Intradermal injection of tranexamic acid versus platelet-rich plasma in the treatment of melasma: a split-face comparative study

Abstract

Millions of people throughout the world suffer from the acquired condition of hyperpigmentation known as melasma. Melasma is characterized by symmetrically oriented hyperpigmented macules and patches. Many treatment options are available with variable degrees of efficacy and tolerability. The aim of the work was to evaluate and compare the effectiveness and safety of intradermal tranexamic acid (TXA) versus intradermal platelet-rich plasma (PRP) in the treatment of various types of melasma. The current split-face prospective study included 40 cases with melasma. Tranexamic acid (TXA) was injected intradermally into the right side of the face by using a concentration of 4 mg/ml, while platelet-rich plasma (PRP) was injected intradermally into the left side. In both sides, a total of three sessions of treatment were provided, once every 4 weeks. Digital photographs were taken before each treatment session and 3 months after the last session. The modified melasma area severity index (mMASI) grading system and dermoscopy were used to assess the improvement in the condition. The disease severity and percentage of improvement were assessed by mMASI score before and after therapy across both sides of the face. along with determining the degree of satisfaction and side effects among the included cases. The mean mMASI score before therapy in the TXA side was 4.59 ± 2.87, while in the PRP side, the mean mMASI score before therapy was 4.72 ± 2.72 with no statistically significant difference between the two sides (p = 0.841). After 3 months of treatment, the mean mMASI score in the TXA-treated side was 2.49 ± 1.58 with a mean percentage of decrease of 45.67 ± 8.10%, while in the PRP side, the mean mMASI score after treatment was 2.17 ± 1.41 with a mean percentage of decrease of 53.66 ± 11.27%. There was a high statistically significant decrease in the mMASI score after treatment on both sides (p < 0.001); however, the percentage of score reduction in the PRP side compared to the TXA side was statistically higher. Intradermal injection with PRP revealed higher efficacy in the treatment of melasma as compared to TXA injection with no significant difference regarding the associated side effects.

A comparison of the effectiveness of intralesional tranexamic acid against platelet-rich plasma in the treatment of melasma

“…Likewise In the study by Elraouf et al there were 39 females among the included cases who represented 97.5% of the cases. 18 This was in agreement with Ewaiss et al's study, which showed that all the included cases in their study were females and the studies by Serra et al and Jin et al [19][20][21] In our study, the mean MASI Score of the tranexamic acid and PRP side before treatment was 7.54 and 6.92 respectively and post treatment MASI Score was 4.6 and 2.83 respectively. A study by Elraouf et al the mean MASI score after treatment did not reveal a difference between the two sides that is statistically significant (2.49±1.58 and 2.17±1.41 in the Tranexamic acid side and PRP side, respectively).…”

“…A study by Elraouf et al the mean MASI score after treatment did not reveal a difference between the two sides that is statistically significant (2.49±1.58 and 2.17±1.41 in the Tranexamic acid side and PRP side, respectively). 18 However, the percentage of score reduction was higher in the PRP side (53.66±11.27) as compared with the Tranexamic acid side (45.67±8.10) (p=0.014). Our results agreed with those of Mumtaz et al who showed that Intradermal PRP was significantly better than intradermal tranexamic acid in the management of melisma.…”

Comparison of the efficacy of Hydroquinone cream versus Hydroquinone cream plus Danggui Shaoyao powder in the treatment of melasma

“…Melasma is chronic disease as a result of increased symmetrical hyperpigmentation of the skin which presents in the form of light to dark brown macules and patches with regular borders [21][22][23][24]. Melasma is related to hyper-production of melanin in the face skin, but this pathogenesis has not been completely determined up to now.…”

Management of Melasma: Laser and Other Therapies—Review Study

“…Significant reductions in the melasma area and severity index (mMASI) score were observed on both sides after treatment ( p < 0.001). However, the percentage of score reduction was notably higher on the PRP-treated side compared to the TXA-treated side [ 54 ]. Furthermore, a recent study indicated that combining topical 5% tranexamic acid in a liposome based cream and autologous PRP injection is more effective than tranexamic acid alone [ 55 ].…”