Dermoscopic evaluation of tranexamic acid versus Vitamin C, with microneedling in the treatment of melasma: a comparative, split-face, single-blinded study

Tahoun, Asmaa Ibrahim; Mostafa, Wedad Z.

doi:10.1080/09546634.2021.1871582

Cited by 12 publications

(17 citation statements)

References 27 publications

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“…This may have contributed to increased patient satisfaction with the TXA‐treated side 34 . 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 .…”

Section: Introductionmentioning

confidence: 78%

“…34 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: 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: 78%

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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“…We retrieved 34 studies from three databases, of which 16 were published between 2013 and 2023 and were finally eligible for inclusion 12,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] (Figure 1). Detailed information of the included studies is presented in Table 1.…”

Section: Study Information and Participant Characteristicsmentioning

confidence: 99%

The efficacy and safety of microneedling with topical tranexamic acid for melasma treatment: A systematic review and meta‐analysis

Feng

Xie

2023

J of Cosmetic Dermatology

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ObjectiveMicroneedling with topical tranexamic acid (TXA) is a novel treatment option for melasma; however, the efficacy and safety of this combined administration therapy is in controversial. This study is conducted to address this issue of this technique in melasma.MethodsAn extensive literature review was performed to identify relevant trials, including randomized split‐face studies, randomized controlled trials and prospective non‐randomized split‐face studies, comparing microneedling plus topical TXA to routine treatments or placebo. The primary outcomes were changes of the Melasma Area Severity Index (MASI)/modified MASI (mMASI)/hemi MASI between before and after treatment, as well as the changes between a particular treatment and microneedling plus TXA. The mean differences (MDs) and 95% confidence intervals (CIs) were calculated for the reduction of melasma severity scores from baseline to each time point. In contrast, the standard mean differences (SMDs) and 95% CIs were calculated for the differences in reduction in melasma severity scores between the experimental and control groups at each time point.ResultsA total of 16 trials were included in the systematic review and data synthesis. The pooled analysis demonstrated that MASI, mMASI, and hemiMASI scores decreased significantly at 4 weeks (MD = 1.85; 95% CI = 1.15–2.54), 8 weeks (MD = 3.28; 95% CI = 2.31–4.24), 12 weeks (MD = 4.73; 95% CI = 2.79–6.50), 16 weeks (MD = 3.18; 95% CI = 1.50–4.85), and 20 weeks (MD = 3.20; 95% CI = 1.95–4.46) after treatment when compared with baseline. The reduction in melasma severity scores of microneedling with TXA group at 4 weeks was more significant than the routine treatment group (SMD = 0.97; 95% CI = 0.09–1.86), while insignificant at 8 weeks (SMD = 1.21; 95% CI = −0.17 to 2.59), 12 weeks (SMD = 0.63; 95% CI = −0.03 to 1.29), 16 weeks (SMD = 0.61; 95% CI = −2.85 to 4.07), or 20 weeks (SMD = 1.04; 95% CI = −1.28 to 3.36).ConclusionDespite the high heterogeneity across these studies, the current findings indicated that microneedling with topical TXA is an alternative treatment option for melasma treatment; and more well‐designed studies are needed to confirm it.

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“…TXA can be used safely and effectively in the treatment of melasma in various forms such as oral, intradermal, or topical application. Its safety profile has been thoroughly explored and elucidated [11,26,40,47,77], however, there is no controlled trial study in other ethnic groups, such as Africans, so further data collection and risk assessment is necessary for these groups [78].…”

Section: Tranexamic Acidmentioning

confidence: 99%

“…Hydroquinone is a first-line topical medical depigmentation therapy, that is used alone or in conjunction with other treatment modalities such as laser and or tranexamic acid [26][27][28]. Most documented treatments have primarily relied on the use of chemical methods [29][30][31][32], laser therapy [33][34][35][36][37][38], and topical creams [39][40][41][42][43]. However, the effectiveness of these treatment modalities is limited due to their adverse effects, especially in darker skin types [44].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Melasma on Darker Skin Types: a Scoping Review

Mpofana¹,

Chibi²,

Visser³

et al. 2022

Preprint

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Melasma is a challenging chronic skin condition associated with hyperpigmentation and un-known etiology. This scoping review mapped evidence of available treatments and their effectiveness in darker skin types. A comprehensive, systematic online search was conducted in Scopus, PubMed, CINAHL Complete, Cochrane, ScienceDirect, and Web of Science Core Collection. All eligible titles were exported to an Endnote20 library. Thematic content analysis was performed to summarise data on current melasma treatments for darker skin types. The quality of included articles was appraised using the Mixed Methods Appraisal Tool (MMAT) 2018 version. A total of 2863 articles were retrieved from the databases, and 10 met the eligibility criteria following abstract and full-text screening. Our findings demonstrate that topical treatments, chemical peels, lasers, and tranexamic acid are common treatment modalities used in darker skin types. Although these treatments may be effective in the short term, they bring about un-desirable side effects and sometimes worsen or result in reoccurrences of melasma. Based on the evidence mapped, current treatment modalities are not suitable for darker skin types. There are very few studies conducted on individuals of African descent. Further research is necessary to investigate treatment interventions which may be user-friendly when dealing with darker skin types.

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Dermoscopic evaluation of tranexamic acid versus Vitamin C, with microneedling in the treatment of melasma: a comparative, split-face, single-blinded study

Cited by 12 publications

References 27 publications

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

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

The efficacy and safety of microneedling with topical tranexamic acid for melasma treatment: A systematic review and meta‐analysis

Treatment of Melasma on Darker Skin Types: a Scoping Review

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