The efficacy and safety of topical tranexamic acid (liposomal or lotion with microneedling) versus conventional hydroquinone in the treatment of melasma

Xing, Xiaoxue; Chen, Li; Xu, Zhongyi; Jin, Shanglin; Zhang, Chengfeng; Xiang, Leihong

doi:10.1111/jocd.13810

Cited by 13 publications

(13 citation statements)

References 23 publications

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“…Given that microneedling has an added cost and requires more frequent office visits, the authors suggest that patients may be more adherent to topical HQ treatment. 33 Vitamin C is another compound that interferes with melanin formation and has been used to decrease hyperpigmentation.…”

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: Evidencementioning

confidence: 99%

“…They also found that the TXA formulations were better than the HQ treatment at reducing inflammation as shown by the erythema index. Given that microneedling has an added cost and requires more frequent office visits, the authors suggest that patients may be more adherent to topical HQ treatment 33 …”

Section: Introductionmentioning

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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“…Microneedles are applied to the skin with the drugs can not only transport active ingredients through the stratum corneum, but also generates multiple micropunctures with bleeding, which could stimulate the wound‐healing response, thereby initiating neocollagenesis and neo‐elastogenesis 40,41 . Two studies 37,42 demonstrated that microneedling with 5% TXA improves pigmentation and erythema, presented as significantly smaller melanin index (MI) and erythema index (EI), bigger improvement in physician assessments, and higher patient satisfaction with minimal side effects. Cassiano et al 40 compared microneedling with oral TXA and other treatments, demonstrating that TXA and microneedling act through two distinct pathways to alleviate melasma, with microneedling providing longer‐lasting remission than standard therapy.…”

Section: Discussionmentioning

confidence: 99%

“…12,39 Microneedles are applied to the skin with the drugs can not only transport active ingredients through the stratum corneum, but also generates multiple micropunctures with bleeding, which could stimulate the wound-healing response, thereby initiating neocollagenesis and neo-elastogenesis. 40,41 Two studies 37,42 providing longer-lasting remission than standard therapy. In order to increase the drug concentration at target melanosomal cells in the stratum basal layer of the epidermis and decrease incidence of adverse events, more and more novel microneedles, such as liposomes, trans-ethosomes, biocompatible polymers, and dissolving microneedles have been explored and developed.…”

Section: Ta B L E 1 (Continued)mentioning

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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“…However, due to its hydrophilic structure, TA is unable to permeate skin passively. Therefore, enhancement techniques such as liposomes or physical modalities (microneedling, lasers) are required to assist transdermal TA delivery [ 8 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of fractional erbium:YAG laser-assisted tranexamic acid delivery alone and in combination with oral tranexamic acid in melasma

et al. 2022

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Tranexamic acid (TA) emerged as a promising agent for melasma. However, due to its hydrophilic structure, topical TA should be combined with a penetration-enhancing strategy to augment efficacy. To evaluate the efficacy of fractional erbium:YAG laser-assisted delivery (LAD) of topical TA 5% either with or without oral TA treatment in recalcitrant melasma patients. The authors retrospectively assessed the treatment outcomes of melasma patients treated by fractional erbium:YAG LAD of topical TA 5%. Patients receiving a standard protocol including four biweekly laser sessions were eligible. The study included two groups: group 1 patients received oral TA and LAD of topical TA 5%, and group 2 patients received only LAD of topical TA 5%. Two blinded dermatologists reported pre-treatment and post-treatment modified MASI (mMASI) scores. Mean mMASI scores in both group 1 ( n = 15) and group 2 ( n = 19) were significantly lower at the end of the treatment than baseline values ( p = 0.001; p = 0.022, respectively). The decrease of mMASI scores were higher in group 1 (median = 2.1) (64.7%) than in group 2 (median = 1.2) (41.8%) ( p = 0.027). Fractional erbium:YAG LAD of topical TA 5% is an efficient treatment regimen for melasma patients recalcitrant to conventional treatment approaches. The implementation of oral TA to this regimen improves the therapeutic outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s10103-022-03547-7.

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The efficacy and safety of topical tranexamic acid (liposomal or lotion with microneedling) versus conventional hydroquinone in the treatment of melasma

Cited by 13 publications

References 23 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

Comparison of fractional erbium:YAG laser-assisted tranexamic acid delivery alone and in combination with oral tranexamic acid in melasma

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