A randomized, open-label, comparative study of oral tranexamic acid and tranexamic acid microinjections in patients with melasma

Khurana, Vinod K; Misri, Rachita; Agarwal, Swati; Thole, Akhilesh V; Kumar, Sachin; Anand, Tanu

doi:10.4103/ijdvl.ijdvl_801_16

Cited by 32 publications

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“…One RCT compared monthly intralesional therapy (4 mg/ml) and oral therapy (250 mg twice a day) for 3 months. The 64‐person study found that both groups significantly decreased MASI score (Oral p < 0.01, intralesional p = 0.047); however, the oral therapy group had a more significant decrease than the intralesional group ( p < 0.001) 40 …”

Section: Introductionmentioning

confidence: 93%

“…The 64-person study found that both groups significantly decreased MASI score (Oral p < 0.01, intralesional p = 0.047); however, the oral therapy group had a more significant decrease than the intralesional group (p < 0.001). 40 An additional RCT compared oral therapy (250 mg twice daily) to intralesional injections at both 100 mg/ml and 4 mg/ml concentrations every 2 weeks for 8 weeks with significant decreases in mMASI of all groups. No significant differences were found between groups.…”

Section: Evidencementioning

confidence: 99%

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Tranexamic acid in melasma: A focused review on drug administration routes

Konisky

Balazic

Jaller

et al. 2023

J of Cosmetic Dermatology

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Background: Melasma is a disorder of hyperpigmentation and vascularization often found in women between the ages of 20 and 40. The pathogenesis is unknown, but melasma often occurs in sun-exposed areas of the face, forearms, and back. Risk factors include family history, increased estrogen/progesterone, certain medications, and UV exposure. Melasma is typically treated with topical hydroquinone (HQ); however, it is often refractory to treatment. Tranexamic acid (TXA) is a plasmin inhibitor used off-label in the treatment of melasma. TXA can be administered orally, topically, or intralesionally. Aims:The purpose of this review is to characterize the wide variety of TXA delivery methods for melasma treatment and the efficacy of these methods compared with traditional treatments.Patients/Methods: A comprehensive PubMed and Embase search was conducted in May 2022 using the phrases tranexamic acid and melasma. Forty-six articles were included in this review.Results: Oral, intralesional, and topical TXA is safe and effective treatments for melasma. They have been studied in a variety of randomized controlled trials and have been compared with several traditional treatments. Overall, MASI scores in patients using TXA in any form improved. Conclusions:Oral TXA was found to be the most effective, especially in cases of refractory melasma; however, it caused GI upset and menstrual irregularities in many patients. The pro-thrombotic nature of this drug must be considered before safely prescribing to patients. Intralesional injections and microneedling with topical TXA were found to be effective alternatives to oral treatment. Lastly, topical TXA alone was found to be the least effective method but can be combined with other cosmeceuticals to improve outcomes. Topical TXA was also found to be better tolerated than hydroquinone, a traditional topical melasma treatment.

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Section: Introductionmentioning

confidence: 93%

Section: Evidencementioning

confidence: 99%

Tranexamic acid in melasma: A focused review on drug administration routes

Konisky

Balazic

Jaller

et al. 2023

J of Cosmetic Dermatology

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“…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. To investigate the reason, the dose and frequency of oTA or with RTA agents were 500 mg/day, 16,17,31,36,37,54,55,57,63,64 while the frequency of iTA and MNsTA was basically once every 2 or 4 weeks, and the concentration of liquid medicine was 4 mg/mL. [16][17][18]27,33,36,39,40,47,48,51 Therefore, oTA with high-frequency and concentration had a faster effect than iTA and MNsTA.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the distinction between the effectiveness of local or intradermal adjuvant TA treatment and oral administration remains unclear. In the study conducted by Khurana VK et al, 16 it was found that the oral administration of TA (250 mg twice daily) yielded superior results compared to the intradermal injection (4 mg/mL) of TA. However, Sharma et al 17 discovered that there was an equivalent whitening effect observed in both the oral TA group with 250 mg twice daily and the intradermal injection group with 4 mg/mL in a period of 4 weeks.…”

mentioning

confidence: 97%

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

Liang,

Luo,

Pan

et al. 2023

J of Cosmetic Dermatology

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BackgroundTranexamic acid (TA) is a new and promising drug for the treatment of melasma.ObjectivesThis network meta‐analysis aims to compare the efficacy and safety of various ways of administration of TA on melasma.MethodsWe collected researches from PubMed, EMBASE, Cochrane Library and Web of Science. Melasma area severity index (MASI) is used to evaluate the severity of melasma. After treatment with different TA administration methods, a difference in MASI is named ΔMASI. We evaluate the curative effect by comparing the ΔMASI of different TA administration methods at a certain time point.ResultsAt the Weeks 4, 8, and 12 and the last follow‐up, the ΔMASI of oral TA combined with routine topical agents (oTA + RTA) was higher than that of intradermal TA (iTA), topical TA (tTA) as well as microneedling TA (MNsTA), with statistical significance. At the 8th week, the ΔMASI of oTA was higher than that of iTA, with statistical significance. Compared with placebo, oTA showed statistically significant differences at Week 4, while tTA, iTA, and MNsTA showed statistically significant differences starting from Week 8.ConclusionsAmong various ways of administration of TA, oTA + RTA has the best effect on melasma. In the short term, the curative effect of oTA is better than that of iTA, and the onset time of oTA is faster than that of tTA, iTA and MNsTA. In the long run, the curative effect of TA alone has nothing to do with the mode of administration.

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“…5 The treatment regimen that is most commonly used is monthly intradermal microinjections of TXA 4 mg/mL at the site of melasma, keeping a distance of around 1 cm from each injection. 5,6 Reported side effects are mild and include irritation, erythema, scaling, and xerosis. 3 Hypopigmentation was reported as a side effect of oral TXA treatment but evidence of its association with intradermal TXA microinjections is lacking.…”

mentioning

confidence: 99%

Hypopigmentation as a side effect of melasma treatment with tranexamic acid intradermal microinjections

Litaiem

Daadaa

Karray

et al. 2020

Dermatologic Therapy

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Melasma is a chronic pigmentary disorder occurring commonly in women with dark skin types. It is a chronic often-relapsing condition that affects patient's quality of life. Its treatment is challenging. 1 The use of tranexamic acid (TXA), an antifibrinolytic agent, as a treatment of melasma was first reported in 1979. 2 Then, several studies have assessed its efficacy and safety. 3 Oral TXA has proved to be an effica

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A randomized, open-label, comparative study of oral tranexamic acid and tranexamic acid microinjections in patients with melasma

Cited by 32 publications

References 0 publications

Tranexamic acid in melasma: A focused review on drug administration routes

Tranexamic acid in melasma: A focused review on drug administration routes

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

Hypopigmentation as a side effect of melasma treatment with tranexamic acid intradermal microinjections

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