The efficacy of combination of 20% azelaic acid with 0.05% tretinoin cream in the treatment of melasma

Background melasma is a common acquired macular hyperpigmentation which involves mostly the sun exposed areas of face and neck. objective to assess the efficacy of the combination of 20% azelaic acid with 0.05% tretinoin cream in the treatment of melasma. patients and methods 30 patients of melasma were treated with daily night application of 20% azelaic acid and 0.05% tretinoin. patients were assessed at 4, 8 and 12 weeks of treatment using melasma area severity index. side effects during therapy were also noted. results majority i.e. 43% cases were between 26 to 30 years, 73.3% of patients were females and 56.7% were housewives, 70% were married and 86.7% were in middle class. family history of melasma was positive in 66.7% cases. 93.3% patients had no history of systemic drug and 73.3% had no history of use of cosmetics. 93.3% of patients had malar area involvement and 6.7% had centrofacial area involvement. after treatment, the average masi score decreased by 38.66% indicating moderate reduction of the severity of melasma. burning sensation, itching and erythema developed in 50%, 30% and 16%, respectively. conclusion the combination of 20% azelaic acid and 0.05% tretinoin cream in the treatment of melasma has a moderate lightening effect with some remarkable side effects.