Table 3.

Randomized clinical trials conducted to compare hydroquinone as the standard treatment with other topical alternative treatments

Comparison groups	Outcome(s)	Author conclusions	References
1 – Hydroquinone 4% cream 2 – 1% flutamide cream	1 – Patient satisfaction 2 – MASI 3 – Mexameter melanin assay	Comparable efficacy in objective assessments but higher patient satisfaction for 1% flutamide cream	Present study
1 – Hydroquinone 4% cream 2 – 3% Rubus occidentalis cream	Patient satisfaction	Occidentalis 3% cream is a safe and effective skin-lightening agent for melasma and is comparable in efficacy with 4% hydroquinone cream	25
1 – Hydroquinone 4% cream 2 – Kojic acid cream (0.75% kojic acid and 2.5% vitamin C)	MASI	Kojic acid cream found to be less effective than hydroquinone 4% cream	26
1 – Hydroquinone 4% cream 2 – Zinc sulfate 10% solution	MASI	Zinc sulfate 10% solution found to be less effective than hydroquinone 4% cream	27
1 – Hydroquinone 4% cream 2 – Azelaic acid cream	MASI	20% Azelaic acid cream applied twice daily may be more effective than hydroquinone 4% in reducing mild melasma	28
1 – Hydroquinone 4% on one side of the face 2 – Niacinamide cream on other side of the face	1 – Colorimetric measures 2 – Histological sections	Generally, similar efficacy but proportion of good to excellent improvement higher for hydroquinone	29
1 – Hydroquinone 2% cream as priming agent 2 weeks before peeling with glycolic acid 2 – Tretinoin and 0.025% cream as priming agent 2 weeks before peeling with glycolic acid	MASI	Results are better with hydroquinone as priming agent compared to tretinoin in enhancing the results with glycolic acid peels in melasma and in decreasing postpeel postinflammatory hyperpigmentation	30
1 – Hydroquinone 4% cream 2 – A triple combination (TC) cream	Static global severity assessment of melasma	Was more effective than the hydroquinone cream for the treatment of moderate-to-severe facial melasma	31
1 – Hydroquinone 5% cream on one side of the face 2 – Ascorbic acid cream on other side of the face	1 – Colorimetry 2 – Digital photography and regular color slides	Hydroquinone showed a better response than ascorbic acid	32

Abbreviation: MASI, Melasma Area and Severity Index.