A Double-Blind, Randomized Clinical Trial of Niacinamide 4% versus Hydroquinone 4% in the Treatment of Melasma

Abstract

Background. Multiple modalities have been used in the treatment of melasma with variable success. Niacinamide has anti-inflammatory properties and is able to decrease the transfer of melanosomes. Objective. To evaluate the therapeutic effect of topical niacinamide versus hydroquinone (HQ) in melasma patients. Patients and Methods. Twenty-seven melasma patients were randomized to receive for eight weeks 4% niacinamide cream on one side of the face, and 4% HQ cream on the other. Sunscreen was applied along the observation period. They were assessed by noninvasive techniques for the evaluation of skin color, as well as subjective scales and histological sections initially and after the treatment with niacinamide. Results. All patients showed pigment improvement with both treatments. Colorimetric measures did not show statistical differences between both sides. However, good to excellent improvement was observed with niacinamide in 44% of patients, compared to 55% with HQ. Niacinamide reduced importantly the mast cell infiltrate and showed improvement of solar elastosis in melasma skin. Side effects were present in 18% with niacinamide versus 29% with HQ. Conclusion. Niacinamide induces a decrease in pigmentation, inflammatory infiltrate, and solar elastosis. Niacinamide is a safe and effective therapeutic agent for this condition.

Use of Redness Assessment in Melasma Lesions in Skin Whitening Evaluation

“…Skin color of UVB-induced pigmentation was brighter in glabridin group than control group, and UVB-induced erythema was reduced compared to control in vivo [20]. In another study, the value of a * was reported to have no significant difference even though the values of L * changed considerably [11]. So, we suggest that the combination of niacinamide and G. glabra provides the synergy on improvement of brightness and redness, and the difference with the previous study comes from different study conditions such as concentration, skin type and comparison method.…”

“…A few agents include niacinamide and plant extracts has various effects on skin [11,12]. Previously, a study has shown that niacinamide inhibits melanosome transfer, suggesting that it reduces melasma [12].…”

Melasma, Novel Treatment Modalities

“…Niacinamide reduced the mast cell infiltrate and showed improvement of solar elastosis in melasma skin. Side effects were present in 18% with niacinamide versus 29% with hydroquinone [41].…”

“…It also increases biosynthesis of ceramides, as well as other stratum corneum lipids with enhanced epidermal permeability barrier function. Moreover, it has antiaging effects [41].…”

Treatment modalities for hyperpigmented skin lesions: A brief overview

“…Hakozaki et al demonstrated in vitro that niacinamide exhibited effective skin-lightening activity by inhibiting the transfer of melanosomes to adjacent keratinocytes by 35%-68% [18,19] . In a clinical study, Navarrete-Solís et al reported that 8 weeks of treatment with 4% niacinamide cream showed good to excellent improvement in 44% of patients with melasma, compared to 55% from a 4% hydroquinone cream treatment [20] .…”