Tranexamic Acid for Melasma Treatment: A Split-Face Study

BACKGROUND Melasma is an acquired hyperpigmented skin disorder. Tranexamic acid (TXA) prevents ultraviolet radiation induced pigmentation in melasma through interfering with the plasminogen–plasmin pathway. OBJECTIVE This study was conducted to evaluate the therapeutic effect and safety of TXA by intradermal injection versus TXA with microneedling for melasma treatment. METHODS Fifty-six female patients with bilateral symmetrical melasma were recruited in a split-face study. All patients received an intradermal injection of TXA on one side of the face, and the other side received TXA with microneedling for 6 sessions at 2 weeks intervals. Clinical efficacy was assessed using a modified Melasma Area Severity Index (mMASI) score at the baseline and after treatment. Global photographs underwent blinded review by 2 dermatologists. Patient self-assessment and satisfaction were recorded. RESULTS After the treatment, the mMASI score was significantly reduced compared with the baseline in both treated sides ( p < .001). No significant difference between both treated sides ( p > .05). Patient satisfaction was higher in the microneedling-treated side than the intradermal-injected side ( p < .001). No significant adverse effects were observed in both treated sides. CONCLUSION Intradermal injection and microneedling of TXA could be safe and effective in melasma treatment. Microneedling of TXA was significantly more satisfying to the patients.