We found no systematic review. We found one RCT, done between autumn and spring in Brazil
(48 people, four men; age range 19-55 years).26 Participating women were asked to use effective contraception during the trial. All participants had a clinical diagnosis of melasma with Wood's lamp evaluation. People using benzoyl peroxide, hydrogen peroxide or alcoholic cleansing agents were excluded. People suffering from alcohol or drug abuse, severe emotional problems, or irritation or wounds in the treatment area were also excluded. All participants received an SPF15 sunscreen. The intervention group received 4% hydroquinone cream applied twice daily, while the control group received placebo. Outcomes were assessed by subjective clinical evaluation and photography. After 12 weeks hydroquinone showed higher improvement rates (20/21 (95%) with hydroquinone versus 16/24 (67%) with placebo; RR 1-4, CI 1-06-1-9; NNT 3-5, CI 1-9-12-1). Total clearance of lesions was more frequent in people receiving hydroquinone (8/21 (38%) compared with placebo (2/24 (8%)) (RR 4-6, CI 1-1-19-2; NNT 3-4, CI 1-8-12-7). We found one RCT comparing hydroquinone with azelaic acid (see above).24
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