Comparison between the efficacies of topical tranexamic acid versus intralesional tranexamic acid in treatment of melasma

trenexemic acid in melasma

Authors

  • Mohsina Awais Department of Dermatology, Fatima Jinnah Medical University/ Sir Gangaram Hospital, Lahore.
  • Saadiya Siddiqui Assistant Professor of Dermatology, Ammerudin Medical College/Post Graduate Medical Institute/ General Hospital, Lahore.
  • Maimona Ilyas Department of Dermatology, Fatima Jinnah Medical University/ Sir Gangaram Hospital, Lahore.
  • Maryam Qayyum Department of Dermatology, Fatima Jinnah Medical University/ Sir Gangaram Hospital, Lahore.
  • Atif Shahzad Associate Professor of Dermatology, Allama Iqbal Medical College/ Jinnah Jospital, Lahore.
  • Nadia Ali Azfar Professor of Dermatology, Gujranwala Medical College, Gujranwala.

Keywords:

pakistani women, melasma, tanexemic acid, intralesional, topical

Abstract

ABSTRACT    Melasma is a common acquired disorder of hyperpigmentation and its treatment often necessitates a multifaceted approach especially in refractory cases. Topical tranexamic acid is commonly used but studies claimed that intralesional injection of tranexamic acid was more efficacious. OBJECTIVE: To compare the efficacy of tranexamic acid intralesional (localized microinjections) versus topical therapy in the treatment of melasma.  METHODOLOGY: This study involved 72 patients of melasma of both genders  between 20-50 years, randomly allocated into two treatment groups. Group-A was given topical TXA while Group-B was treated with intradermal injection of TXA. Efficacy was labeled as ≥50% reduction in baseline MASI score after 12 weeks of treatment. RESULTS: The mean age of the patients was 30.53±8.68 years. There were 13 (18.1%) male and 59 (81.9%) female patients. Majority (n=49, 68.1%) of the patients had Fitz-Patrick Type-V skin phototype.Moderate melasma in 47 (65.3%) patients and severe in 25 (34.7%) patients. Melasma was epidermal in 43 (59.7%) patients while dermal and mixed type was noted in 18.1% and 22.2% patient’s respectively. The frequency of efficacy was significantly higher in patients treated with intralesional TXA as compared to topical TXA (66.7% vs. 27.8%; p-value=0.001). CONCLUSION: Intralesional injection of tranexamic acid was found superior to conventional practice of its topical application in the management of patients with melasma regardless of patient’s age, gender, marital and educational status, skin type and type, pattern and severity of disease which along with its well established safety profile and convenience of once-weekly dosage advocate the preferred use of this novel approach in the management of such patients in future dermatologic practice. KEY WORDS: Melasma, Topical, Intralesional, Tranexamic Acid

Author Biography

Saadiya Siddiqui, Assistant Professor of Dermatology, Ammerudin Medical College/Post Graduate Medical Institute/ General Hospital, Lahore.

assistant professor dermatology Ammerudin medical college /post graduate medical institute lhr

References

A review of treatments for melasma, British Journal of Dermatology, Volume 187, Issue 3, 1 September 2022, Page e135, https://doi.org/10.1111/bjd.21725

Christopher EM. Griffith’s MD Acquired pigmentary disorders, melasma, Rook’s textbook of Dermatology, 9th edition. 2016; 88: 10-12.

Majid I, Aleem S, Melasma: Update on Epedemiology, Clinical Presentation, Assesment, and Scoring. J Skin Stem Cell. 2021; 8(4):e120283. doi: 10.5812/jssc.120283

Espósito ACC, Cassiano DP, da Silva CN, Lima PB, Dias JAF, Hassun K, Bagatin E, Miot LDB, Miot HA. Update on Melasma-Part I: Pathogenesis. Dermatol Ther (Heidelb). 2022 Sep;12(9):1967-1988. doi: 10.1007/s13555-022-00779-x. Epub 2022 Jul 29. PMID: 35904706; PMCID: PMC9464278.

Kim EH, Kim YC, Lee ES, Kang HY. The vascular characteristics of melasma. J Dermatol Sci 2007;46(2):111-6.

Aishwarya K, Bhagwat PV, John N. Current concepts in melasma - A review article. J Skin Sex Transm Dis 2020;2(1):13-7.

Aamir S, Naseem R. Oral tranexamic acid in treatment of melasma in Pakistani population: a pilot study. J Pak Assoc Dermatol 2014;24(3):198-203.

Sarkar SK, Sen KG, Mostofa MK, Das AR, Saha SK, Islam MS. The role of triple combination topical agents in the treatment of facial melasma. Faridpur Med Coll J 2017;12(2):68-70.

Freitag FM, Cestari TF, Leopoldo LR, Paludo P. Boza JC. Effect of melasma on quality of life in a sample of women living in southern Brazil. J Eur Acad Dermatol Venereol 2008;22:655-62.

