Background: Melasma is a common acquired pigmentary disorder with significant cosmetic and psychosocial implications, particularly in individuals with darker skin types. Topical therapies are the mainstay of treatment; however, comparative data on their efficacy in North Indian populations remain limited. Objectives: To evaluate and compare the efficacy and safety of commonly used topical therapies in the management of melasma among North Indian patients. Methods: This prospective observational study was conducted in a tertiary care hospital in North India from March 2022 to November 2022. A total of 124 patients with clinically diagnosed melasma were enrolled and allocated to three treatment groups: hydroquinone, azelaic acid, and triple combination therapy. Clinical assessment was performed using the Melasma Area and Severity Index (MASI) at baseline and at 4, 8, and 12 weeks. Statistical analysis was conducted using SPSS version 20.0, with a p-value <0.05 considered significant. Results: The majority of participants were females (77.4%), with the highest prevalence in the 31–40 years age group. Centrofacial melasma was the most common pattern observed. All treatment groups demonstrated a progressive reduction in MASI scores over 12 weeks. Triple combination therapy showed the greatest mean reduction, followed by hydroquinone and azelaic acid, with statistically significant differences between groups (p < 0.05). Adverse effects were more frequent in the triple combination group but were generally mild and did not require discontinuation of therapy. Conclusion: Triple combination therapy is more effective than monotherapy in the treatment of melasma but is associated with a higher incidence of mild adverse effects. Individualized treatment selection and adherence to photoprotection are essential for optimal outcomes.

Melasma; Topical therapy; Hydroquinone; Azelaic acid; Triple combination; MASI score; North India