Therapeutic efficacy of a cream based azelaic acid 20% versus hydroquinone 4% in patients with melasma

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.