Therapeutic efficacy and safety of oral tranexamic acid and that of tranexamic acid local infiltration with microinjections in patients with melasma: a comparative study

BackgroundTranexamic acid (TXA) has been used orally, intravenously, topically and intradermally (microinjection, microneedling) for treating melasma. However, the comparative efficacy of these different routes of administration remains underevaluated. AimTo ascertain the comparative efficacy of different routes of administration of TXA. MethodsIn total, 100 consecutive patients with melasma (8 men, 92 women, age range 18-55years) were randomly assigned to one of two groups comprising 50 patients each. Group A (3 men, 47 women) received oral TXA 250mg twice daily, while group B (5 men, 45 women) received intradermal microinjections of TXA 4mg/mL every 4weeks. The treatment continued for 12weeks in both groups. Percentage reduction in baseline Melasma Area and Severity Index (MASI) was assessed at 4-week intervals, and response was scored as very good (>75% reduction), good (50% to <75% reduction), moderate (25% to <50% reduction), mild (<25% reduction) or no response. ResultsThe study was completed by 39 patients in group A and 41 patients in group B. Very good response was seen in 25 and 32 patients in groups A and B, respectively, while good response was seen in 14 and 9 patients, respectively. Both treatment methods were equally effective, with an average reduction of MASI at 12weeks of 77.969.39 in group A and 79.00 +/- 9.64 in group B. The main adverse effects were mild epigastric discomfort, hypomenorrhea, headache and injection site pain, which did not warrant discontinuation of treatment. Two patients in group A had relapses at 24weeks. ConclusionTXA appears to be an effective and safe treatment for melasma, irrespective of its route of administration.