The efficacy of oral vs different dilutions of intradermal tranexamic acid microinjections in melasma—A randomized clinical trial

Abstract

Melasma is a common acquired disorder of pigmentation, remains challenging despite numerous treatment modalities. Tranexamic acid (TXA) has emerged as a potential treatment for melasma. Different forms of TXA (oral, topical, and intradermal microinjections) have shown promising results. To evaluate and compare the efficacy of oral vs different dilutions of intradermal TXA in melasma. A total of 45 female patients with melasma were randomly and equally assigned to three treatment groups. Group A (oral TXA 250 mg bid), Group B (100 mg/mL intradermal TXA) & Group C (4 mg/mL intradermal TXA) every 2 weeks, treatment period was 8 weeks.At 8 weeks, a significant reduction in the mMASIwas noted in groups A, B, and C (P value .002, .003, and .005). Melanin index (MI) was significantly reduced in groups A, B, and C (P value .016, .005, and .003). Erythema index (EI) showed significant improvement in group A (P value .028), however was statistically insignificant for groups B and C. No statistically significant difference was found between the three groups as regards changes in mMASI, MI, and EI at 8 weeks. Both oral and intradermal microinjections of TXA regardless dilution appear to be effective and safe in treatment of melasma with comparable results.

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

“…Oral therapy showed rapid reduction in mMASI and EI compared to mesotherapy. Furthermore, maximum effectiveness in mesotherapy group was observed after 1 month; thus, it was assumed that monthly interval of injection may be sufficient for mesotherapy 12 …”

“…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 …”

“…Different concentrations of TXA from 4 to 100 mg/cc were utilized. Three RCTs found no significant difference between different concentrations of TXA mesotherapy (4 mg/cc vs. either 10 mg/cc or 100 mg/cc) regarding erythema index (EI), melanin index (MI), MASI, or modified MASI (mMASI) scores 12,13,18 . The 4 mg/cc concentration showed significantly higher percentage of patient’s satisfaction compared to 10 mg/cc; while relapse was more frequent with 4 mg/cc versus 10 mg/cc (54.5% vs. 25%) 13 .…”

“…Two subsequent RCTs indicated no significant difference between TXA mesotherapy (4 mg/cc) and oral TXA (250 mg twice a day for 12 weeks). Side effects such as hypomenorrhea (15.4%–26.7%), epigasteric discomfort, and nausea (4%–26.7%) were reported with oral treatment 12,16 . Oral therapy showed rapid reduction in mMASI and EI compared to mesotherapy.…”

“…Side effects such as hypomenorrhea (15.4%-26.7%), epigasteric discomfort, and nausea (4%-26.7%) were reported with oral treatment. 12,16 Oral therapy showed rapid reduction in mMASI and EI compared to mesotherapy. Furthermore, maximum effectiveness in mesotherapy group was observed after 1 month; thus, it was assumed that monthly interval of injection may be sufficient for mesotherapy.…”