Assessment of clinical efficacy of different concentrations of topical ascorbic acid formulations in the treatment of melasma

Background Several methods of treatment are available for patients with melasma but none are satisfactory. Ascorbic acid is used for the treatment of various skin problems. However, ascorbic acid has limited stability and permeability, and development of ascorbic acid derivatives with improved properties is needed. Objective The aim of the study was to assess the clinical efficacy and safety of different concentrations of ascorbic acid cream in the treatment of melasma. Patients and methods This study included 40 patients with different clinical varieties of melasma, such as centrofacial and malar. The patients were divided equally into four groups: groups I, II, III, and IV. The first three groups were treated with different concentrations of ascorbic acid cream (5, 10, and 25%), whereas the fourth group were treated with topical placebo and served as the control group. Melasma was evaluated with modified melasma area and severity index and patients were followed up for a period of 6 months. Results Significant improvement in melasma (reduction in modified melasma area and severity index score) was observed with all ascorbic acid preparations in comparison with the control group, which showed no response. Group III treated with 25% ascorbic acid gave the best results, followed by the group treated with 10% ascorbic acid and the group treated with 5% ascorbic acid; however, there were nonstatistically significant differences between the three groups. The patients with epidermal melasma showed better response than those with mixed and dermal types. Conclusion Ascorbic acid topical formulations can effectively treat melasma especially with 10 and 25% concentration with minimum and tolerable adverse effects.