Efficacy of overnight leave-on sandwich therapy with 5% cysteamine and ectoine cream compared to hydroquinone 4% cream for treatment of melasmaKusumawardani, Arie (Avtor) Murasmita, Alamanda (Avtor) Rosmarwat, Ervina (Avtor) Ashadi, Lilik Norawati (Avtor) Setiawan, Silvia V. (Avtor) Nikolovska, Suzana (Avtor) Murlistyarini, Sinta (Avtor) Wahyu Fitriyani, Nurrahma (Avtor) cysteaminehydroquinonetherapeuticquality of lifemelasmaIntroduction: Melasma is a common hypermelanosis presenting as dark patches on sun-exposed skin. Its treatment remains challenging due to slow response, especially in chronic cases. This study compares the efficacy of 5% cysteamine with ectoine cream versus 4% hydroquinone with ectoine cream in treating melasma. Methods: A double-blind randomized controlled trial was conducted from January to March 2024 across three centers in Indonesia: Dr. Moewardi Hospital (Surakarta), Gatot Soebroto Army Hospital (Jakarta), and Dr. Saiful Anwar Hospital (Malang). Participants were randomly assigned to Group A (5% cysteamine + ectoine) or Group B (4% hydroquinone + ectoine). Efficacy was evaluated using the modified Melasma Area and Severity Index (mMASI) and the JANUS-I skin analyzer. Quality of life was assessed using Melasma Quality of Life Scale (MELASQoL) and Dermatology Life Quality Index (DLQI) questionnaires. Results: Both groups demonstrated reduced mMASI and JANUS-I scores, with slightly greater improvement in Group A, although the difference was not statistically significant (p > 0.05). Quality of living also improved in both groups, with no significant difference between them (p > 0.05). Conclusions: Both treatment regimens effectively improved melasma pigmentation and QoL. Either 5% cysteamine with ectoine or 4% hydroquinone with ectoine can be considered viable treatment options for melasma.Združenje slovenskih dermatovenerologov20252026-06-09 08:37:58Neznano29901slNa spletni strani revije navedeno: Acta Dermatovenerologica Alpina, Pannonica et Adriatica (ISSN 1318-4458) is an open access medical journal published quarterly by the Association of Slovenian Dermatovenerologists (https://acta-apa.mf.uni-lj.si/index.php); Authors publishing in our journal retain copyright of their work under the Creative Commons Attribution License (CC BY 4.0). This license allows unrestricted use, distribution, and reproduction of the work in any medium, provided the original author(s) and copyright holder(s) are appropriately credited, and the original publication in the journal is properly cited, following established academic practices (https://acta-apa.mf.uni-lj.si/submissions.php).