Efficacy of topical Raphanus sativus seed powder mixed with honey versus hydroquinone 4 % cream in the treatment of melasma – A randomized controlled trial

Melasma is a prevalent skin disorder affecting a wide range of populations. In Unani system of medicine, a traditional healing system with a rich historical background, there exists a repository of therapeutic modalities elucidated by esteemed scholars and practitioners. Despite its extensive utilization, the scientific substantiation supporting these interventions remains limited. This study aims to scientifically evaluate and compare the safety and efficacy of topically applied Raphanus sativus seed powder and honey mixture versus hydroquinone (4% w/w) cream for melasma treatment. In this 8-week open-label, randomized controlled trial, 40 participants (20 per group), aged 18-65 years and diagnosed with melasma, successfully completed the study. The test group applied finely powdered Raphanus sativus seeds mixed with honey twice daily, while the control group used hydroquinone (4% w/w) cream. Primary outcome measure was changes in modified Melasma Area and Severity Index ( mMASI ) at each follow-up. Secondary measures examined subjective nuances using a 100 mm visual analogue scale ( VAS ) and recorded the dermatology life quality index ( DLQI ) at baseline and the conclusion of the study. Safety was ensured through comprehensive clinical reviews, with documentation of adverse events during bi-weekly follow-ups. Following the conclusion of the study, the mean difference in the mMASI score between the test and control groups was –0.22 (95% CI: –0.75 to 0.30, d =0.27, p =0.394). Additionally, post-trial mean differences in VAS and DLQI scores between the test and control groups were determined as –5.25 (95% CI: –10.65 to –0.15, d =0.62, p =0.056) and –0.10 (95% CI: –1.53 to 1.33, d =0.04, p =0.888), respectively. Based on the investigative findings, the test intervention involving Raphanus sativus and honey demonstrated therapeutic efficacy statistically comparable to conventional hydroquinone treatment for managing melasma, with no reported adverse reactions. Moreover, both groups exhibited statistically comparable improvements in the dermatology life quality index.