Iranian Journal of Dermatology

Vol. 16, No. 63, Spring 2013
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Therapeutic efficacy of a cream based azelaic acid 20% versus hydroquinone 4% in patients with melasma
Maryam Emad, Jafar Moezzi, Ladan Dastgheib

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Date Received: 2013 / Jul / 22 Date Revised: 2013 / Jul / 22 Date Accepted: 2013 / Jul / 22

Background: Melasma is an acquired therapeutically problematic
disease characterized by symmetrical facial hypermelanosis. The
aim of this study was to evaluate the efficacy of azelaic acid
20% cream in the treatment of melasma in Iranian patients and
compare it with hydroquinone 4% cream which has been the
standard treatment.
Method: The study was an open clinical trial with a split-face
design. All patients applied hydroquinone 4% cream on the
right side and azelaic acid 20% cream on the left side for 20
weeks. Modified melasma area and severity index (mMASI) was
determined for each patient at the beginning and at the end of
study and compared statistically.
Result: Thirty-three patients were included in the study. Although
both medications were effective in reducing mMASI, there was
no statistical difference between the two (P value=0.6). Overall,
69.7% of the patients on the hydroquinone 4% side and 63.6%
on the azelaic acid 20% side showed good to excellent response.
The subjective patient assessment of improvement was 75.7% for
hydroquinone 4% and 66.6% for azelaic acid 20%.
Conclusion: Both topical hydroquinone 4% and topical azelaic
acid 20% had almost similar effects. Considering the relatively
less known side effects of azelaic acid compared to hydroquinone,
it can be an appropriate substitute in the treatment of melasma.


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