Comparative efficacy of topical 4% hydroquinone vs. 4% hydroquinone plus 10% mandelic acid in the treatment of melasma


  • Sadia Majeed
  • Nasir Mahmood
  • Saeed Ahmed


Melasma, hydroquinone, 10% mandelic acid serum, sunscreen


Objective To compare the efficacy of topical 4% hydroquinone with combination of 4% hydroquinone and 10% mandelic acid serum in the treatment of melasma. Methods This comparative study was conducted from 1st June, 2017 to 31st December, 2017 at dermatology outpatient (OPD). The trial included 100 patients age ranging from 16 to 50 years, having facial melasma. Patients were randomized to receive topical 4% hydroquinone (group I) or 4% hydroquinone along with 10% mandelic acid (group II). Efficacy was determined at week 24. Results Both groups showed improvement in melasma; however, group II showed better results. At final follow-up, 50% patients in group II showed a response of >50%; however, in group I, only 20% patients showed >50% response. Conclusion The combination of 4% hydroquinone with 10% mandelic acid is more effective in melasma as compared to conventional topical treatment. 


Ogbechie-Godec OA, Elbuluk N. Melasma: an Up-to-Date Comprehensive Review. Dermatol Ther (Heidelb). 2017;7:305-18.

Guinot C, Cheffai S, Latreille J, Dhaoui MA, Yousef S, Jaber K et al. Aggravating factors for melasma: a prospective study in 197 Tunisian patients. J Eur Acad Dermatol Venereol. 2010;24:1060-9.

Tamega Ade A, Miot LD, Bonfietti C, Gige TC, Marques ME, Miot HA. Clinical patterns and epidemiological characteristics of facial melasma in Brazilian women. J Eur Acad Dermatol Venereol. 2013;27:151-6.

Hexsel D, Lacerda DA, Cacalcante AS, Machado Filho CA, Kalil CL, Ayres EL et al. Epidemiology of melasma in Brazilian patients: a multicenter study. Int J Dermatol. 2014;53:440-4.

Achar A, Rathi SK. Melasma: A clinic-epidemiological study of 312 cases. Indian J Dermatol. 2011;56:380-2.

Rivas S, Pandya AG. Treatment of melasma with topical agents, peels and lasers: an evidence-based review. Am J Clin Dermatol. 2013;14:359-76.

Abou-Taleb DA, Ibrahim AK, Youssef EM, Moubasher AE. Reliability, Validity, and Sensitivity to Change Overtime of the Modified Melasma Area and Severity Index Score. Dermatol Surg. 2017;43:210-7.

Monteiro RC, Kishore BN, Bhat RM, Sukumar D, Martis J, Ganesh HK. A comparative study of the efficacy of 4% hydroquinone vs 0.75% kojic acid cream in the treatment of facial melasma. Indian J Dermatol. 2013;58:157.

Sarkar R, Grag V, Bansal S, Sethi S, Gupta C. Comparative evaluation of efficacy and tolerability of glycolic acid, salicylic acid, mandelic acid, and phytic acid combination peels in melasma. Dermatol Surg. 2016;42:384-91.

Castanedo-Cazares JP, Hernandez-Blanco D, Carlos-Ortega B, Fuentes-Ahumada C, Torres-Alvarez B. Near-visible light and UV photoprotection in the treatment of melasma: a double-blind randomized trial. Photodermatol Photoimmunol Photomed. 2014;30:35-42.

Tung RC, Bergfeld WF, Vidimos AT, Remzi BK. Alpha-hydroxy acid-based cosmetic procedures. Guidelines for patient management. Am J Clin Dermatol. 2000;1(2):81-8.




How to Cite

Majeed S, Mahmood N, Ahmed S. Comparative efficacy of topical 4% hydroquinone vs. 4% hydroquinone plus 10% mandelic acid in the treatment of melasma. J Pak Assoc Dermatol [Internet]. 2018Dec.13 [cited 2024Jun.17];28(3):311-4. Available from:



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