Combined use of 20% azelaic acid cream and 0.05% tretinoin cream in the topical treatment of melasma

The efficacy of the combination of 20% azelaic acid cream and 0.05% tretinoin cream in the treatment of melasma was compared with that of 20% azelaic acid cream alone in an open-label randomized study (n = 50). Over the 6-month treatment period both treatments yielded approximately 73% therapeutically meaningful (rated as ‘good’ or ‘excellent’) results. Tretinoin augmented the depigmenting effect of azelaic acid as shown by a faster response and a more pronounced improvement with the combination treatment during the first 3 months, and by a higher rate of excellent results at the end of therapy. Both treatment regimens were well tolerated, and no hypochromia, photosensitivity reactions or exogenous ochronosis were observed.