Silymarin may be alternative to hydroquinone for melasma

Silymarin cream may be an effective and tolerable alternative to hydroquinone in patients with melasma, according to a study.

“Hydroquinone is effective in melasma treatment, but side effects may limit its use,” Penpun Wattanakrai, MD, of Ramathibodi Hospital in Bangkok, and colleagues wrote. “Silymarin cream may be a safer alternative.”

The randomized, double-blind, split-face study compared silymarin 1.4% with hydroquinone 2% in epidermal or mixed-type melasma. The cohort included 25 Asian participants who were randomly assigned silymarin cream on one side of the face and hydroquinone on the other side for 3 months.

A colorimeter was used to assess treatment effects, with the results calculated by the relative lightness index (RL*I). Outcomes also included the modified Melasma Area and Severity Index (MASI) score and patient self-assessment.

The full treatment course was completed by 23 participants.

Findings as assessed by RL*I demonstrated no statistical difference between silymarin and hydroquinone. The differences from baseline in RL*I were significant for both groups, with silymarin yielding a 14.56% improvement and hydroquinone yielding a 12.82% improvement.

Similarly, both treatments yielded improvements as assessed by modified MASI score, a 17.97% statistically significant reduction for hydroquinone and a 7.11% reduction for silymarin. Again, there was no statistical difference between the two interventions.

Regarding patient assessment, hydroquinone had a 69.6% good-excellent rating for improvement and a visual analog scale (VAS) satisfaction score of 7.82.

By comparison, the good-excellent improvement rate for silymarin was 73.9%, while the VAS score was 7.65.

All reported adverse events were mild, with three participants treated with hydroquinone reporting side effects compared with two treated with silymarin.

“Although hydroquinone showed a better response, topical silymarin was effective in the treatment of epidermal and mixed-type melasma with fewer side effects,” the study authors wrote.