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ketotifen + metformin is a topical combination therapy consisting of ketotifen and metformin nanoparticles currently being investigated for the treatment of melasma. Metformin, a biguanide typically used for diabetes, has shown melanopenic (depigmenting) properties when applied topically by activating AMP-activated protein kinase (AMPK), which leads to the inhibition of melanogenesis. Ketotifen is a second-generation H1-antihistamine and mast cell stabilizer; its inclusion in melasma treatment is based on the role of mast cells and histamine in stimulating melanocyte activity and promoting hyperpigmentation. This combination is being evaluated in a split-face randomized clinical trial (NCT06942390) by Assiut University, often in conjunction with microneedling to enhance skin penetration and efficacy.
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