4% hydroquinone versus 4% hydroquinone, 0.05% dexamethasone and 0.05% tretinoin in the treatment of melasma: a comparative study

A randomized, controlled, double-blind clinical study was conducted on 64 patients (phototypes III to V) with melasma, in order to compare 4% hydroquinone cream with a combination product, containing 4% hydroquinone, 0.05% tretinoin and 0.05% dexamethasone, that can be applied as a single cream. The aim of this study was to determine whether hydroquinone provides additional improvement when combined with tretinoin and dexamethasone. Patients were randomly divided into two groups of 32 individuals. One group received 4% hydroquinone (group A) in a cream base. The other received a cream that contains 4% hydroquinone, 0.05% tretinoin and 0.05% dexamethasone (group B). The creams were applied once daily at night and a broad spectrum sunscreen (sun protection factor 15) was used every morning. Patients were evaluated by a clinical investigator subjectively at baseline and after 4, 8 and 12 weeks of therapy. At the baseline visit, the history of melasma, such as duration of disease, patient's age, type of melasma, distribution of melasma, family history, association with pregnancy, sun exposure, genetic factors and oral contraceptive consumption, was taken. Improvement was determined subjectively compared with baseline, on a three-point scale as follows: worse, same and improved (excellent, good, moderate and slight). Descriptive statistics (the chi(2) test) were used to report the characteristics of the patients in the two groups.