Efficacy of topical versus intradermal injection of Tranexamic Acid In Egyptian melasma Patients: A randomised clinical trial

Badran, Aya Y.; Ali, Ahmed U.; Gomaa, Ahmed S.

doi:10.1111/ajd.13575

Cited by 11 publications

(15 citation statements)

References 26 publications

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“…The MASI scores decreased by 39.1% for the 4 mg/ml, 62.7% for the 10 mg/ml group with no significant difference between them ( p = 0.070). The topical MASI group decreased by 4.2%, which was significantly different than both intralesional groups 42 …”

Section: Introductionmentioning

confidence: 62%

Tranexamic acid in melasma: A focused review on drug administration routes

Konisky

Balazic

Jaller

et al. 2023

J of Cosmetic Dermatology

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Background: Melasma is a disorder of hyperpigmentation and vascularization often found in women between the ages of 20 and 40. The pathogenesis is unknown, but melasma often occurs in sun-exposed areas of the face, forearms, and back. Risk factors include family history, increased estrogen/progesterone, certain medications, and UV exposure. Melasma is typically treated with topical hydroquinone (HQ); however, it is often refractory to treatment. Tranexamic acid (TXA) is a plasmin inhibitor used off-label in the treatment of melasma. TXA can be administered orally, topically, or intralesionally. Aims:The purpose of this review is to characterize the wide variety of TXA delivery methods for melasma treatment and the efficacy of these methods compared with traditional treatments.Patients/Methods: A comprehensive PubMed and Embase search was conducted in May 2022 using the phrases tranexamic acid and melasma. Forty-six articles were included in this review.Results: Oral, intralesional, and topical TXA is safe and effective treatments for melasma. They have been studied in a variety of randomized controlled trials and have been compared with several traditional treatments. Overall, MASI scores in patients using TXA in any form improved. Conclusions:Oral TXA was found to be the most effective, especially in cases of refractory melasma; however, it caused GI upset and menstrual irregularities in many patients. The pro-thrombotic nature of this drug must be considered before safely prescribing to patients. Intralesional injections and microneedling with topical TXA were found to be effective alternatives to oral treatment. Lastly, topical TXA alone was found to be the least effective method but can be combined with other cosmeceuticals to improve outcomes. Topical TXA was also found to be better tolerated than hydroquinone, a traditional topical melasma treatment.

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Section: Introductionmentioning

confidence: 62%

Tranexamic acid in melasma: A focused review on drug administration routes

Konisky

Balazic

Jaller

et al. 2023

J of Cosmetic Dermatology

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“…On the contrary, a subsequent RCT by Badran et al reported significantly higher reduction in MASI score with different concentrations of TXA mesotherapy (4 mg/cc and 10 mg/cc) compared to topical TXA 10% cream (39.1%, 62.7%, and 4.2%, respectively). Irritation was reported in topical therapy group, and pain was reported in mesotherapy groups 19 …”

Section: Discussionmentioning

confidence: 98%

“…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%.…”

Section: Discussionmentioning

confidence: 99%

“…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 …”

Section: Discussionmentioning

confidence: 99%

“…Irritation was reported in topical therapy group, and pain was reported in mesotherapy groups. 19 There were 5 articles that evaluated efficacy of TXA mesotherapy with hydroquinone (HQ) or triple combination cream (TCC). In a RCT, Patil et al examined the efficacy of TXA mesotherapy (4 mg/cc) compared with TCC (2% HQ, 0.025% tretinoin and 0.01% fluocinolone acetonide).…”

Section: Comparison Of Txa Mesotherapy With Oral Txamentioning

confidence: 99%

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

Khalili

Amiri

Iranmanesh

et al. 2021

J of Cosmetic Dermatology

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Background Mesotherapy is a popular novel therapeutic modality that is defined as intradermal or subcutaneous microinjection of pharmaceutical compounds. Although this novel treatment method is used commonly in aesthetic dermatology, there is little information about details of injections, efficacy, and side effects of mesotherapy in melasma. Aim In this review, we evaluated efficacy and safety of various types of mesotherapy in the treatment of melasma. Method We searched Google Scholar, Medline, and PubMed for related articles with keywords “melasma” OR “chloasma” AND “mesotherapy” OR “injection.” Inclusion criteria were articles that evaluated intradermal injection of lightening drugs and published dates between January 2000 and September 2021. Exclusion criteria were articles in languages other than English or non‐human studies. Results Thirty‐three articles evaluated efficacy of mesotherapy in melasma, including 28 articles about tranexamic acid, 4 articles about vitamin C, 2 articles about glutathione, and 2 articles about triamcinolone. Conclusion Mesotherapy is a good alternative or adjunctive choice in patients who are refractory to first‐line therapy, patients with low compliance with everyday use of topical therapy, patients with contraindication to oral tranexamic acid therapy, or who wish short downtime and fast recovery period. Further studies with large sample sizes are required to determine ideal concentrations of mesotherapy substances and intervals between sessions and to evaluate the efficacy of different substances for mesotherapy as monotherapy compared to combination therapy and other treatment modalities for melasma.

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Intradermal injection of tranexamic acid versus platelet-rich plasma in the treatment of melasma: a split-face comparative study

Elraouf¹,

Obaid

Fouda

2023

Arch Dermatol Res

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Millions of people throughout the world suffer from the acquired condition of hyperpigmentation known as melasma. Melasma is characterized by symmetrically oriented hyperpigmented macules and patches. Many treatment options are available with variable degrees of efficacy and tolerability. The aim of the work was to evaluate and compare the effectiveness and safety of intradermal tranexamic acid (TXA) versus intradermal platelet-rich plasma (PRP) in the treatment of various types of melasma. The current split-face prospective study included 40 cases with melasma. Tranexamic acid (TXA) was injected intradermally into the right side of the face by using a concentration of 4 mg/ml, while platelet-rich plasma (PRP) was injected intradermally into the left side. In both sides, a total of three sessions of treatment were provided, once every 4 weeks. Digital photographs were taken before each treatment session and 3 months after the last session. The modified melasma area severity index (mMASI) grading system and dermoscopy were used to assess the improvement in the condition. The disease severity and percentage of improvement were assessed by mMASI score before and after therapy across both sides of the face. along with determining the degree of satisfaction and side effects among the included cases. The mean mMASI score before therapy in the TXA side was 4.59 ± 2.87, while in the PRP side, the mean mMASI score before therapy was 4.72 ± 2.72 with no statistically significant difference between the two sides (p = 0.841). After 3 months of treatment, the mean mMASI score in the TXA-treated side was 2.49 ± 1.58 with a mean percentage of decrease of 45.67 ± 8.10%, while in the PRP side, the mean mMASI score after treatment was 2.17 ± 1.41 with a mean percentage of decrease of 53.66 ± 11.27%. There was a high statistically significant decrease in the mMASI score after treatment on both sides (p < 0.001); however, the percentage of score reduction in the PRP side compared to the TXA side was statistically higher. Intradermal injection with PRP revealed higher efficacy in the treatment of melasma as compared to TXA injection with no significant difference regarding the associated side effects.

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Efficacy of topical versus intradermal injection of Tranexamic Acid In Egyptian melasma Patients: A randomised clinical trial

Cited by 11 publications

References 26 publications

Tranexamic acid in melasma: A focused review on drug administration routes

Tranexamic acid in melasma: A focused review on drug administration routes

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

Intradermal injection of tranexamic acid versus platelet-rich plasma in the treatment of melasma: a split-face comparative study

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