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Trial registered on ANZCTR
Registration number
ACTRN12622000522718p
Ethics application status
Not yet submitted
Date submitted
20/03/2022
Date registered
1/04/2022
Date last updated
17/04/2023
Date data sharing statement initially provided
1/04/2022
Type of registration
Prospectively registered
Titles & IDs
Public title
Comparison of the efficacy of two triple therapy topical combinations in the treatment of melasma
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Scientific title
Comparison of the efficacy of two triple therapy topical combinations in the treatment of melasma in adults
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Secondary ID [1]
306255
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None
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Melasma
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Condition category
Condition code
Skin
323018
323018
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0
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Dermatological conditions
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Combination topical therapy of:
1. Thiamidol 100g
2. Retinoic acid 0.05%, 0.1g
3. Dexamethasone acetate 0.1%, 0.1g
Patients will be instructed to apply a pea-sized (approximately 2mL) amount of the combination product across their entire face every night for 12 consecutive weeks. Patients will also be instructed to apply a teaspoon amount of SPF 50 sunscreen 3 times a day for the same treatment period as well as 12 weeks after cessation of the combination therapy while the skin is expected to remain photosensitive due to the residual effects of treatment.
Medication adherence will be evaluated at the end of the 12-week treatment period by assessing the amount of remaining product.
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Intervention code [1]
323149
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Treatment: Drugs
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Comparator / control treatment
Combination topical therapy of:
1. Hydroquinone 5%, 5g
2. Retinoic acid 0.1%, 0.1g
3. Dexamethasone acetate 0.1%, 0.1g
4. Excipial hydro 100g
This combination is commonly referred to as the 'Kligman's Trio' or 'Kligman's formula' and is the current gold standard treatment for melasma. Patients will be instructed to apply a pea-sized (approximately 2mL) amount of the combination product across their entire face every night for 12 consecutive weeks. Patients will also be instructed to apply a teaspoon amount of SPF 50 sunscreen 3 times a day for the same treatment period as well as 12 weeks after cessation of the combination therapy while the skin is expected to remain photosensitive due to the residual effects of treatment.
Medication adherence will be evaluated at the end of the 12-week treatment period by assessing the amount of remaining product.
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Control group
Active
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Outcomes
Primary outcome [1]
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Treatment efficacy, measured using the modified melasma area and severity index (mMASI) score.
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Assessment method [1]
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Timepoint [1]
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Assessed after 12 weeks of treatment (week 12) and 12 weeks after treatment cessation (week 24), comparing to mMASI score at baseline (measured at week 0).
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Secondary outcome [1]
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Tolerance, as assessed using a visual scale ranging from 0 to 10 quantifying the degree of erythema, dry skin, irritation and flaking. The component scores will be assessed as a composite outcome.
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Assessment method [1]
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Timepoint [1]
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Assessed after 12 weeks of treatment (week 12) and 12 weeks after treatment cessation (week 24).
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Secondary outcome [2]
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Effectiveness, measured by colorimetric evaluation of skin pigmentation changes in lesional and perilesional skin. A mexameter will be used for this.
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Assessment method [2]
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Timepoint [2]
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Assessed after 12 weeks of treatment (week 12), and 12 weeks after cessation of treatment (week 24), comparing to colorimetry score at baseline (measured at week 0).
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Secondary outcome [3]
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Quality of life, as assessed using the Melasma Quality of Life (MELASQOL) self-questionnaire.
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Assessment method [3]
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Timepoint [3]
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Assessed after 12 weeks of treatment (week 12), and 12 weeks after cessation of treatment (week 24), comparing to MELASQOL score at baseline (measured at week 0).
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Secondary outcome [4]
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Overall patient perception of products, as evaluated through the question "have the products you have used to improve your melasma reduced its severity" with a 5-point Likert scale answer option ranging from strongly agree to strongly disagree.
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Assessment method [4]
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Timepoint [4]
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Assessed after 12 weeks of treatment (week 12).
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Eligibility
Key inclusion criteria
- Patient clinically diagnosed with melasma
- If patient is of childbearing age, she will be required to use a reliable contraceptive for at least 1 month and agree not to change her contraceptive status for the duration of the study
- Patient who has signed the written informed consent form for study participation
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
- Women who are pregnant or breast-feeding or who are planning for pregnancy during the course of the study. (A urine b-HCG or urine dipstick test will be performed)
- Patient with another pigmentation disorder on the face.
