Evaluation of the Efficacy of a Serum Containing Niacinamide, Tranexamic Acid, Vitamin C, and Hydroxy Acid Compared to 4% Hydroquinone in the Management of Melasma.

Summary

In a randomized, investigator-blind trial (n=60), a niacinamide–tranexamic acid–vitamin C–hydroxy acids serum achieved comparable melasma improvement to 4% hydroquinone at 3–5 months. The serum showed better tolerability (less erythema) and superior skin hydration/barrier metrics, with significant QoL gains in both groups.

Key Findings

• Both groups had significant pigmentation reduction at 3 months (p<0.001).
• Higher erythema scores in the hydroquinone-first group; better hydration and barrier function with the serum.
• Quality of life improved significantly in both groups by day 84.
• Melanin density reduction by confocal reflectance microscopy was similar between regimens at 3 and 5 months.
• Serum B3 exhibited better local tolerability and cosmetic acceptability.

Clinical Implications

Consider multi-ingredient serum as first-line or maintenance therapy for melasma in patients intolerant to hydroquinone or where HQ use is restricted; monitor erythema and skin barrier metrics to tailor regimens.

Limitations

• Single-site study with modest sample size (n=60).
• Short-to-intermediate follow-up (3–5 months) without long-term relapse data.

Future Directions

Conduct multicenter, double-blind RCTs with longer follow-up and diverse skin phototypes to assess durability, relapse, and optimal sequencing/maintenance.