Topical silymarin versus combined topical silymarin and microneedling in treatment of melasma: split-face study

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Background Melasma is a common acquired pigmentary skin disease that is more predominant in females and darker skin types. Objectives To evaluate and to compare the efficacy and safety of topical silymarin alone and of combined topical silymarin and microneedling in the treatment of melasma. Patients and methods The study design was a split-face, right-left, randomized controlled trial, which was done on 30 adult patients with melasma. History taking and dermatological examination were done. Each side of the patient’s face was randomly (by closed envelop method) allocated to either topical silymarin 0.7% and microneedling or topical silymarin 0.7% alone. All patients were assessed monthly by hemi-Melasma Area and Severity Index (MASI) score hemi-modified Melasma Area and Severity Index (mMASI) score by comparing hemi-mMASI score throughout the 3-month treatment course, patient self-assessment scale, and Melasma Quality of Life Scale. Results There was an insignificant difference in the mean hemi-MASI and hemi-mMASI scores between both sides at each study point (P>0.05 for each). Mean hemi-MASI and hemi-mMASI scores showed significant (P<0.001 for each) steady reduction after treatment for both groups. Conclusions Both modalities of treatment can be used effectively and safely in the treatment of melasma.