Randomized, double‐blind, placebo‐controlled split‐face trial of the efficacy of tranexamic acid by drug delivery through microneedling in the treatment of melasma

Abstract

Melasma is a skin pigmentation disorder characterized by irregular brownish macules, symmetrically distributed in photoexposed areas, most commonly on the face. It is more common in women, with a higher phototype (III-IV) and in fertile age. Due to the high prevalence, the predominantly facial involvement, and the high index of therapeutic recurrence, melasma has an important impact on quality of life, being a frequent cause of dermatological consultations. 1,2 The exact pathophysiology of melasma is not yet known.However, some triggering factors are already well described, such as ultraviolet radiation, pregnancy, use of hormonal therapies, photosensitizing medications, inflammatory stimuli, and stressful events. Genetic factors are also involved, evidenced by the high prevalence of associated family history.

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

“…Results showed improvement in both sides with a better, but not significant, improvement in the TXA side using the hemi-MASI scale. 28 Comparatively, another study performed microneedling to the entire face with the application of 10% TXA to one side and distilled water on the other side in 40 patients (dermaroller, 1 mm depth). This was done four times every 2 weeks with a final visit at week 8.…”

“…A double‐blind, split‐faced RCT compared microneedling topical 5% TXA to microneedling with a placebo in 3 monthly sessions for 20 patients in addition to a topical treatment regimen of 0.5% retinoic acid, 4% hydroquinone, and 0.01% fluocinolone acetonide (polyethylene roll, 1.5 mm needle length). Results showed improvement in both sides with a better, but not significant, improvement in the TXA side using the hemi‐MASI scale 28 . Comparatively, another study performed microneedling to the entire face with the application of 10% TXA to one side and distilled water on the other side in 40 patients (dermaroller, 1 mm depth).…”

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

“…The goal of microneedling is to improve drug delivery, which has shown promising results with TXA in previous studies. 13 This has been challenged by Kuster et al, 19 who demonstrated that TXA through microneedling did not bring about any additional benefit to the treatment of melasma; nonetheless, they first performed microneedling and then applied TXA. Contrarily, Ebrahim et al 20 showed that microneedling of TXA was as safe and effective as its intradermal injection with higher patient satisfaction with microneedling, which is in line with our findings.…”

Effectiveness of combination therapy of broadband light and intradermal injection of tranexamic acid in the treatment of chloasma

“…Photoelectric therapy like intense pulsed light and various lasers have also been used 14,16–19 . However, the treatment approach of using a single method has certain limitations; thus, combination therapy is more likely to be developed and applied in the clinical treatment of melasma 5,20 …”

“…At present, there are various treatments for melasma, including photoelectric and drug therapies 4 . Tranexamic acid (TA) has been used in the treatment of melasma and has shown good therapeutic effects; it is given orally or via intradermal injection 5–7 . Photoelectric therapy is also one of the main treatment methods for melasma.…”