Efficacy of topical versus intradermal injection of Tranexamic Acid In Egyptian melasma Patients: A randomised clinical trial

Abstract

Background: Melasma is one of the common pigmentary problems affecting females in our community, owing to the frequent use of hormonal contraceptives as well as our sunny climate. A lot of treatment options are available but none of them is completely satisfactory. Many patients prefer the use of topical preparations and minimally invasive methods. Tranexamic acid (TA) is a potential treatment option for hyperpigmentation with different delivery routes. Aim:We designed the study in order to evaluate the efficacy of TA in melasma using 2 different routes of delivery.Patients and methods: A randomised clinical trial was performed on 60 female patients with melasma, they randomly divided into three groups; A, B and C. Group (A) patients received TA (4 mg/mL) intradermal injections every 2 weeks with, group B received TA (10 mg/mL) intradermal injections every 2 weeks, group C received TA cream (10% concentration) twice daily, treatment continued for 12 weeks in all groups. Melasma Area and Severity Index (MASI) scores were measured for each patient before and after completion of treatment. Results:The percentage of MASI score reduction was highest in group B (62.7%) versus (39.1%) in group A, while the percentage of MASI reduction was the lowest in group C (4.2%). Conclusion:Tranexamic acid is a safe effective and well-tolerated treatment option for melasma patients. Intradermal injection of TA leads to better results than the topical application. Topical TA cream (even in a high concentration) produce fair improvement of melasma.

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

“…The MASI scores decreased by 39.1% for the 4 mg/ml, 62.7% for the 10 mg/ml group with no significant difference between them ( p = 0.070). The topical MASI group decreased by 4.2%, which was significantly different than both intralesional groups 42 …”

Safety and efficacy of mesotherapy in the treatment of melasma: A review article

“…On the contrary, a subsequent RCT by Badran et al reported significantly higher reduction in MASI score with different concentrations of TXA mesotherapy (4 mg/cc and 10 mg/cc) compared to topical TXA 10% cream (39.1%, 62.7%, and 4.2%, respectively). Irritation was reported in topical therapy group, and pain was reported in mesotherapy groups 19 …”

“…Injections were performed at 1 mm depth and 1 cm distance by 28–30‐gauge insulin syringe. Follow‐up periods were between 1 and 12 months 7–33 . Based on published articles, significant reductions in melasma area and severity index (MASI) scores were reported with TXA mesotherapy, from 33.3% to 81.2%.…”

“…Therefore, TXA inhibits angiogenesis by suppression of VEGF, endothelin (ET)‐1, and IL‐8, while reducing the number of mast cells. It also causes competitive inhibition of tyrosinase (an important enzyme in melanogenesis) 7–33 …”

“…Irritation was reported in topical therapy group, and pain was reported in mesotherapy groups. 19 There were 5 articles that evaluated efficacy of TXA mesotherapy with hydroquinone (HQ) or triple combination cream (TCC). In a RCT, Patil et al examined the efficacy of TXA mesotherapy (4 mg/cc) compared with TCC (2% HQ, 0.025% tretinoin and 0.01% fluocinolone acetonide).…”