A Comparison of Efficacy of Intradermal Tranexamic Acid With Topical 20% Azelaic Acid in the Treatment of Melasma

Komal, Sayyida; Mashhood, Asher Ahmed; Farooq, Muhammad; Qayyum, Nida

doi:10.51253/pafmj.v71i2.4528

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…The statistical significance of these differences, underscored by a Pvalue of 0.00, clearly favored tranexamic acid over azelaic acid in treating melasma. These observations align with previous studies, such as those by Sayyida Komal et al (19) and Fahmida Malik (20), which also reported superior outcomes with tranexamic acid, both in monotherapy and in combination with other treatments, compared to azelaic acid. Moreover, Nasrin Saki's controlled trial (21) lends further support, illustrating the rapid onset of action of intradermal tranexamic acid compared to 2% hydroquinone, albeit with comparable long-term efficacy.…”

Section: Discussionsupporting

confidence: 92%

Comparison of Efficacy of 5% Tranexamic Acid vs 20% Azelaic Acid in Patients of Melasma

Mushtaq,

Marwat,

Saleem

et al. 2024

JHRR

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Background: Melasma is a significant cosmetic concern globally, affecting individuals across various ethnic backgrounds, particularly in South Asian populations. The condition's etiology is complex, involving genetic, hormonal, and environmental factors such as sun exposure. Despite numerous treatment options, melasma remains challenging to manage effectively. Recent studies have explored the efficacy of tranexamic acid and azelaic acid, both of which target the melanin synthesis pathway but through different mechanisms. Objective: The aim of this study was to compare the effectiveness of topical 5% tranexamic acid versus 20% azelaic acid in the treatment of melasma, with a focus on changes in the Melasma Area and Severity Index (MASI) scores. Methods: This prospective comparative study was conducted at the Dermatology department of PIMS Hospital, Pakistan, over six months from August 2023 to January 2024. A total of 200 patients with melasma were enrolled and randomly assigned to two groups: Group A received 5% tranexamic acid cream, and Group B received 20% azelaic acid cream, both applied twice daily. Inclusion criteria included men and women aged 18 to 50 years with a diagnosis of melasma for at least six months. Pregnant women, patients with a history of Systemic Lupus Erythematosus (SLE) or Discoid Lupus Erythematosus (DLE), and those on hormonal therapy were excluded. The primary outcome measure was the change in MASI scores from baseline to the end of the study period. Data were analyzed using SPSS Version 25. Results: The study found significant differences in treatment efficacy between the two groups. Group A (tranexamic acid) showed a reduction in MASI scores from 7.94 ± 1.88 at baseline to 5.50 ± 1.61 post-treatment. Group B (azelaic acid) demonstrated a decrease from 8.21 ± 1.96 to 5.89 ± 1.49. The proportion of patients experiencing excellent response was higher in Group A (36.0%) compared to Group B (19.0%), with a statistically significant difference in overall treatment efficacy (P<0.0001). Conclusion: Topical 5% tranexamic acid was more effective than 20% azelaic acid in improving MASI scores in patients with melasma. This study supports the inclusion of tranexamic acid as a preferable treatment option for melasma, offering a promising alternative for those not responding to conventional therapies.

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Section: Discussionsupporting

confidence: 92%

Comparison of Efficacy of 5% Tranexamic Acid vs 20% Azelaic Acid in Patients of Melasma

Mushtaq,

Marwat,

Saleem

et al. 2024

JHRR

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“…Sample size was calculated to be 88 (44 females in each group) by using the hypothesis tests for two population proportions (one sided test). Intradermal Tranexamic acid in group A (P1= 31%) 13 , IPL in group 2 B (P2= 49.5%).…”

Section: Methodsmentioning

confidence: 93%

“…11 Taking level of significance 5% and Power of test 80%, using the following formula The difference in efficacy between the two groups was found to be statistically significant (p = 0.001). 13 Another study done in Egypt by Fawzy et al, sixty females received weekly sessions of intradermal tranexamic acid treatment. The decrease in mMASI score after treatment was found to be statistically significant (p value < 0.001*).…”

Section: Methodsmentioning

confidence: 99%

Efficacy of intradermal injected tranexamic acid vs intense pulse light in the treatment of melasma.

