than topical triple cream.

Abstract licence: CC BY-NC

Objective: To compare 30% Metformin plus 2% Nicotinamide solution with Kligman formula in the management of melasma in patients managed at tertiary care hospital of Rawalpindi.  Study Design: Randomized controlled trial (ClinicalTrials.gov: NCT 05790577). Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Feb 2022 to Feb 2023. Methodology: A total of eighty-eight patients of melasma were recruited for this trial and allocated randomly into two groups: A and B. Group-A received the 30% metformin plus 2% nicotinamide solution while Group-B received the Kligman formula (fluocinolone acetonide 0.01%+ tretinoin 0.025% + hydroquinone 2%). Both groups were followed up for 12 weeks to look for response which was assessed on Melasma Area and Severity Index (MASI). MASI was calculated at the start of treatment, and at 4, 8 and 12 weeks. Adverse events such as itching and burning were noted and addressed at each visit. Results:  Out of eighty-eight patients, 66(75.0%) were females while 22(25.0%) were males. Mean age of the study participants was 30.93±7.94 years. Out of 44 patients in Group-A, 13(29.0%) showed mild improvement, 21(47.0%) patients showed moderate while marked improvement was seen in 4(9.0%) patients. In Group-B, out of 44 patients grade 1, 2, 3 and 4 improvements were seen in 14(31.81%) mild, 26(59.0%) moderate, 03(9.0%) marked and total improvement in one patient, respectively. Adverse effects were .... Conclusion: Both the treatment options used, 30% metformin with 2% nicotinamide solution and Kligman formula were equally efficacious in management of ..

Abstract licence: CC BY-NC

Acne and post-inflammatory hyperpigmentation (PIH) are prevalent dermatological conditions that significantly impact young individuals, especially those with darker skin tones. Effective management of these conditions requires a comprehensive approach that integrates topical, systemic, and procedural therapies. The evaluation of the data from multiple clinical studies and dermatological reviews revealed the superior efficacy of combination therapies for acne and PIH. The studies incorporated the analysis of the effectiveness of topical agents such as retinoids (tretinoin and adapalene) and hydroquinone, systemic treatments such as antibiotics and hormonal agents, and procedural interventions including laser therapy and chemical peels. Topical therapies showed a significant efficacy in reducing acne lesions and PIH and emphasized on a superior response in patients on combination therapies when compared to monotherapy. Systemic treatments are very effective for severe acne and aid indirectly in mitigating PIH. Procedural therapies enhance treatment efficacy by targeting pigmented cells and stimulating skin regeneration. The integration of multiple treatment modalities addresses the complex pathophysiology of acne and PIH in a better way. Topical retinoids accelerate cell turnover and reduce inflammation, while hydroquinone inhibits melanogenesis. Combining these agents with systemic treatments or procedural interventions maximizes therapeutic benefits. Personalized treatment plans, tailored to individual skin types and conditions, are crucial for optimizing outcomes. Combination therapy thus represents a robust approach to managing acne and PIH, offering enhanced efficacy through synergistic effects. Further research in the light of present work is needed to refine these strategies and develop new formulations that address both cosmetic and biomedical aspects of PIH.

Abstract licence: CC BY-NC-SA