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This topical combination therapy consists of 30% metformin and 2% nicotinamide formulated as a lotion for the treatment of melasma. Metformin, traditionally an oral biguanide used for type 2 diabetes, is being investigated topically for its anti-melanogenic properties. It acts by activating AMP-activated protein kinase (AMPK), which subsequently downregulates the expression of key melanogenic enzymes such as tyrosinase. Nicotinamide (Vitamin B3) complements this action by inhibiting the transfer of melanosomes from melanocytes to keratinocytes. This specific formulation is being evaluated in investigator-led Phase 2 clinical trials by Ishtiaq Ahmed as a potentially safer and more tolerable alternative to the Kligman formula, which typically contains hydroquinone, tretinoin, and a corticosteroid.
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