Efficacy of a Polyherbal Syrup Containing Lemon Balm, Damask Rose, and Fennel to Treat Melasma: A Randomized, Triple - Blind, Controlled Clinical Trial

Background: Melasma is an acquired pigmentary disorder that typically affects sun - exposed areas of the skin. Due to the challenges of conventional medicines, many dermatologic patients skew toward complementary and alternative medicine (CAM). Herbal medicine, as the most popular modality of CAM, is an invaluable approach to finding treatments for dermatologic diseases. Objectives: The purpose of this study was to assess the effectiveness of a multi - herbal syrup, which included lemon balm, damask rose, and fennel, in patients with melasma. Methods: This study was designed as a randomized, triple - blind, placebo - controlled clinical trial. A total of 110 patients (55 in the intervention group and 55 in the placebo group) were enrolled in the study for a period of 12 weeks. The Melasma Area and Severity Index (MASI), melanin, erythema, lightness, and pigmentation were used to assess the effectiveness of the syrup. The Melasma Quality of Life (MELASQOL) questionnaire was also completed by both groups. Results: The results of the comparison between the intervention and placebo groups indicated a significant difference observed in all parameters, including melanin (P = 0.017), lightness (P < 0.001), pigmentation (P < 0.001), MASI (P < 0.001), and MELASQOL (P = 0.019), except for erythema, which was marginally insignificant (P = 0.06). All parameter scores in the intervention group showed improvement (P < 0.05); however, in the placebo group, they remained insignificant or even worsened. Conclusions: The results suggest that this traditional multiherbal syrup can be considered a safe and effective treatment for melasma.