COMPARATIVE STUDY OF 1%TURMERIC, 1% KOJIC ACID, 5% VITAMIN C COMBINED CREAM VS KLIGMAN'S FORMULA CREAM (4% HYDROQUINONE, 0.05% TRETINOIN, 0.01% FLUOCINOLONE ACETONIDE) FOR POST-ACNE HYPERPIGMENTATION IN THAI PATIENTS: A SPLIT-FACE CLINICAL TRIAL

Abstract

Acne-induced post-inflammatory hyperpigmentation (PIH) significantly impacts the quality of life in patients with darker skin phototypes (Fitzpatrick IV–VI). While Kligman's formula (4% hydroquinone, 0.05% tretinoin, 0.01% fluocinolone acetonide) remains the gold standard, its irritating potential can limit long-term use. This prospective, randomized, double-blinded, split-face trial evaluated the clinical efficacy, safety, and tolerability of a novel combination cream containing (1% turmeric, 1% kojic acid, and 5% vitamin C) versus Kligman's cream for the treatment of acne-induced hyperpigmentation in 18 Thai patients (Fitzpatrick skin types III–VI) over 12 weeks. Outcomes were assessed using the Post-Acne Hyperpigmentation Index (PAHPI), Mexameter® MX 18 melanin index (MI), patient satisfaction scores (quartile grading scale), and side-effect monitoring at weeks 0, 4, 8, and 12. Both treatments significantly reduced PAHPI scores (p < 0.001). At week 12, Kligman’s cream demonstrated greater overall clinical efficacy (PAHPI reduction of 26.40% vs. 18.62%). However, in Week 4, the intervention cream achieved significantly greater early melanin suppression, indicated by a larger reduction in MI (97.32 vs. 39.90 reduction, p = 0.021), even though Kligman’s cream maintained a higher overall reduction in PAHPI. Notably, the interventional cream showed an exceptional safety profile with zero adverse events, whereas Kligman’s cream caused transient peeling (72.2%), burning, and erythema. These findings suggest that the novel combination cream is a safe, effective alternative for PIH, offering an advantage in rapid melanin reduction and superior tolerability for long-term maintenance.