European Journal of Molecular & Clinical Medicine

Abstract

Kligman's formula (Triple Combination) or modified Kligman's is a topical drug for that combines fluocinolone acetonide 0.1 %, hydroquinone 4%, and tretinoin 0.05%, and is now the only US FDA-approved medication for the treatment of melasma topically. It has recently gained widespread popularity among the general public for a variety of uses. When used incorrectly, it might produce negative consequences and undesirable side effects.
Methods: 
A cross-sectional, observational study was performed using Kligman's formula misuse questionnaire in a  convenient sample of 2634 participants. The statistical analysis included descriptive analysis, and tests of association (chi square and Fisher’s exact test).
Results: 
knowledge regarding triple combination cream is poor. 2% of the respondents correctly chose skin melasma, 1.3% chose hyperpigmentation, and 10.3% chose acne post pigmentation, however, as these conditions are all approved indications for using triple combination cream, only 18% chose at least two of them. Acne post pigmentation was the most common reason for using triple combination creams (42.5%), followed by other causes of pigmentation (21.1%), inflamed acne (13.8%), melasma (12.3%), and other non-reported causes (10.3%). Social media was the most prevalent source of cream-related information among non-users (23.1%) and the second most common source among users (35.9%).
Conclusions: 
knowledge regarding triple combination cream is poor. Kligman’s formula misuse and its adverse reactions is a concern in Saudi Arabia. The diversity in sources of informations of using Kligman’s formula is negatively affecting the correct use of it. Therefore, we recommend using social media websites, malls, and television to raise awareness for the correct way to use Kligman's formula and how to avoid its misuse