Comparison of effectiveness and safety of topical 30% metformin versus 4% hydroquinone in the treatment of epidermal melasma
DOI:
https://doi.org/10.66344/jpad.34.1.2024.2748Keywords:
Epidermal, Melasma, Metformin, HydroquinoneAbstract
Objective To compare the effectiveness and safety of topical 30% metformin versus 4% hydroquinone in the treatment of epidermal melasma.
Methods The study was a randomized controlled trial conducted at Outpatient Department of Dermatology Unit II, Mayo Hospital Lahore over a duration of six months. A total of 62 patients were enrolled from the outpatient Dermatology department as per inclusion and exclusion criteria. Two equal groups were formed randomly by lottery system, as group A and group B. In Group-A patients were advised to apply 30% Metformin cream over the affected area on the face at night and sunscreen of SPF 30 in the morning for a period of 12 weeks and in Group-B patients were advised to apply 4% Hydroquinone cream over the affected area on the face at night and sunscreen of SPF 30 in the morning for 12 weeks. Patients were asked to come for follow-up every 4 weeks till completion of the treatment (till 12 weeks) and last follow up was done one month after the last treatment session (at 16th week). All patients’ photographs were taken before and after starting the therapy. MASI score for all patients was calculated at each visit. Percentage of improvement was calculated by deducting MASI score from pretreatment MASI score and dividing it by post-treatment MASI score.
Results Mean age of patients in Group-A and B was 41.29±13.01 years and 36.16±11.46 years. Among these patients 16 (25.81%) were male and 46 (74.19%) were female. The male to female ratio was 2:6. Mean percentage reduction in MASI score in Group-A and B was 60.28±14.04 and 55.02±13.35, respectively. As per efficacy criteria patients treated with metformin had higher efficacy as compared to patients treated with hydroquinone. i.e. Group-A: 80.6% vs. Group-B: 58.1%, p-value=0.054. No significant difference was seen for hypopigmentation and swelling between both groups from 1st month till 4th month follow up post treatment.
Conclusion The present study showed that 30% topical metformin is more effective and safe as compared to 4% hydroquinone in the treatment of epidermal melasma.
References
1. Roerden A, Neunhoeffer F, Götz A, Häfner HM, Kofler L. Benefits, safety and side effects of tumescent local anesthesia in dermatologic surgery in infants. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2021;19(3):352-7.
2. Glick M. Burket's oral medicine: PMPH USA; 2015.
3. Pirie K, Traer E, Finniss D, Myles PS, Riedel B. Current approaches to acute postoperative pain management after major abdominal surgery: a narrative review and future directions. Br J Anaesth. 2022; 129(3):378-93.
4. Patel J, Otto E, Taylor JS, Mostow EN, Vidimos A, Lucas J, et al. Patient safety in dermatology: a ten-year update. Dermatol Online J. 2021;27(3):13030/qt9cp0t2wt.
5. Sadhasivam S, Chidambaran V, Ngamprasertwong P, Esslinger HR, Prows C, Zhang X, et al. Race and unequal burden of perioperative pain and opioid related adverse effects in children. Pediatrics. 2012;129(5):832-8.
6. McCleskey PE, Patel SM, Mansalis KA, Elam AL, Kinsley TR. Serum lidocaine levels and cutaneous side effects after application of 23% lidocaine 7% tetracaine ointment to the face. Dermatol Surg. 2013;39(1pt1):82-91.
7. Alster T. Review of lidocaine/tetracaine cream as a topical anesthetic for dermatologic laser procedures. Pain and Therapy. 2013;2(1):11-9.
8. Franchi M, Cromi A, Scarperi S, Gaudino F, Siesto G, Ghezzi F. Comparison between lidocaine-prilocaine cream (EMLA) and mepivacaine infiltration for pain relief during perineal repair after childbirth: a randomized trial. Am J Obstet Gynecol. 2009;201(2):186;e1-e5.
9. Eidelman A, Weiss JM, Enu IK, Lau J, Carr DB. Comparative efficacy and costs of various topical anesthetics for repair of dermal lacerations: a systematic review of randomized, controlled trials. J Clin Anesth. 2005;17(2):106-16.
10. Kouba DJ, LoPiccolo MC, Alam M, Bordeaux JS, Cohen B, Hanke CW, et al. Guidelines for the use of local anesthesia in office-based dermatologic surgery. J Am Acad Dermatol. 2016;74(6):1201-19.
11. Lee EJ, Khandwala M, Jones CA. A randomised controlled trial to compare patient satisfaction with two different types of local anaesthesia in ptosis surgery. Orbit. 2009;28(6):388-91.
12. Wong N, Godinez-Puig V, Makdisi J, Zloty D, Kossintseva I. Interpolation flaps in the outpatient Mohs surgery setting: a prospective cohort study of patient pain, anxiety, and satisfaction. Dermatol Surg. 2021;47(1):24-9.
13. Eckardt J, Häfner HM, Kofler K, Mroz G, Scheu A, Schulz C, Kofler L. Post‐ operative follow‐up of 150 patients with sentinel lymph node biopsy under tumescence local anesthesia. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2021;19(4):536-43.
14. Liu Y, Lyengar S, Schmults CD, Ruiz ES, Besaw R, Tom LK, et al. Tumescent Local Anesthesia: A Systematic Review of Outcomes. medRxiv.
doi: https://doi.org/10.1101/2020.08.10.20170720
15. McKnight KN, Smith VJ, MacFadden LN, Chong AC, Van Demark Jr RE. Wide- Awake Hand Surgery Has Its Benefits: A Study of 1,011 Patients. J Hand Surg Global Online. 2022;4(6):394-8.
16. Bolletta A, Dessy LA, Fiorot L, Tronci A, Rusciani A, Ciudad P, Trignano E. Sub- muscular breast augmentation using tumescent local anesthesia. Aesthet Plast Surg. 2019;43:7-13.
17. Schnabl SM, Garbe C, Breuninger H, Walter V, Aebischer V, Eckardt J, et al. Risk analysis of systemic side effects of tumescent local anaesthesia in the surgical treatment of geriatric and multimorbid patients with skin cancer. J Eur Acad Dermatol Venereol. 2023;37(1):65-74.
18. Imamura T, Nakamura Y, Tanaka R, Teramoto Y, Asami Y, Maruyama H, et al. Cutaneous surgery under local anesthesia in very elderly patients 90 years of age and older is as safe as in elderly patients ranging in age from 75 to 80 years old. Int J Dermatol. 2017;56(6):681-5.
19. Brewer JD, Roenigk RK. Tumescent anesthesia as an aid for wide local excision in dermatologic surgery. Surg Cosmet Dermatol. 2010;2(2):140-3.
20. Häfner HM, Röcken M, Breuninger H. Epinephrine‐supplemented local anesthetics for ear and nose surgery: Clinical use without complications in more than 10,000 surgical procedures: Lokalanästhetika mit Adrenalinzusatz an Ohr und Nase–Klinische Erfahrungen über die unbedenkliche Anwendung an über 10000 operativen Eingriffen. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2005;3(3):195-9.
21. Hung W-Y, Tung C-C, Fang W-Y, Kao W-P, Lin S-L, Poon Y, Chao W-N. Free flap transfer for head and neck reconstruction using local anesthesia in elderly patients. Ann Plast Surg. 2018;80(2S):S30-S5.
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Copyright (c) 2024 Abid Hussain, Usama Shahbaz, Eima Shaheen, Aisha Ghias, Raffad, Amna Khalid, Shahbaz Aman
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