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

Abstract

Background: Melasma is a hyperpigmentary disorder causing cosmetic disfigurement.We aimed to compare the efficacy and safety of tranexamic acid (TXA) microinjections with TXA mesoneedling for facial melasma.Methods: This randomized assessor-blind split-face controlled trial included patients with symmetric facial melasma. One side of the face received TXA (100 mg/ml) mesoneedling and the other side intradermal TXA microinjections. The interventions were repeated three times with 4-week intervals (weeks 0, 4, and 8). The primary outcome was improvement in modified Melasma Area and Severity Index (mMASI) 4 weeks after the final treatment session. Secondary outcomes were complications and patient satisfaction with the treatments evaluated by a visual analog scale (VAS).Results: All 27 patients included in the study were female (mean age: 44.22 ± 8.39 years).Both groups were comparable in terms of mMASI scores before and after treatment (standardized mean difference [SMD] = 0.32, 95% confidence interval [CI] −0.22; 0.85, p = 0.248 and SMD = −0.13, 95% CI −0.66; 0.40, p = 0.633, respectively). The mMASI score change from baseline was not different (SMD = −0.39, 95% CI −0.93; 0.15, p = 0.157). However, patient satisfaction was significantly higher with TXA mesoneedling (SMD = 0.77, 95% CI 0.21; 1.32, p = 0.007). Post-inflammatory hyperpigmentation occurred in one patient in the TXA mesoneedling group. Erythema, scaling, and edema were significantly higher with TXA mesoneedling (p < 0.001).Conclusions: TXA mesoneedling was comparable with TXA microinjection in the treatment of facial melasma, while patient satisfaction was significantly higher with TXA mesoneedling; however, the high frequency of complications occurring with this treatment should be taken into account.

The efficacy and safety of microneedling with topical tranexamic acid for melasma treatment: A systematic review and meta‐analysis

“…Three studies 12,22,34 compared microneedling with topical TXA to microinjections with TXA; the pooled analysis suggested that intradermal microinjections with TXA were more effective (overall effect, SMD = 1.94, 95% CI = 1.02–2.87; Figure S10). Due to less skin trauma, less pain, and shorter treatment sessions, patient satisfaction and tolerance of microneedling were higher 22,34 …”

“…In the 16 studies, 621 patients were included. Three studies 12,22,34 evaluated the efficacy and safety between microneedling and microinjection with TXA; four studies 21,[31][32][33] adopted microneedling with vitamin C in control; and three studies 20,24,26 used microneedling alone or with placebo in control; two 23,28 included 4% hydroquinone; two 25,29 used a laser with TXA; one 27 employed microneeding with platelet rich plasma (PRP); and one 30 included oral TXA.…”

“…7 TXA is an off-label drug used to treat refractory melasma because it inhibits melanin synthesis via the plasminogen-plasmin pathway and modulates the number of vessels and mast cells in melasma-associated dermal changes, as found via histological evaluation, dermoscopy, reflectance confocal microscopy, and Visia. 7,[33][34][35][36][37] TXA is available in topical, intralesional, and oral formulations, 38 among which oral TXA was found to be the most effective, particularly in cases of refractory melasma. Due to the drug's thrombotic nature, oral TXA has the possibility to cause a gastrointestinal reaction and menstrual irregularities in many patients; therefore, further consideration must be given before prescription.…”

Comment on article by Poostiyan et al.: Tranexamic acid microinjections versus tranexamic acid mesoneedling in the treatment of facial melasma: A randomized assessor‐blind split‐face controlled trial

“…In conclusion, we would like to voice our cordial thanks to Poostiyan et al 1 as a result of their hard work, once again. To reach a definitive conclusion, additional studies with larger sample sizes are needed to emphasize these conclusions.…”

“…It was with great interest that we read the paper by Poostiyan et al 1 entitled “Tranexamic acid microinjections versus tranexamic acid mesoneedling in the treatment of facial melasma: A randomized assessor‐blind split‐face controlled trial” published on Journal of Cosmetic Dermatology . The authors found comparable improvement in modified Melasma Area and Severity Index (mMASI) scores with both Tranexamic acid (TXA) mesoneedling and TXA microinjections for the treatment of facial melasma.…”