Gupta AK, Gover MD, Nouri K, Taylor S. The treatment of melasma: a review of clinical trials. J Am Acad Dermatol 2006;55:1048-65.

Bentley-Phillips B, Bayles MA. Cutaneous reactions to topical application of hydroquinone. Results of a 6-year investigation. S Afr Med J 1975;49:1391-5.

Li YH, Chen JZ, Wei HC, Wu Y, Liu M, Xu YY, et al. Efficacy and safety of intense pulsed light in treatment of melasma in Chinese patients. Dermatol Surg 2008;34:693-700.

Hurley ME, Guervara IL, Gonzales RM, Pandya AG. Efficacy of glycolic acid peels in the treatment of melasma. Arch Dermatol 2002;138:1578-82.

Lee JH, Park JG, Lim SH, Kim JY, Ahn KY, Kim MY, et al. Localized intradermal microinjection of tranexamic acid for treatment of melasma in Asian patients: a preliminary clinical trial. Dermatol Surg 2006;32:626-31.

Maeda K, Tomita Y. Mechanism of the inhibitory effect of tranexamic acid in melanogenesis in cultured human melanocytes in the presence of keratinocytes-conditioned medium. J Health Sci 2007;53(4):389-96.

Khurana VK, Misri RR, Agarwal S, Thole AV, Kumar S, Anand T. A randomized, open-label, comparative study of oral tranexamic acid and tranexamic acid microinjections in patients with melasma. Indian J Dermatol Venereol Leprol 2019;85:39-43.

Atefi N, Dalvand B, Ghassemi M, Mehran G, Hevdarian A. Therapeutic effects of topical tranexamic acid in comparison with hydroquinone in treatment of women with melasma. Dermatol Ther 2017;7(3):417-24.

Kondou S, Okada Y, Tomita Y. Clinical study of effect of tranexamic acid emulsion on melasma and freckles. Skin Res 2007;6:309-15.

Kim S J, Park JY, Kang HY. Efficacy and possible mechanism of topical tranexamic acid in melasma. Clin Exp Dermatol 2016;41(5):1-9.

Shetty VH, Shetty M. Comparative study of localized intradermal microinjection of tranexamic acid and oral tranexamic acid for the treatment of melasma. Int J Res Dermatol 2018;4:363-7.

Veggalam V, Perumalla N. Intralesional tranexamic acid: safe and effective way of treatment for melasma. Indian J Drugs Dermatol 2017;3:81-3.

Steiner D, Feola C, Bialeski N, de Morais e Silva FA, Antiori ACP, Addor FASA, et al. Study evaluating the efficacy of topical and injected tranexamic acid in treatment of melasma. Surg Cosmet Dermatol 2009;1(4):174-7.

Ejaz A, Raza N, Iftikhar N, Muzzafar F. Comparison of 30% salicylic acid with Jessner’s solution for superficial chemical peeling in epidermal melasma. J Coll Physicians Surg Pak 2008;18:205-8.

Aman S, Nadeem M, Mahmood K, Ghafoor MB. Pattern of skin diseases among patients attending a tertiary care hospital in Lahore, Pakistan. J Taibah Uni Med Sci 2017;12(5):392-6.

Ali R, Aman S, Nadeem M, Kazmi AH. Quality of life in patients of melasma. J Pak Dermatol 2013;23(2):143-8.

SDesale SP, Gugle AS, Kote R, Jadhav VM. Comparative study of efficacy of glycolic acid peel and intense pulsed light in the treatment of melasma. MVP J Med Sci 2015;2(1):39-48.

Divya KG, Narasimhan M, Rajagopalan V, Parveen B. Efficacy and safety of 70% glycolic acid versus q switched ND: YAG laser in the treatment of melasma: a comparative study. Int J Res Dermatol 2017;3(1):1-6.

Kakru SN, Raihan M, Beg MA, Kakroo B. Efficacy of oral tranexamic acid in the treatment of melasma: a pilot study. Int Arch BioMed Clin Res 2017;3(4):93-6.

Bari AU, Iqbal Z, Rahman SB. Tolerance and safety of superficial chemical peeling with salicylic acid in various facial dermatoses. Indian J Dermatol Venereol Leprol 2005;71(2):87-90.

Budamakuntla L, Loganathan E, Suresh D, Shanmugam S, Dongare A, Prabhu N, et al. A randomised, open-label, comparative study of tranexamic acid microinjections and tranexamic acid with microneedling in patients with melasma. J Cutan Aesthet Surg 2013;6(3):139.

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Published

2023-08-07

How to Cite

1.
Awais M, Siddiqui S, Ilyas M, Qayyum M, Shahzad A, Azfar NA. Comparison between the efficacies of topical tranexamic acid versus intralesional tranexamic acid in treatment of melasma: trenexemic acid in melasma. J Pak Assoc Dermatol [Internet]. 2023Aug.7 [cited 2024Nov.8];33(3):883-90. Available from: https://www.jpad.com.pk/index.php/jpad/article/view/2254

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