title: Evaluation of the efficacy and safety of combinations of hydroquinone, glycolic acid, and hyaluronic acid in the treatment of melasma.
abstract: BACKGROUND
  Various treatments are currently available for melasma. However, results are often disappointing.
  
  
  OBJECTIVE
  1 To assess the efficacy and safety of combinations of hydroquinone, glycolic acid, and hyaluronic acid in the treatment of melasma after topical application. 2 To evaluate the dermoscopy as a tool in diagnosis and follow-up of melasma treatment.
  
  
  METHODS
  One hundred patients with mild, moderate-to-severe melasma were divided into five groups. Group I (twenty patients were treated with cream formula containing 4% hydroquinone), group II (twenty patients were treated with cream formula containing 4% hydroquinone + 10% glycolic acid), group III (twenty patients were treated with cream formula containing 4% hydroquinone + 0.01% hyaluronic acid), group IV (twenty patients were treated with cream formula containing 4% hydroquinone + 10% glycolic acid + 0.01% hyaluronic acid), and group V (twenty patients were treated with placebo cream). All patients were subjected to dermoscopic examination and digital photographs before and after treatment. The response and side effects were evaluated.
  
  
  RESULTS
  Groups I, III, and IV showed highly significant changes in modified Melasma Area and Severity Index (mMASI) score after using the treatment. Group II showed significant change in mMASI score after using the treatment. The side effects were more reported in group II, followed by group IV, followed by group I, followed by group III. There was highly significant difference between the dermoscopic color findings before and after treatment. Vascularization was another dermoscopic finding.
  
  
  CONCLUSIONS
  A cream formula containing 4% hydroquinone + 10% glycolic acid + 0.01% hyaluronic acid was very effective in treatment of melasma with tolerable side effects. Dermoscope is a valuable noninvasive tool in the diagnosis and follow-up of melasma treatment.
authors.affiliation: Dermatology and Venereology, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt.
authors.forename: Zeinab A
authors.initials: ZA
authors.lastname: Ibrahim
authors.affiliation: Dermatology and Venereology, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt.
authors.forename: Shereen F
authors.initials: SF
authors.lastname: Gheida
authors.affiliation: Pharmaceutical Technology, Faculty of Pharmacy, Tanta University, Tanta, Egypt.
authors.forename: Gamal M
authors.initials: GM
authors.lastname: El Maghraby
authors.affiliation: Dermatology and Venereology, Ministry of Health, El Mansora Hospital, Mansora, Egypt.
authors.forename: Zeinab E
authors.initials: ZE
authors.lastname: Farag
mesh_terms: D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D046169:Dermoscopy; D005260:Female; D006016:Glycolates / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D006873:Hydroquinones / Q000009:adverse effects / Q000627:therapeutic use*; D008548:Melanosis / Q000175:diagnosis / Q000188:drug therapy*; D063465:Skin Cream; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D006016:Glycolates; D006873:Hydroquinones; C031149:glycolic acid; D006820:Hyaluronic Acid; C031927:hydroquinone
keywords: dermoscope; glycolic acid; hyaluronic acid; hydroquinone; melasma