A split face comparative study of safety and efficacy of microneedling with tranexamic acid versus microneedling with Vitamin C in the treatment of melasma

Menon, Ashok; Eram, Hafsa; Kamath, Prashanth R; Goel, Saumya; Babu, Anuradha Kakkanatt

doi:10.4103/idoj.idoj_22_19

Cited by 33 publications

(22 citation statements)

References 19 publications

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“…In a clinical trial conducted in Greece in 2019, Ismail et al 32 patients who had previously received medication that the researchers tried to correct these limitations in the current study. 34 Also, parallel studies were conducted in Iran by Pazyar et al, 35 which showed that TXA was safe and effective in treating melasma, similar to the present study's findings. The final recommendation of the study is to increase the dose of TXA.…”

Section: Discussionsupporting

confidence: 89%

“…The findings of the current study align with the results reported by Menon. Several limitations were identified in Menon's investigation, including a limited number of microneedling sessions, a short‐term follow‐up period, a low drug concentration, a lack of examination of disease recurrence, and some patients who had previously received medication that the researchers tried to correct these limitations in the current study 34 …”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the effectiveness of microneedling with tranexamic acid in comparison with microneedling with vitamin C in the treatment of melasma: A prospective and single‐blind clinical trial

Pazyar,

Raeispour,

Yaghoobi

et al. 2023

Health Science Reports

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Background and AimsMelasma is a common skin condition. Microneedling acts as a dermal delivery system that facilitates the penetration of lightening agents such as vitamin C and tranexamic acid (TXA) into the deeper layers of the skin. Therefore, this study aimed to compare the effectiveness of microneedling with TXA with microneedling and vitamin C in treating melasma.MethodsIn patients with melasma, microneedling was performed at 2–3 mm depth. During that, TXA and vitamin C were poured on the skin of each side of the face, and then each ampoule was soaked for 15 min. This method was performed three times in 2‐week intervals, and the results were compared by measuring the Melasma Area and Severity Index (MASI) score before, during, and 2 months after the completion of the treatment.ResultsThe average MASI score in the baseline in the TXA group was 4.61, and in the vitamin C group was 4.58. The average MASI score in the patients treated with TXA in the last treatment session was 2.40, and the group treated with vitamin C was 2.44. The study results showed that the treatment was effective in both groups based on MASI score. Although there was a difference between the responses of the two groups, it was not significant.ConclusionMicroneedling with vitamin C and TXA is a safe and effective treatment option without side effects for treating melasma.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Evaluation of the effectiveness of microneedling with tranexamic acid in comparison with microneedling with vitamin C in the treatment of melasma: A prospective and single‐blind clinical trial

Pazyar,

Raeispour,

Yaghoobi

et al. 2023

Health Science Reports

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“…35 Another split-face study comparing microneedling 4 mg/ml TXA and 20% vitamin C in 30 patients found that they both showed significant improvement in melasma, with the TXA side having slightly better improvement and higher patient satisfaction by the 8th week (dermaroller, 1.5 mm needle length). 36 Overall, while microneedling with either TXA or vitamin C significantly improves melasma, TXA generally had higher patient satisfaction, which the authors suggest could be due to its ability to reduce vascularity and therefore erythema in the area.…”

Section: Evidencementioning

confidence: 93%

“…These results were mirrored in another study, which compared microneedling 100 mg/ml TXA with microneedling 20% vitamin C for five sessions over 10 weeks (dermapen, 1.5 mm needle length) They also found that both vitamin C and TXA significantly decreased pigmentation, dark fine granules, and pseudo reticular brown networks, while only TXA significantly reduced vascularization 35 . Another split‐face study comparing microneedling 4 mg/ml TXA and 20% vitamin C in 30 patients found that they both showed significant improvement in melasma, with the TXA side having slightly better improvement and higher patient satisfaction by the 8th week (dermaroller, 1.5 mm needle length) 36 . Overall, while microneedling with either TXA or vitamin C significantly improves melasma, TXA generally had higher patient satisfaction, which the authors suggest could be due to its ability to reduce vascularity and therefore erythema in the area.…”

Section: Introductionmentioning

confidence: 96%

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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“…22 Intralesional TXA has been reported to be superior to cryotherapy regarding both safety and efficacy. 23 On the other hand, microneedling with TXA yielded better but not statistically significant results compared to microneedling with vitamin C. 24 In another study, local infiltration of TXA combined with 4% hydroquinone resulted in significantly better outcomes than hydroquinone alone, 25 showing the efficacy of TXA as an adjunct therapy. 26 Another finding of the current study was the significantly higher frequency of complications, including erythema, edema, and scaling with TXA mesoneedling vs. TXA microinjections.…”

Section: Discussionmentioning

confidence: 99%

Tranexamic acid microinjections versus tranexamic acid mesoneedling in the treatment of facial melasma: A randomized assessor‐blind split‐face controlled trial

Poostiyan

Alizadeh

Shahmoradi

et al. 2023

J of Cosmetic Dermatology

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Background: Melasma is a hyperpigmentary disorder causing cosmetic disfigurement.We aimed to compare the efficacy and safety of tranexamic acid (TXA) microinjections with TXA mesoneedling for facial melasma.Methods: This randomized assessor-blind split-face controlled trial included patients with symmetric facial melasma. One side of the face received TXA (100 mg/ml) mesoneedling and the other side intradermal TXA microinjections. The interventions were repeated three times with 4-week intervals (weeks 0, 4, and 8). The primary outcome was improvement in modified Melasma Area and Severity Index (mMASI) 4 weeks after the final treatment session. Secondary outcomes were complications and patient satisfaction with the treatments evaluated by a visual analog scale (VAS).Results: All 27 patients included in the study were female (mean age: 44.22 ± 8.39 years).Both groups were comparable in terms of mMASI scores before and after treatment (standardized mean difference [SMD] = 0.32, 95% confidence interval [CI] −0.22; 0.85, p = 0.248 and SMD = −0.13, 95% CI −0.66; 0.40, p = 0.633, respectively). The mMASI score change from baseline was not different (SMD = −0.39, 95% CI −0.93; 0.15, p = 0.157). However, patient satisfaction was significantly higher with TXA mesoneedling (SMD = 0.77, 95% CI 0.21; 1.32, p = 0.007). Post-inflammatory hyperpigmentation occurred in one patient in the TXA mesoneedling group. Erythema, scaling, and edema were significantly higher with TXA mesoneedling (p < 0.001).Conclusions: TXA mesoneedling was comparable with TXA microinjection in the treatment of facial melasma, while patient satisfaction was significantly higher with TXA mesoneedling; however, the high frequency of complications occurring with this treatment should be taken into account.

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A split face comparative study of safety and efficacy of microneedling with tranexamic acid versus microneedling with Vitamin C in the treatment of melasma

Cited by 33 publications

References 19 publications

Evaluation of the effectiveness of microneedling with tranexamic acid in comparison with microneedling with vitamin C in the treatment of melasma: A prospective and single‐blind clinical trial

Evaluation of the effectiveness of microneedling with tranexamic acid in comparison with microneedling with vitamin C in the treatment of melasma: A prospective and single‐blind clinical trial

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

Tranexamic acid microinjections versus tranexamic acid mesoneedling in the treatment of facial melasma: A randomized assessor‐blind split‐face controlled trial

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