Tranexamic acid versus fractional carbon dioxide laser in post‐acne hyperpigmentation

Abstract

Post-acne hyperpigmentation is a common undesirable sequela of acne vulgaris that causes distress for many patients. This study's objective was to compare the efficacy of both low-power/low-density fractional carbon dioxide (CO 2 ) laser and tranexamic acid (TXA) microinjection on post-acne hyperpigmentation. Twenty-five post-acne hyperpigmentation patients (resistant to regular treatment for more than 6 months) were enrolled in this randomized split-face study. One side of the face was randomly assigned to low-power fractional CO 2 laser every 4 weeks, and the other side was assigned to TXA intradermal-microinjection every 2 weeks for 3 months. Efficacy was evaluated using digital photography, dermoscopy, post-acne hyperpigmentation index (PAHPI), melanin index (MI), and erythema index (EI) at baseline and 4 weeks

Efficacy and Best Mode of Delivery for Tranexamic Acid in Post-Inflammatory Hyperpigmentation: A Systematic Review

“…All these articles were published in English. From a timing standpoint, out of these 9 selected articles, 3 were published in 2021, [16][17][18] two in 2019, 19,20 and only four in the period from 2011 to 2018. [21][22][23][24] No article was published before 2011.…”

“…All were transient and quickly resolved after the product application. Shereen Osama Tawfic, 2021 18 Egypt RCT 25 >16 Intradermal injections (0.02 mL/injection --- 2 mL/session max – total number of injections are approximately 15–60 injections/session) 3 months None Fractional carbon dioxide was more effective than intradermal TXA for treating resistant post acne PIH All patients reported mild burning pain and mild erythema after the sessions that lasted for a few hours Aleksandra L. Lindgren, 2021 17 USA Case series 2 Case1: 38 years / case 2:20 years Oral 650 mg\d Case 1: 8 weeks Case 2: not specified Case1: clobetasol 0.05% cream BID/ case 2: topicals (sunscreen and tretinoin 0.05%) and daily spironolactone 100 mg Case 1: No new episodes of PIH after oral 650 mg TXA daily for 8 weeks and clobetasol 0.05% cream twice daily for one week. Case 2: In the course of the excoriation, she did not develop any new PIH after prophylactic oral 650 mg TXA.…”

“…Among these 9 studies, 2 were conducted in Korea, 22 , 23 2 in Thailand, 20 , 21 2 in the USA, 16 , 17 and 1 from each of the following countries: Japan, 24 Brazil, 19 and Egypt. 18 Of the included studies, 2 were case reports, 22 , 23 4 were RCTs, 18 , 20 , 21 , 24 1 was a single-center clinical study, 19 1 was a longitudinal single-blind single-center study, 16 and 1 was a case series study. 17 Tranexamic acid was delivered orally in 4 studies, 17 , 20 , 22 , 24 topically in 2 studies, 16 , 19 and both concurrently in 1 study.…”

“…The selected studies included all types of PIH: PIH after Q-switched ruby laser, 24 post Intense Pulsed Light (IPL) spots, 23 PIH after allergic contact dermatitis to pure henna, 22 PIH post Q-switched 532-nm Nd YAG laser, 20 , 21 and post-acne hyperpigmentation. 17 , 18 …”

“…18,21 The selected studies included all types of PIH: PIH after Q-switched ruby laser, 24 post Intense Pulsed Light (IPL) spots, 23 PIH after allergic contact dermatitis to pure henna, 22 PIH post Q-switched 532-nm Nd YAG laser, 20,21 and postacne hyperpigmentation. 17,18 The additional treatments used were Q-switched ruby laser (QSRL), 24 Q-switched Nd:YAG laser, 22 spironolactone, 17 and various topicals (kojic acid, niacinamide, clobetasol, sunscreen and tretinoin). 17,19 However, the dose, duration, and side effects differ among these studies.…”