Tranexamic Acid for Melasma Treatment: A Split-Face Study

Abstract

BACKGROUND Melasma is an acquired hyperpigmented skin disorder. Tranexamic acid (TXA) prevents ultraviolet radiation induced pigmentation in melasma through interfering with the plasminogen–plasmin pathway. OBJECTIVE This study was conducted to evaluate the therapeutic effect and safety of TXA by intradermal injection versus TXA with microneedling for melasma treatment. METHODS Fifty-six female patients with bilateral symmetrical melasma were recruited in a split-face study. All patients received an intradermal injection of TXA on one side of the face, and the other side received TXA with microneedling for 6 sessions at 2 weeks intervals. Clinical efficacy was assessed using a modified Melasma Area Severity Index (mMASI) score at the baseline and after treatment. Global photographs underwent blinded review by 2 dermatologists. Patient self-assessment and satisfaction were recorded. RESULTS After the treatment, the mMASI score was significantly reduced compared with the baseline in both treated sides (p < .001). No significant difference between both treated sides (p > .05). Patient satisfaction was higher in the microneedling-treated side than the intradermal-injected side (p < .001). No significant adverse effects were observed in both treated sides. CONCLUSION Intradermal injection and microneedling of TXA could be safe and effective in melasma treatment. Microneedling of TXA was significantly more satisfying to the patients.

Microneedling with cutaneous delivery of topical agents for the treatment of melasma: A systematic review

“…Localized microinjections of tranexamic acid have also been compared to microneedling in the treatment of melasma 16 . When comparing groups treated by microneedling associated with tranexamic acid to the same drug by intradermal injections, no significant differences in the MASI scores were reported, 16 even though microneedling may be a less invasive option, as microinjections have the inconvenient to be considered more painful when compared to microneedling 22 . Although the RCTs included in this review did not report a comparison of this parameter, another study observed that the presence of pain on the face side that received microinjections was the main adverse effect reported (42.9%), being more frequent than pain on the side that received microneedling (19.6%) 22 …”

“…22 Although the RCTs included in this review did not report a comparison of this parameter, another study observed that the presence of pain on the face side that received microinjections was the main adverse effect reported (42.9%), being more frequent than pain on the side that received microneedling (19.6%). 22 Fractional laser results in the formation of microscopic columns of damaged tissue that are surrounded by areas of normal tissue, and thus, reduces the skin damage caused by conventional laser therapy and shortens the subsequent recovery period. 2,3 Fractional CO 2 laser has been used to increase topical administration of a number of substances such as tranexamic acid.…”

Effect of platelet-rich plasma combined with tranexamic acid in the treatment of melasma and its effect on the serum levels of vascular endothelial growth factor, endothelin-1 and melatonin

“… 11 At present, a large number of studies have confirmed the safety and reliability of TXA in the treatment of melasma. 3 , 12 Ebrahim HM et al 13 studied the treatment of melasma by intradermal injection of TXA and TXA microneedle. They showed that both methods are safe and effective, but microinjection of TXA is more satisfactory to patients, thus becoming one of the research directions of the follow-up team.…”

The efficacy of energy‐based devices combination therapy for melasma

“…There were 11 articles evaluating efficacy of combination of microneedling with other topical treatments, including TA (6 articles), TCC, mesotherapy, 20% vitamin C solution, depigmenting serum (rucinol, and sophora‐alpha), and PRP 36‐46 . Combination therapy showed significantly superior efficacy in five studies 36‐39 .…”

“…There were 11 articles evaluating efficacy of combination of microneedling with other topical treatments, including TA (6 articles), TCC, mesotherapy, 20% vitamin C solution, depigmenting serum (rucinol, and sophora-alpha), and PRP. [36][37][38][39][40][41][42][43][44][45][46] Combination therapy showed significantly superior efficacy in five studies. [36][37][38][39] Two studies demonstrated significantly more improvement with combination of microneedling and topical TA in comparison with microneedling alone or combined of sham device and topical TA.…”