Evaluation of Micro-Needling Followed by Tranexamic Acid Cream versus Micro-Needling Followed by Tranexamic Acid Solution in Treatment of Melasma: A Comparative Split Face Study

Abstract

elasma is a common pigmentary disorder clinically characterized by symmetric light brown to bluish-gray macules and patches with irregular, sharp borders that affect cutaneous areas, particularly the face and neck. It is commonly identified in women of reproductive ages and more commonly described in darker-skinned patients with Fitzpatrick skin types IV to VI residing in high-intensity (UVR) worldwide as in Hispanic, Asian, and Afro-descendant countries. It causes significant cosmetic disfigurement, psychosocial stress, and embarrassment, affecting patients’ quality of life. Various underlying risk factors have been implicated in the etiology of melasma including; genetic factors, pregnancy, oral contraceptives, endocrine dysfunction, hormonal treatments, drugs (phototoxic agents, phenothiazines, anticonvulsants), cosmetic contact sensitivity, and exposure to (UV) light. Our study aimed to evaluate the efficacy and safety of microneedling followed by application of TXA cream 5% versus microneedling followed by TXA solution 5% in the treatment of melasma.

This prospective split-face comparative study included thirty female patients with different types of melasma, their ages ranged from 25 to 40 years, recruited from the Dermatology outpatient clinic of Ain Shams University Hospitals. The right side of the face was treated with 3 sessions of microneedling followed by TXA cream 5 % one month apart as well as application of TXA cream 5 % by the patient twice daily during 3 months. While the left side of the face was treated with 3 microneedling sessions followed by TXA solution 5 % one month apart. Our findings showed significant improvement in a different type of melasma regarding Hemi MASI score, patients’ satisfaction score, and area percentage of melanin concentration assessed by histopathological examination by FM stain one month after 3rd treatment session in both sides of the face. However, a minor melasma recurrence was observed two months after 3rd treatment session on both sides of the face.