A comparative study of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women

Abstract

Objective To assess the efficacy and safety of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women. Topical 5% cysteamine is an antioxidant and tyrosinase inhibitor that has been shown to be effective in the treatment of melasma. However, to date, no study has compared the performance of topical cysteamine to hydroquinone for facial melasma. Methods A quasi-randomized, multicenter, evaluator-blinded clinical trial was conducted on 40 women with facial melasma who were submitted to the nightly application of 5% cysteamine (CYS) or 4% hydroquinone (HQ) on hyperpigmented areas for 120 days. Both groups were required to use tinted sunscreen (SPF 50; PPD 19). Subjects were assessed at the inclusion and after 60 and 120 days of treatment for mMASI, MELASQoL, and the difference in colorimetric luminosity between melasma and the adjacent unaffected skin. The Global Aesthetic Improvement Scale was used to assess the difference in the appearance of the skin through standardized photographs. Results The mean reduction of the mMASI scores was 24% for CYS and 41% for HQ (P = 0.015) at 60 days, and 38% for CYS and 53% for HQ (P = 0.017) at 120 days. The photographic evaluation revealed up to 74% improvement for both groups, without statistically significant difference between them (P = 0.087). The MELASQoL score showed a progressive decrease for both groups over time, despite the greater reduction for HQ after 120 days (P = 0.018). Colorimetric assessment disclosed progressive depigmenting in both groups, without statistically significant difference between them (P > 0.160). No severe adverse effects were identified in either group. Erythema and burning were the most important local adverse effects with cysteamine, although their frequency did not differ between groups (P > 0.170). Conclusion Cysteamine proved to be safe, well-tolerated, and effective, despite its inferior performance to hydroquinone in decreasing mMASI and MELASQoL in the treatment of melasma.

Efficacy and safety of topical isobutylamido thiazolyl resorcinol (Thiamidol) vs. 4% hydroquinone cream for facial melasma: an evaluator‐blinded, randomized controlled trial

“…epidermis, basement membrane and upper dermis), and Thiamidol should be further explored in combination with other treatments, such as oral tranexamic acid, antioxidants, lasers and microneedling, to maximize its benefits. [30][31][32][33][34] In conclusion, the melasma improvement achieved using 0.2% Thiamidol did not differ from that of 4% hydroquinone cream; Thiamidol has a safe profile with well-tolerated adverse effects. Thiamidol can be considered a suitable option for melasma patients with poor tolerability or treatment failure with 4% hydroquinone cream.…”

Comparison of the efficacy of cysteamine 5% cream and hydroquinone 4%/ascorbic acid 3% combination cream in the treatment of epidermal melasma

“…A few trials have evaluated the effect of cysteamine versus hydroquinone and the results have been controversial. [17][18][19] Lima et al 17 quasi-randomized trials found cysteamine effective in the treatment of melasma. Cysteamine reduced mMASI score, and colorimetric index, and improved quality of life.…”

Concerns on comparing drugs in dermatologic treatments from different suppliers

“…We demonstrated the proper efficacy and good tolerability of a Brazilian brand 5% cysteamine gel‐cream (Clarité Cysteamin; Dermage, São Paulo‐Brazil) for the treatment of melasma in women 1 . Table 1 presents the results of published trials on topical cysteamine in facial melasma; the clinical improvement ranged from 38 to 58% after 16 weeks of treatment, regardless of the supplier 2–6 …”