Micro‐needling versus fractional carbon dioxide laser for delivery of tranexamic acid in the treatment of melasma: A split‐face study

Abstract

Background Tranexamic acid (TXA) in oral, topical, and intra‐dermal injection routes showed efficacy in melasma treatment. Micro‐needling and fractional carbon dioxide (CO2) laser were reported to enhance the drug delivery of TXA. Aims This study aimed at comparing the use of micro‐needling and fractional CO2 laser for drug delivery of TXA in the treatment of facial melasma. Patients/Methods Thirty female patients with bilateral symmetrical facial melasma were subjected to micro‐needling, for one side of the face, and fractional CO2 laser, for the other, followed by an immediate topical application of TXA solution 4 mg/mL. Patients received six biweekly sessions. Results Two weeks after the last session, a significant reduction in baseline modified melasma area and severity index (mMASI) score was observed on both sides. The mean ± SD baseline mMASI dropped from 3.43 ± 1.84 to 1.59 ± 1.51 (mean reduction 57.73%, P < .001) and from 3.51 ± 1.84 to 1.78 ± 1.51 (mean reduction 55.82%, P < .001) in the micro‐needling–treated side and in the fractional CO2 laser–treated side, respectively. However, no statistically significant differences were found between the two sides (P = .81). Conclusions Micro‐needling and fractional CO2 laser are equally safe and effective for the delivery of TXA in the treatment of facial melasma.

The efficacy of energy‐based devices combination therapy for melasma

“…In two other studies, there was no significant differences in efficacy of treatment between patients treated with combination of FCO 2 laser with 2% HQ or topical TA in comparison with 2% HQ alone, or microneedling with topical TA, respectively. Ten percent of patients in microneedling group showed PIH 48,49 …”

The efficacy and safety of topical tranexamic acid (liposomal or lotion with microneedling) versus conventional hydroquinone in the treatment of melasma

“…Microneedling could enhance the delivery of TA with relatively intact epidermis and limited adverse effects 23 . Furthermore, the procedure of microneedling could solely improve melasma by stimulating the proliferation of fibroblasts, the release of growth factors, and the upper dermal collagen formation 24,25 . However, we still lack objective and randomized studies regarding the comparison of the efficacy of these novel therapies.…”

Lessons Learned from the First Decade of Laser-Assisted Drug Delivery

“…The use of tranexamic acid in combination with fractional ablative CO 2 laser treatment requires further investigation [25]. A separate study compared microneedling on one side of the face with fractional CO 2 laser treatment in combination with tranexamic acid on the other side of the face in 30 melasma patients, and found no statistically significant difference between the sides [26]. A randomized, single-blinded, splitface clinical trial of 40 melasma patients treated with topical hydroquinone 4% or a combination of topical hydroquinone 4% and a fractional laser noted improvements in hyperpigmentation and darkness on both face sides, with no significant difference in improvement between sides [27].…”