20% azelaic acid cream in the topical treatment of melasma : a double-blind comparison with 2% hydroquinone

The efficacy of a 20% azelaic acid (AzA) cream in the treatment of epidermal and epidermo-dermal melasma was compared with that of a 2% hydroquinone (HQ) cream in a randomized, double-blind study involving 340 patients. Both treatments were used in conjunction with a broad-spectrum sunscreen. Over the 24-week treatment, period the 20% AzA cream (68.9% good and excellent results) proved to be significantly and substantially superior to the 2% HQ preparation (43.7% good and excellent results). This was further supported by significant differences in the classified percentage improvement and by the number of patients having achieved a bleaching of their melasma. Mild local side effects, in particular itching and burning sensations, were observed in about one third of the AzA patients. However, no serious adverse events, allergic sensitization, leukoderma or exogenous ochronosis were associated with the use of azelaic acid. In summary, it is concluded that 20% AzA cream may be considered an effective and safe, novel alternative in melasma therapy.