- Patient with other dermatoses that may interfere with the evaluation or application of the products involved in the study.
- Patient who has used a depigmentation agent in the month prior to inclusion.
- Patient who has used a local corticosteroid on the skin, eyes, nose or mouth (inhaled corticosteroid) or systemic corticosteroids during the month prior to inclusion.
- Patient who has used local tretinoin or hydroquinone in the month prior to inclusion.
- Patient on chronic anti-inflammatory therapies (patient accepted into study if cumulative NSAID use is less than 10 days over the duration of the study).
- Patient with a clinically significant history of allergy, especially to the components of the products studied.
- Vulnerable persons including people under the age of 18 and those who are unable to take care of or protect themselves against harm or exploitation.
- Patient being in a situation that, in the investigator's opinion, may interfere with optimal participation in the study.
- Patient who is participating or has participated in another clinical drug trial in the month prior to inclusion.
- Patient who cannot communicate effectively with the investigator or who cannot follow the instructions involved in the study.
- Patient who is refusing to be photographed as part of the study.
- Patient who withdraws their informed consent from the study.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation will take place at the off-site Atara compounding pharmacy.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using a randomisation table created by computer software.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 1
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/08/2023
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Actual
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Date of last participant enrolment
Anticipated
1/10/2023
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
20
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Funding & Sponsors
Funding source category [1]
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Self funded/Unfunded
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Name [1]
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Michelle Rodrigues
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Address [1]
310603
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Chroma Dermatology: Ground Floor, suite 15/202 Jells Rd, Wheelers Hill VIC 3150
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Country [1]
310603
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Australia
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Primary sponsor type
Individual
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Name
Michelle Rodrigues
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Address
Chroma Dermatology: Ground Floor, suite 15/202 Jells Rd, Wheelers Hill VIC 3150
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
311796
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Country [1]
311796
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
310208
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Bellberry Limited
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Ethics committee address [1]
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123 Glen Osmond Road Eastwood Adelaide South Australia 5063
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Ethics committee country [1]
310208
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Australia
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Date submitted for ethics approval [1]
310208
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10/01/2022
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Approval date [1]
310208
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Ethics approval number [1]
310208
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Summary
Brief summary
Melasma is a common disorder of hyperpigmentation, primarily affecting the face. It can affect all racial types but predominately affects women with darker skin types. The exact cause of melasma is unknown, but it is thought to be due to many things including pregnancy, hormonal contraception, and sunlight. Melasma can be very difficult to treat and often frustrating for the patient and doctor with evidence showing that it may adversely affect quality of life. The standard topical treatment for melasma that has been used since the 1970’s, is a combination agent including hydroquinone 5%, retinoic acid 0.1% and dexamethasone acetate 0.1% (commonly called “Kligman’s Trio”). Although this treatment is effective, it frequently causes skin irritation, and the hydroquinone is largely responsible for this. Hydroquinone also carries a risk of causing skin discolouration with long-term use. Thiamidol, like hydroquinone, is a depigmentation agent. Recent studies showed that thiamidol was better than hydroquinone in treating melasma while causing fewer side effects (Arrowitz et al, Journal of Investigative Dermatology, 2019). Replacing hydroquinone with thiamidol in this readily prescribed depigmentation formula has never been studied. Therefore, this study aims to determine if topical thiamidol + retinoic acid + dexamethasone acetate combination treats melasma as well as the standard Kligman's Trio.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Michelle Rodrigues
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Address
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Chroma Dermatology: Ground Floor, suite 15/202 Jells Rd, Wheelers Hill VIC 3150
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Country
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Australia
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Phone
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+61 3 85606946
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Michelle Rodrigues
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Address
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Chroma Dermatology: Ground Floor, suite 15/202 Jells Rd, Wheelers Hill VIC 3150
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Country
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Australia
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Phone
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+61 3 85606946
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Michelle Rodrigues
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Address
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Chroma Dermatology: Ground Floor, suite 15/202 Jells Rd, Wheelers Hill VIC 3150
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Country
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Australia
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Phone
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+61 3 85606946
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Fax
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Email
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
15448
Study protocol
383452-(Uploaded-17-03-2022-00-13-37)-Study-related document.docx
15449
Informed consent form
383452-(Uploaded-17-03-2022-00-13-50)-Study-related document.docx
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF