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Background  Recent data demonstrated that an altered basal membrane, activated melanocytes and secreted factors from keratinocytes but also fibroblasts and endothelial cells are involved in the pathophysiology of melasma.    Objectives  To evaluate the efficacy and tolerability on melasma of a new topical skin‐lightening cosmetic product combination ( CCP ) targeting several factors identified to be involved in melasma pathogenesis compared to 4% hydroquinone ( HQ ).    Methods  Forty‐three women with melasma were enrolled in a 12‐week double‐blind, randomized, parallel‐group trial and treated with  CCP  or 4%  HQ  cream. Efficacy was evaluated with the modified Melasma Area Severity Index (mMASI) score and colorimetric change. Cutaneous tolerability and patient satisfaction were also investigated.    Results  The  mMASI  score decreased for both products from baseline and over the study period. At week 12, 90% of the subjects who received the combination products had an improvement in pigmentation vs. 79% with  HQ . Similarly, both products significantly increased Individual Typological Angle parameters. For both measures, no statistically significant difference was observed between  CCP  and  HQ  in terms of change from baseline.  CPP  was very well tolerated.    Conclusions  Cosmetic product combination is as effective as  HQ  in the management of facial dyspigmentation and represents a safe alternative.

journal of the european academy of dermatology and venereology

Efficacy and tolerability on melasma of a topical cosmetic product acting on melanocytes, fibroblasts and endothelial cells: a randomized comparative trial against 4% hydroquinone