A comparative evaluation of the efficacy of intralesional tranexamic acid versus platelet rich plasma in the treatment of melasma

Abstract

Melasma is a benign, acquired disorder of hyperpigmentation commonly affecting the face. Though easily diagnosable, a tangible treatment for melasma still remains elusive. Our aim was to compare the therapeutic efficacy and safety of tranexamic acid (TXA) and platelet rich plasma (PRP) microinjections in treating patients with melasma. In total, 40 patients with melasma (10 males, 30 females; age range: 21–54 years) were enrolled, and randomly assigned to one of the two groups consisting of 20 patients each. Group A (3 males, 17 females) received intradermal microinjections of TXA (4 mg/ml) and group B (5 males, 15 females) received intradermal microinjections of PRP, once every 4 weeks for a total of five treatment sessions. Clinical images were taken at each visit and improvement in melasma was evaluated using both melasma area severity index (MASI) and modified melasma area severity index (mMASI) scoring systems. Percentage reduction of both MASI and mMASI scores were also assessed at each visit, and the grade of melasma improvement was accordingly outlined for each patient. The study was completed by 18 patients in group A (TXA) and 15 patients in group B (PRP). In group A, both MASI and mMASI scores reduced significantly from 16.6 ± 9.227 at baseline to 10.028 ± 8.07 at end point; and 8.885 ± 5.418 at baseline to 4.639 ± 3.863 at end point, respectively (p value <0.01). Similarly in group B significant reduction in both scores were observed at the end of treatment. MASI declined from 20.42 ± 7.979 to 12.253 ± 7.37; and mMASI plummeted to 5.613 ± 3.98 from 10.673 ± 4.642 (p value <0.01). In group A, the difference in mean reduction of MASI and mMASI from baseline to end point was 6.572 ± 4.528 and 4.211 ± 2.647, respectively. In group B, the difference in mean reduction of both scores at the end of treatment reflected values of 8.167 ± 4.975(MASI) and 5.06 ± 2.977 (mMASI). No significant adverse effects were encountered in both treatment arms during the entire duration of study. Both TXA and PRP microinjections were found to be effective and safe therapeutic options for melasma, providing rapid and substantial improvement even when used as standalone therapies. Although PRP mesotherapy was found to be slightly better than intradermal TXA in our study, the results were not significant statistically.

Combination of autologous platelet rich plasma and hydroquinone 4% is more effective than hydroquinone alone in treatment of melasma: A split‐face comparative study

“…However, we found that younger patients (21–30 years) were more satisfied (statistically insignificant) with treatment with PRP + HQ as compared to their older counterpart. Similarly, Abdelshafy et at did not observe any correlation between age and degree of improvement 7 …”

“…Emam et al 15 have demonstrated that PRP was equally effective in melasma when delivered by two different techniques: micro‐needling using dermapen (as in our study) versus micro‐injection using mesoneedles. Abdelshafy et at 7 . found a better improvement with intralesional PRP against intralesional Tranexamic acid.…”

“…In a study by Abdelshafy et al, tranexamic acid treated side showed correlation with duration of melasma. 7 Patients with shorter duration of disease responded better to treatment. In contrast, improvement in melasma (for both sides of face) was found to be independent of duration in our study.…”

“…type of melasma with Tranexamic acid and PRP. 7 It has been shown that patients with longstanding melasma had a significantly higher MASI score than those who presented with recent onset. Melasma is a gradually progressive condition; hence, individuals with longer duration of melasma can be expected to have larger area and depth of involvement, which in turn can influence response to treatment.…”

A utilização do ácido tranexâmico para o tratamento de melasma

“…Outro estudo abordou a comparação entre microinjeções e plasma rico em plaquetas (PRP). Ainda que a mesoterapia com PRP tenha se mostrado mais eficaz, os resultados não foram estatisticamente significativos, uma vez que ambos mostraram-se como opções terapêuticas eficazes(Patil & Bubna, 2022).…”