Comparison of efficacy of Tranexamic Acid Mesotherapy versus 0.9% normal Saline for Melasma; A split face study in a Tertiary Care Hospital of Karachi

Abstract

Objectives: To compare the efficacy of tranexamic acid mesotherapy versus 0.9% normal saline for melasma by split-face study.
 Methods: It was a non-randomized clinical trial performed at the Dermatology ward of JPMC from September 2018 to June 2019 after getting approval from the Ethical Committee. A total of sixty patients were recruited in the study, who had symmetrical melasma on their faces. Both halves of the face were treated by Injection Tranexamic Acid (TA) with a dose of 4mg/ml and Normal Saline (NS) two weekly for twelve weeks. Hemi Modified Melasma Area and Severity Scoring (H-mMASI) was calculated at the start and end of the study. Analyses were done by SPSS version 23. P < 0.05 was taken as significant.
 Results: Mean of H-mMASI score was compared on both sides at the end of study, which showed significant reduction in mean score from 3.19 ±2.57 to 1.52 ± 1.2 (P < 0.05) on A side as compared to decline in scores on NS side from 3.46 ± 2.7 to 3.45 ± 2.6 (P > 0.05). Erythema, swelling, and burning were documented as temporary side effects on both sides.
 Conclusion: Tranexamic Acid (TA) mesotherapy can be considered as the most cost-effective, safe and directly observed therapy for melasma which showed significant improvement when old prior therapies have failed.
 doi: https://doi.org/10.12669/pjms.36.5.2379
 How to cite this:Kaleem S, Ghafoor R, Khan S. Comparison of efficacy of Tranexamic Acid Mesotherapy versus 0.9% normal Saline for Melasma; A split face study in a Tertiary Care Hospital of Karachi. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.2379
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The influence of topical5%tranexamic acid at pH2.38with and without corundum microdermabrasion on pigmentation and skin surface lipids

“…1,3 Many studies discussed the use of TA administered by intradermal injection (microneedling + tranexamic acid). 1,3,[33][34][35] The aim of the study was to compare the influence of topical treatment with 5% tranexamic acid (pH 2.38) alone and in combination with corundum microdermabrasion on the skin of the back surface and dorsal surfaces of the hands.…”

“…It is also possible to combine TA with azelaic and boswellic acids 1,3 . Many studies discussed the use of TA administered by intradermal injection (microneedling + tranexamic acid) 1,3,33‐35 …”

Safety and efficacy of mesotherapy in the treatment of melasma: A review article

“…Application of ice‐pack after mesotherapy for several hours can be used to mitigate erythema and swelling. Occasionally, adverse effects such as acne formation (6.4%), PIH (8.3%), stuffy feeling (5.8%), and abscesses formation (2.5%) were reported 21,31,33,36 …”

“…Therefore, TXA inhibits angiogenesis by suppression of VEGF, endothelin (ET)‐1, and IL‐8, while reducing the number of mast cells. It also causes competitive inhibition of tyrosinase (an important enzyme in melanogenesis) 7–33 …”

“…Injections were performed at 1 mm depth and 1 cm distance by 28–30‐gauge insulin syringe. Follow‐up periods were between 1 and 12 months 7–33 . Based on published articles, significant reductions in melasma area and severity index (MASI) scores were reported with TXA mesotherapy, from 33.3% to 81.2%.…”