Oral tranexamic acid, hydroquinone 4% and low‐fluence 1064 nm Q‐switched Nd:YAG laser for mixed melasma: Clinical and dermoscopic evaluation

Abstract

Background: Tranexamic acid (TA) can prevent melanocyte activation by various stimuli. Combining TA with either hydroquinone 4% or Q-switched Nd:YAG laser may be associated with greater improvement of melasma. Objectives:We aimed to evaluate the efficacy and safety of oral TA alone and combined with either topical hydroquinone 4% or low-fluence 1064 nm Q-switched Nd:YAG laser in treatment of mixed melasma.Patients & Methods: Patients were randomly divided into three groups of 20 patients each. Group A were treated with oral TA 250 mg twice daily for three months; group B were treated with TA similarly combined with topical hydroquinone 4% cream; group C were treated with TA combined with two sessions of 1064 nm low-fluence Qswitched ND:YAG laser (850-1200 mJ/cm 2 , 4-5 Hz,spot size 4 mm) spaced 4 weeks apart. Patients were followed monthly for 9 months.Results: After cessation of therapy, the mean mMASI score was lowest in group B (2.34 ± 2.37) followed by groups A (6.38 ± 4.04) and C (7.24 ± 4.95).Mean percentage of mMASI score improvement was 35.91 ± 24.13, 77.47 ± 19.07, and 24.94 ± 27.79 in groups A, B, and C (p < 0.001). There was a significant reduction of telangiectasia in the three groups. Reported side effects were itching & irritation, post-inflammatory hyperpigmentation, and gastritis. Conclusion:Oral TA is a tolerable effective treatment modality for melasma.Combining hydroquinone 4% with oral TA is associated with a relatively earlier and better cosmetic outcome.

Comparative efficacy and safety of tranexamic acid for melasma by different administration methods: A systematic review and network meta‐analysis

“…The present study revealed that the therapeutic effect of oTA combined with routine topical agents is superior to that of oTA alone, topical TA, iTA, MNsTA in the long term. This result is consistent with a previous study in Elkamshoushi's opinion 37 that combining 4%HQ with oTA achieves an earlier and better cosmetic improvement than oTA alone. Natalia et al 71 combination of oTA with topical therapy utilizing HQ and retinoid products is recommended as a first-line treatment.…”

“…Elkamshoushi et al 37 suggested that the reason might be that TA treatment should be long-term and needs long-term maintenance. Once TA is stopped for several months, patients who take TA orally or in combination with conventional external drugs have a certain degree of recurrence and an elevated MASI, which is also consistent with the results reported by Ebrahim et al 33 In conclusion, we figured that oTA + RTA is the best mode of administration.…”

Efficacy and safety of laser‐related therapy for melasma: A systematic review and network meta‐analysis

“…Then, by screening the titles and abstracts, we further eliminated 793 studies. Ultimately, 39 randomized clinical trials 12,18–55 were included in the network meta‐analysis. The flowchart of screening and selection is depicted in Figure 1.…”

Understanding Melasma-How Can Pharmacology and Cosmetology Procedures and Prevention Help to Achieve Optimal Treatment Results? A Narrative Review

“…Since there is no cell death and skin heating is kept to a minimum, the risk of melasma exacerbation is much lower. This technique achieved the best results and the lowest risk of recurrence when it is combined with other agents such as topical HQ [199,200], triple combination cream [201], azelaic acid [202], chemical peels, e.g., Jessner's formula [203,204], GA [205,206] and systemic treatment with TA [199,[207][208][209][210], as well as other treatment procedures, such as microneedling with ascorbic acid [211], microneedle radiofrequency (RF) [212], microdermabrasion [213], pulsed-dye laser [214], and IPL [188,215,216]. In each of these cases, combination therapy was more effective than the laser toning procedure alone [197,217].…”