Clinical Efficacy of Topical Tranexamic Acid With Microneedling in Melasma

Abstract

BACKGROUND Melasma is a common, recurrent, and refractory cause of facial pigmentation resulting in cosmetic disfigurement. Tranexamic acid (TA) has been used systemically and locally for clearance of pigmentation. OBJECTIVE To assess the clinical efficacy of topical TA (10%) with microneedling in melasma. METHODS A split face, prospective, randomized, open-label study with a sample size of 40. Left or right side of the face was chosen randomly and microneedling was done on both the sides, followed by 10% TA solution application on one side of the face (test side) and distilled water on the other side of face (control). The procedure was done at 2 weekly intervals (0, 2, 4, and 6 weeks). Clinical images were taken at each visit including modified Melasma Area and Severity Index (mMASI) scoring of each half of the face to assess the clinical response along with patient satisfaction scores and side effects. RESULTS On the test side, there was 65.92% improvement in the mean mMASI score compared with 20.75% on the control side of the face at the end of 8 weeks. CONCLUSION Tranexamic acid may be a promising therapeutic agent in melasma and the topical solution along with microneedling seems to be efficacious.

Efficacy and safety of tranexamic acid in the treatment of adult melasma: An updated meta‐analysis of randomized controlled trials

“…Eight studies [14][15][16][17][18][19][20][21] evaluated the efficacy and safety of oral TXA, four studies [22][23][24][25] evaluated the efficacy and safety of intradermal TXA, and twelve studies evaluated the efficacy and safety of topical TXA. 5,[26][27][28][29][30][31][32][33][34][35][36] In the study by Tawfic SO, 30 topical and intradermal TXA administration routes were adopted in the treatment arm; thus, the study was analysed separately.…”

Efficacy of microneedling plus topical 4% tranexamic acid solution vs 4% hydroquinone in the treatment of melasma: A single‐blind randomized clinical trial

“…Plasmin can activate melanocytes by increased production of prostaglandin E2 from arachidonic acid (AA), activation of α‐melanocyte stimulating hormone (α‐MSH) and release of fibroblast growth factor (FGF). Furthermore, plasmin increases numbers of mast cells and leads to induce angiogenesis by release of VEGF that contributes in the pathogenesis of melasma 24‐27 …”

“…Consequently, combination of microneedling with TA is related to enhanced transdermal drug absorption and better efficacy on deep component of melasma. One disadvantage of combination therapy of TA with microneedling is higher treatment cost than HQ 4%, but because of monthly performance of microneedling and application of TA, total cost of treatment is acceptable 24‐27 …”

“…23 croneedling is higher treatment cost than HQ 4%, but because of monthly performance of microneedling and application of TA, total cost of treatment is acceptable. [24][25][26][27] Our study limitations were absence of performance of skin biopsy for evaluation of histological changes and also absence of application of spectrophotometry for objective analysis of treatment modalities. Also, there is no follow-up.…”

Platelet‐rich plasma is a promising therapy for melasma

“…Chemical peels and lasers have also yielded good results in melasma but they carry a significant risk of worsening the disease by causing post‐inflammatory hyperpigmentation 2 . Some newer systemic therapies that have been tried are vitamin C, glutathione, tranexamic acid (TA), melatonin, and platelet‐rich plasma (PRP) therapy 6,7 . Melasma is a treatment refractory disorder, hence despite the available multitude of treatments it tends to recur.…”