Safety and Feasibility of Compound Glycyrrhizin–Based Combination Therapy for Coexisting Facial Vitiligo and Melasma: A Real-World Retrospective Study

Zhengzhou Shi,* Yijian Zhu,* Qianqian Wang, Li Zhang, Suqing Liu, Min Jiang, Leihong Xiang Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Leihong Xiang, Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Urumqi Middle Road, Jing’an District, Shanghai, 200010, People’s Republic of China, Email [email protected]: The coexistence of vitiligo and melasma poses a therapeutic challenge, as interventions for one condition may adversely affect the other. Compound glycyrrhizin (CG), an immunomodulatory agent widely used in vitiligo management in China, has been explored in combination treatment strategies. However, data on its use in patients concurrently affected by melasma are limited.Methods: This retrospective analysis included 29 adults with facial non-segmental vitiligo and coexisting melasma who received oral CG for 12 months, in combination with topical tacrolimus and phototherapy using melasma shielding. Clinical parameters were evaluated using the Facial Vitiligo Area Scoring Index (F-VASI) and Melasma Area and Severity Index (MASI), along with standardized facial photography and serum chemokine profiling.Results: Among the 29 patients who underwent combination therapy, the mean baseline F-VASI was 0.99 ± 0.65, which decreased by 54.93% ± 19.99% over 12 months. Initial repigmentation was observed at a mean of 4.17 ± 1.26 months. Melasma severity remained largely stable throughout the treatment period (baseline MASI 16.51 ± 7.31 vs 15.97 ± 7.02 post-treatment). In parallel, serum CXCL10 and CCL20 levels showed a downward trend over time, coinciding with clinical improvement.Conclusion: In this retrospective real-world cohort, facial vitiligo improved during 12 months of CG-based combination therapy without apparent worsening of coexisting melasma. The regimen was well tolerated, with no severe adverse events. Controlled studies are needed to confirm efficacy and clarify the independent role of CG.Plain Language Summary: This retrospective real-world study evaluates the efficacy and safety of oral CG in patients with coexisting facial vitiligo and melasma.Significant repigmentation was achieved in vitiligo without worsening melasma severity, despite concurrent phototherapy.Serum CXCL10 and CCL20 levels decreased in parallel with vitiligo improvement, supporting an anti-inflammatory mechanism.CG was well tolerated, with no serious adverse events observed during 12-month follow-up.Findings support the potential of CG as a safe, integrative approach for managing complex pigmentary disorders.Keywords: vitiligo, melasma, compound glycyrrhizin, F-VASI, CXCL10, CCL20