Evaluating the efficacy of Terminalia chebula Retz. 5% cream compared to hydroquinone 2% cream in the treatment of melasma

Objective: Melasma is a multifactorial, chronic, acquired skin disorder of hyperpigmentation. Terminalia chebula Retz. (T. chebula) has shown antioxidant, anti-inflammatory and tyrosinase enzyme inhibitory activities. So, the present study was designed to evaluate the efficacy of T. chebula 5% cream compared to hydroquinone 2% cream in treating patients with melasma. Materials and Methods: The formulation of T. chebula 5% cream was prepared. The stability and release study of the cream were performed. In this randomized, controlled, triple-blind clinical trial, participants with facial melasma were randomly assigned to receive T. chebula 5% cream or hydroquinone 2% cream at bedtime for 12 weeks. Modified Melasma Area and Severity Index (mMASI) scores were recorded for all the participants at the baseline and 4, 8, and 12 weeks after initiating the study. Results: No statistically significant differences regarding mMASI scores were detected between T. chebula and hydroquinone groups at each time point. The reduction in mMASI scores was statistically significant (p<0.05) in T. chebula group 4, 8, and 12 weeks after initiating the study. However, it reached statistical significance (p<0.05) in hydroquinone group 8, and 12 weeks after the study initiation. The frequencies of side effects especially skin irritation were significantly (p<0.05) lower in T. chebula group. Conclusion: T. chebula 5% cream could be as effective as hydroquinone 2% cream in treating melasma with fewer side effects.