The treatment of melasma by silymarin cream

Patients were randomized in a double-blind manner to receive one treatment of the tested drugs; group I (G I) SM (7 mg/ml) cream, group II (G II) SM (14 mg/ml) cream, or group III (G III) placebo, applied topically to the affected areas, twice daily for 4 weeks, all advised to avoid sun exposure and to use topical sunscreen with sun protection factor (SPF) of 15+ during the entire period of treatment and thereafter. The patients were seen regularly every week for one month to assess; the response to treatment was rated by the size of lesions. Skin pigment evaluation by melasma area and severity index (MASI), physician global assessment (PGA) by an independent observer, and record the presence of any side effect. The Subjective assessment depending on recording improvement in patient satisfaction measures during the time course, and graded as follows: Grade 0 =not satisfied, Grade 1 =moderately or partially satisfied, Grade 2 =greatly but not fully satisfied, Grade 3 =fully or completely satisfied.