Combination of 20% Azelaic Acid Cream and 20% Salicylic Acid Peel Versus Azelaic Acid Cream Alone in the Treatment of Melasma Patients

Background and Objectives: Melasma is a common hyperpigmentation disorder affecting mainly the facial skin. The study aimed to evaluate the efficacy and safety of a combination therapy involving 20% Salicylic acid chemical peel and 20% Azelaic acid cream compared to Azelaic acid cream alone for the treatment of melasma. Methods: A comparative clinical trial done in Sulaymaniyah, Iraq, from October 2023 to March 2024, involved 40 melasma patients, they were split into Group A (Azelaic acid cream with Salicylic acid peel) and Group B (Azelaic acid cream only) for data collection and treatment interventions. Follow-up evaluations, including photographic assessments and modified Melasma Area and Severity Index scoring, were performed every two weeks to monitor melasma severity and treatment efficacy. Results: The majority of patients were females 34 (85%), with a mean age of 36.58 ± 6.20 years, predominantly having Fitzpatrick skin type IV. The Centro facial pattern was the commonest (90%). After treatment, Group A showed a more significant reduction in modified Melasma Area and Severity Index score from 7.70 ± 2.64 to 4.47 ± 2.38 (P<0.001) compared to Group B, which reduced from 7.87 ± 2.06 to 6.03 ± 1.97 (P<0.001). The epidermal type of melasma showed more responsiveness compared to dermal and mixed types. Conclusion: Treatment with 20% Azelaic acid alone or combined with 20% Salicylic acid peel effectively reduces modified Melasma Area and severity Index score in melasma patients; combination therapy shows better results and fewer side effects than Azelaic acid alone.