Aqsa Naheed,

Tehseen Naveed,

Javeria Hafeez

et al. 2023

TPMJ

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Objective: To compare the efficacy of Intradermal Tranexamic acid and Intense Pulse Light (IPL) in the treatment of melasma. Study Design: Interventional study. Setting: Department of Dermatology, HIT Hospital. Period: Dec 2022 to May 2023. Material & Methods: 88 Female aged between 18 and 50 with melasma were included in this study. Participants who have used topical treatments for melasma, with any medical illness or bleeding disorder, history of photosensitivity were excluded. Participants of ITA group received intradermal tranexamic acid in a concentration of 4mg/ml monthly for four sessions. While the participants of IPL group were treated fortnightly for four sessions. mMASI was used to calculate the severity of melasma before and 2 weeks after last session. Patients perception of treatment efficacy and side effects were noted in each group. SPSS-28 was used. Paired t- test and independent t- test was applied to compare the effectiveness of both treatment modalities. A p-value ≤0.05 was considered as significant. Chi square was used to compare the side effects of both the groups. Results: Paired t-test indicated a highly significant p-value of less than 0.000 in both the groups. mMASI-II scores of both groups were compared using an independent t-test, p-value was found to be statistically insignificant at 0.512. Participants in ITA group experienced more side effects, comparison of side effects between both groups was done using chi-square test, and p-value was found to be statistically significant at 0.002. Conclusion: ITA and IPL have emerged as secure and efficacious therapeutic choices.

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“…Previous studies have compared the clinical effectiveness of azelaic acid in comparison to hydroquinone in skin hyperpigmentation management. Based on the reports, azelaic acid was superior to hydroquinone in terms of hyperpigmentation treatment ( Baliña and Graupe, 1991 ; Farshi, 2011a ; Komal et al, 2021 ; Sobhan et al, 2023 ). Despite the promising therapeutic potential of azelaic acid in melasma, however due to limited water solubility and poor skin permeability, its conventional topical formulations have been fabricated in higher doses (10%–20%) to achieve the desired clinical outcome ( Sieber and Hegel, 2014 ; Sobhan et al, 2023 ).…”

Section: Therapeutic Options and Limitationsmentioning

confidence: 99%

Different therapeutic approaches in melasma: advances and limitations

Ghasemiyeh,

Fazlinejad,

Kiafar

et al. 2024

Front. Pharmacol.

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Melasma is a chronic hyperpigmentation skin disorder that is more common in the female gender. Although melasma is a multifactorial skin disorder, however, sun-exposure and genetic predisposition are considered as the main etiologic factors in melasma occurrence. Although numerous topical and systemic therapeutic agents and also non-pharmacologic procedural treatments have been considered in melasma management, however, the commonly available therapeutic options have several limitations including the lack of sufficient clinical effectiveness, risk of relapse, and high rate of unwanted adverse drug reactions. Recruitment of nanotechnology for topical drug delivery in melasma management can lead to enhanced skin penetration, targeted drug delivery to the site of action, longer deposition at the targeted area, and limit systemic absorption and therefore systemic availability and adverse drug reactions. In the current review, first of all, the etiology, pathophysiology, and severity classification of melasma have been considered. Then, various pharmacologic and procedural therapeutic options in melasma treatment have been discussed. Afterward, the usage of various types of nanoparticles for the purpose of topical drug delivery for melasma management was considered. In the end, numerous clinical studies and controlled clinical trials on the assessment of the effectiveness of these novel topical formulations in melasma management are summarized.

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A Comparison of Efficacy of Intradermal Tranexamic Acid With Topical 20% Azelaic Acid in the Treatment of Melasma

Cited by 4 publications

References 14 publications

Comparison of Efficacy of 5% Tranexamic Acid vs 20% Azelaic Acid in Patients of Melasma

Comparison of Efficacy of 5% Tranexamic Acid vs 20% Azelaic Acid in Patients of Melasma

Efficacy of intradermal injected tranexamic acid vs intense pulse light in the treatment of melasma.

Different therapeutic approaches in melasma: advances and limitations

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