Azelaic acid vs hydroquinone for melasma
Every row cites its source. Where a cell reflects our own reading of the evidence rather than an external source, the row says so.
The classic bleaching agent against its non-phenol challenger. The trials are real and old; the modern rankings put other agents first, and both facts render here.
| Aspect | Azelaic acid 20% | Hydroquinone | Source |
|---|---|---|---|
| Head-to-head vs 4% | 65% good or excellent, no significant differences, 329 women, 24 weeks, double-blind | Reference arm in the same trial | source |
| Head-to-head vs 2% | 73% good-to-excellent vs 19%: clear superiority, 155 patients | Low strength clearly inferior | source |
| Small open trial vs 4% | MASI 7.6 to 3.8 at 2 months, significant advantage; open design, 29 women | MASI 7.2 to 6.2 | source |
| Modern evidence rank | 8th of 14 melasma therapies in the 2021 network meta-analysis; not among 2019 strong recommendations | 13th of 14 in the same NMA ranking; triple combination cream (which contains hydroquinone) ranked 4th | source |
| Signature risk | No exogenous ochronosis or allergic sensitization observed in its largest trial; isolated hypopigmentation reports on labels | Exogenous ochronosis is hydroquinone's known long-term risk, which the azelaic trial explicitly checked for | source |
| Pregnancy posture | Recommended as baseline acne therapy in pregnancy; about 4% absorption | Singled out in a pregnancy-safety review for relatively high systemic absorption | source |