INTRODUCTIONMelasma is an acquired, symmetrical hypermelanosis of the face and is particularly seen in women with skin types IV to VI living in areas with intense UV radiation. The exact etiopathogenesis is unknown. However, various etiological factors proposed in the literatureinclude sun exposure, pregnancy, hormonal therapy, genetic factors and vascular factors. Various treatment modalities such as topical depigmenting agents, chemical peels, dermabrasion and laser therapies have been utilised with varying, not so satisfactory outcomes. [2][3][4][5] Tranexamic acid, (TXA) a plasmin inhibitor, is now gaining popularity as a depigmenting agent. TXA prevents the binding of plasminogen to the keratinocytes, which ultimately results in less free arachidonic acids and thus inhibits UV-induced plasmin activity in keratinocytes.6 Oral TXA also produces significant decrease in the mMASI in melasma patients.7 TXA administered intradermally is effective for dermal and mixed variants of melasma. TXA is a safe and well ABSTRACT Background: Melasma is an acquired hypermelanosis affecting the sun-exposed areas of the skin, most commonly the face and neck. Different treatment modalities have been utilized in different studies with varying, not so satisfactory outcomes. The aim of the study was to compare the efficacy of localized intradermal microinjection of tranexamic acid with oral tranexamic acid in melasma patients. Methods: It is a prospective comparative study. All patients enrolled in the study were divided into 2 groups -twenty in each treatment group. In group A, patients were given intradermal injections of tranexamic acid (4 mg/ml) once at three week intervals (0, 3, 6, 9, 12 weeks) for 12 weeks. Group B patients were given oral tranexamic acid 250 mg twice a day for 12 weeks. Following parameters were evaluated before and after 12 weeks of treatment: a) digital photographs b) MASI score c) patient subjective assessment d) dermoscopic photographs. Software (SPSS, version 16.0 statistical packages) was used. Results: Clinical efficacy of the treatment in 2 different groups showed higher efficacy with intradermal microinjection (35.6%) compare to oral tranexamic acid (21.7%). Patient's subjective assessment showed good improvement in 63.15% of cases in group A, whereas in group B 27.8% of cases showed good improvement. Conclusions: Intralesional localized microinjection of tranexamic acid is a promising new therapeutic modality for the treatment of resistant melasma.
Introduction: Periorbital dermatoses are the dermatological manifestations of the area around the eye excluding eyelid. It greatly affects quality of life. As there is lack of adequate data about frequency and distribution of periorbital dermatoses, there is need for studies to be conducted to study clinical patterns of periorbital dermatoses. Aesthetic facial concerns have been the main reason for dermatological consults in the last few years, one among which is the periorbital dermatoses. Methodology: It was a hospital based cross sectional study of 75 patients, attending Dermatology OPD in a tertiary care hospital, with complains of periorbital dermatoses. Detailed history, general physical, and detailed cutaneous examination was done in all patients included in the study. Clinical tests, routine haematological investigations & skin biopsy were performed in relevant cases.Results and Discussion: Among 75 patients, common dermatological condition distributed in the periorbital region was periorbital tumors 26 patients(34.7%), pigmentary disorders 18(24%) ,dermatitis 18(24%) infections 7(9.33%) and miscellaneous 6(8%). Among all seborrheic keratosis and periorbital hyperpigmentation were observed to be the commonest conditions in our study. Conclusion:Certain periorbital dermatoses are heralding features of underlying systemic disease, so it helps in early diagnosis and treatment of underlying condition. In our study periorbital tumours were the commonest dermatoses seen.
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