Main Article Content

Khadija Asadullah
Rabia Ghafoor
Parisa Sanawar
Nazia Jabeen
Faiza Inam Siddiqui
Misbah Qadir


Melasma, kligman formula, TAM formula, Melasma Area, Severity Index


Objective: Comparison of the efficacy of combination of TAM formula versus Kligman formula for melasma at Tertiary Care Hospital, Karachi.

Study design: Randomized controlled trail.

Place and duration of study: This study was conducted at Department of Dermatology, JPMC, Karachi from 1st January, 2022 till 31st January, 2023.

Material and methods: Data was prospectively collected from patients after taking consent. The sample size for the study was 122 patients, 61 in each group were included. Medical history, complete examination of skin and Melasma Area and Severity Index (MASI) Scores calculated before and after treatment to evaluate the change from baseline. Quantitative data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables was presented as frequency and percentages.

Results: The mean ages were 35.95 ± 7.17 years and 38.85 ± 7.80 years in Groups T and K, respectively. Both groups had a predominantly female distribution (98.4% in Group T, 88.5% in Group K). In terms of efficacy, TAM group demonstrated a higher response (98.4%) compared to Kligman group (90.2%). Over the eight weeks, group T and group K showed notable decrease in their mean MASI score, but group T has more better results.

Conclusion: In conclusion, the comparison between the TAM and Kligman formulas suggests that both have good efficacy and results in treating melasma patients, with TAM demonstrating more prominent decrease in mean MASI scores in a smaller time period and good patient satisfaction rates.  However, further studies are needed to evaluate the long term results and side effects of this new formula.

Abstract 120 | pdf Downloads 77


1. Fitton A, Goa KL. Azelaic acid: A review of its pharmacological properties and therapeutic efficacy in acne and hyperpigmentory skin disorders. Drugs. 1991;41:780–98.
2. Rigoni C, Toffolo P, Serri R, Caputo R. Use of a cream based 20% azelaic acid in the treatment of melasma. G Ital Dermatol Venerol. 1989;124:1–6.
3. Boissy RE, Visscher M, Delong MA. Deoxyarbutin: A novel reversible tyrosinase inhibitor with effective in vivo skin lightening potency. Exp Dermatol. 2005;14:601–8.
4. Espinal-Perez LE, Moncada B, Castanedo-Cazares JP. A double blind randomized trial of 5% ascorbic acid versus 4% hydroquinone in melasma. Int J Dermatol. 2004;43:604–7.
5. Kang WH, Chun SC, Lee S. Intermittent therapy for melasma in Asian patients with combined topical agents (retinoic acid, hydroquinone and hydrocortisone): Clinical and histological studies. J Dermatol. 1998;25:587–96.
6. Guevara IL, Pandya AG. Melasma treated with hydroquinone, tretinoin and a fluorinated steroid. Int J Dermatol. 2001;40:212–5.
7. Taylor SC, Torok H, Jones T, Lowe N, Rich P, Tschen E, et al. Efficacy and safety of a new triple combination agent for the treatment of facial melasma. Cutis. 2003;72:67–72.
8. Torok HM, Jones T, Rich P, Smith S, Tschen E. Hydroquinone 4%, tretinoin 0.05%, fluocinolone acetonide 0.01%: A safe and efficacious 12month treatment for melasma. Cutis. 2005;75:57–62.
9. Trelles MA. Velez M. Gold MH. The treatment of melasma with topical creams alone, CO2 fractional ablative resurfacing alone, or a combination of the two. A comparative study, J Drugs Dermatol 2010;9:315–22.
10. Ho SG, Chan HH. The Asian Dermatologic patient: Review of Common Pigmentary Disorders and Cutaneous Diseases. Am J Clin Dermatol 2009;10:153–68.
11. Halder RM, Richards GM. Management of dyschromias in ethnic skin. Dermatol Ther. 2004;17:151–7.
12. Ho WS, Chan HH, Ying SY, Chan PC, Burd A, King WW. Prospective Study on the Treatment of Postburn Hyperpigmentation. Lasers Surg Med. 2003;32:42–5.
13. Chang MW. In: Disorders of Hyperpigmentation. Dermatology. 2nd ed. Bolognia JI, Jorizzo JI, Rapini RP, editors. Mosby: 2008. pp. 939–64.
14. Desai SR, Alexis AF, Elbuluk N, Grimes PE, Weiss J, Hamzavi IH, Taylor SC. Best practices in the treatment of melasma with a focus on patients with skin of color. Journal of the American Academy of Dermatology. 2023 Sep 23.
15. Sarkar R, Handog EB, Das A, Bansal A, Macarayo MJ, Keshavmurthy V, Narayan V, Jagadeesan S, Pipo III E, Ibaviosa GM, Podder I. Topical and Systemic Therapies in Melasma: A Systematic Review. Indian Dermatology Online Journal. 2023 Nov 1;14(6):769-81.
16. Mpofana N, Chibi B, Visser T, Paulse M, Finlayson AJ, Ghuman S, Gqaleni N, Hussein AA, Dlova NC. Treatment of Melasma on Darker Skin Types: A Scoping Review. Cosmetics. 2023 Jan 27;10(1):25.
17. Bertold C, Fontas E, Singh T, Gastaut N, Ruitort S, Wehrlen Pugliese S, Passeron T. Efficacy and safety of a novel triple combination cream compared to Kligman's trio for melasma: A 24‐week double‐blind prospective randomized controlled trial. Journal of the European Academy of Dermatology and Venereology. 2023 Aug 24.
18. Mpofana N, Chibi B, Gqaleni N, Hussein A, Finlayson AJ, Kgarosi K, Dlova NC. Melasma in people with darker skin types: a scoping review protocol on prevalence, treatment options for melasma and impact on quality of life. Systematic Reviews. 2023 Aug 10;12(1):139.
19. Chang YF, Lee TL, Oyerinde O, Desai SR, Aljabban A, Bay CP, Bain PA, Chung HJ. Efficacy and safety of topical agents in the treatment of melasma: What's evidence? A systematic review and meta‐analysis. Journal of Cosmetic Dermatology. 2023 Apr;22(4):1168-76.

Most read articles by the same author(s)