Treatment of melasma using kojic acid in a gel containing hydroquinone and glycolic acid.
BACKGROUND
Melasma is difficult to clear. Many agents have been used, such as hydroquinone, and glycolic acid and glycolic acid peels, kojic acid, a tyrosinase inhibitor in the fungus Aspergilline oryzae.


OBJECTIVE
To see if the addition of 2% kojic acid in a gel containing 10% glycolic acid and 2% hydroquinone will improve melasma further.


METHODS
Forty Chinese women with epidermal melasma were treated with 2% kojic acid in a gel containing 10% glycolic acid and 2% hydroquinone on one half of the face. The other half was treated with the same application but without kojic acid. The side receiving the kojic acid was randomized. Determination of efficacy was based on clinical evaluation, photographs and self-assessment questionnaires at 4 weekly intervals until the end of the study at 12 weeks. The non-parametric Wilcoxon's rank sum test was used for statistical analysis.


RESULTS
All patients showed improvement in melasma on both sides of the face. The side receiving the kojic acid did better. More than half of the melasma cleared in 24/40 (60%) patients receiving kojic acid compared to 19/40 (47.5%) patients receiving the gel without kojic acid. In 2 patients, there was complete clearance of melasma, and this was on the side where kojic acid was used. Side effects include redness, stinging, and exfoliation. These were seen on both sides of the face, and they settled by the third week.


CONCLUSIONS
The addition of kojic acid to a gel containing 10% glycolic acid and 2% hydroquinone further improves melasma.
National Skin Care Center, Singapore.
J T
JT
Lim
D000328:Adult; D001236:Aspergillus oryzae; D004311:Double-Blind Method; D004338:Drug Combinations; D005148:Facial Dermatoses / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005782:Gels; D006016:Glycolates / Q000627:therapeutic use*; D006801:Humans; D006873:Hydroquinones / Q000627:therapeutic use*; D007641:Keratolytic Agents / Q000627:therapeutic use*; D008548:Melanosis / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D009183:Mycotoxins / Q000627:therapeutic use*; D011753:Pyrones / Q000627:therapeutic use*; D016896:Treatment Outcome
D004338:Drug Combinations; D005782:Gels; D006016:Glycolates; D006873:Hydroquinones; D007641:Keratolytic Agents; D009183:Mycotoxins; D011753:Pyrones; C031149:glycolic acid; C011890:kojic acid; C031927:hydroquinone