Abstract

ABSTRACT:
BACKGROUND:
Melasma is an acquired hyperpigmentation of the skin. Exacerbating factors include pregnancy, use
of oral contraceptives and sunexposure.
OBJECTIVE:
To study the effectiveness of intralesional tranexamic acid in the treatment of melasma.
PATIENTS AND METHODS:
This is an interventional single-blinded comparative outpatient study carried out at the Center
of Dermatology, Baghdad Teaching Hospital during the period from March 2017 to May 2018.
Forty patients with melasma were included in the study. The patients were divided into three
groups. Group A was treated with tranexamic acid 4mg/ml delivered by microneedling approach
at monthly interval for 3 months with topical hydroquinone 4% daily at night for 3 months. Group B
was treated with intradermal injection of 4mg/ml of tranexamic acid by using insulin syringe
monthly for 3 months with topical hydroquinone 4% daily at night. Group C was treated with
topical hydroquinone 4% daily at night for 3 months.
The severity of melasma was assessed before, during and after treatment with the melasma area and
severity index (MASI) score. Every patient was instructed to apply a broad-spectrum sunscreen
before sun exposure during the treatment period.
RESULTS:
Thirty-two patients with melasma completed the study. In group A: Eleven patients were included,
the mean age and SD was 33.81 ± 4.55 years. The MASI score before treatment was 5.31 ±1.65,
whereas after treatment it became 3.69± 1.79 (P value: 0.0001). The reduction of MASI score was
32.39%. In group B: Eleven patients were included, the mean age and SD was 39.72 ±6.27 years.
The MASI score before treatment was 4.52±1.79, whereas after treatment it became 3.50 ±1.61
(P value: 0.002). The reduction of MASI score was 20.96%. In group C: Ten patients were
included, the mean age and SD was 37.20 ± 7.55 years. The MAI score before treatment was
4.01±1.07 whereas after treatment became 3.13±0.17 (p value=0.002). The reduction in the MASI
score was 14.11. The percent reduction in the MASI score at follow up visits was significantly
higher in group A than in groups B and C ( p value= 0.026) while there were no significant
difference between group B and C.
CONCLUSION:
Tranexamic acid is an effective drug when it used with other conventional treatments of melasma,
and the microneedling approach of delivering tranexamic acid showed better response than the
other modes of drug delivery and this may be due to uniform delivery of the drug through the
microchannels.