COMPARISON OF THE EFFICACY OF AZELAIC ACID 20% VERSUS GLYCOLIC ACID 12% IN PATIENTS WITH MELASMA

Abstract

Background: Melasma is commonly encountered acquired hyperpigmentation disorder, mainly affecting women, with a significant socio-psychological impact. Topical depigmenting agents continue to be the mainstay of therapy. Azelaic acid and glycolic acid are commonly used due to their good safety profiles, but there is limited evidence of their relative effectiveness. Objective: To assess the effectiveness of 20% azelaic acid and 12% glycolic acid in the treatment of melasma in the patients brought to the dermatology outpatient department. Duration and place of study: This study was conducted at Dermatology Department in PEMH (Pak Emirates Military Hospital) Rawalpindi after approval from ethnic committee. The duration Form 01 January to 31 May 2026. Methods: A randomized controlled trial in Department of Dermatology, a tertiary care hospital. 100 patients with clinically diagnosed melasma were randomly assigned to either topical 20% azelaic acid (n=50) or topical 12% glycolic acid (n=50), which were applied one a day for 12 weeks. Baseline demographic parameters and Melasma Area and Severity Index (MASI) were assessed and followed-up at 4, 8 and 12 weeks. Data was analyzed by SPSS version 26.0. Independent and paired t-tests were used and p≤0.05 was used as the cut-off for statistical significance. Results: Of the 100 patients, 92% were female, and 8% were male. The mean age was 34.7 ± 7.2 years. Baseline MASI scores were comparable between the two groups (p=0.68). After 12 weeks, the mean MASI score decreased from 12.6 ± 2.8 to 6.2 ± 1.9 in the azelaic acid group and from 12.4 ± 2.6 to 8.1 ± 2.3 in the glycolic acid group, representing reductions of 50.8% and 34.7%, respectively (p=0.003). Good-to-excellent clinical improvement was achieved in 76.0% of patients receiving azelaic acid compared with 54.0% receiving glycolic acid (p=0.02). Mild transient burning and erythema occurred in 10.0% and 18.0% of patients, respectively, without serious adverse events. Conclusion: Topical 20% azelaic acid was more effective than 12% glycolic acid in reduction in melasma severity and was safe. It can be used as a first-line topical therapy in patients suffering from melasma and may be considered as preferred.