Abstract
Objective: To compare the efficacy of Intradermal Tranexamic acid and topical 20% Azelaic acid cream in the treatment of melasma.
 Study Design: Comparative prospective study.
 Place and Duration of Study: Dermatology department, Combined Military Hospital Peshawar, from Sep 2018 to Mar 2019.
 Methodology: A total of 116 female patients, at the outpatient department of dermatology at Combined Military Hospital Peshawar, were randomly assigned into two groups; group A (intradermal tranexamic acid) and group B (topical azelaic acid) by lottery method. Patients in group A received intradermal injection, while the participants of group B received topical azelaic acid only, fortnightly for 6 weeks. Melasma area severity index score was calculated for each patient in both groups at the start and at the end of the treatment.
 Results: The mean Melasma area severity index score in group A (intradermal tranexamic acid) before and at 6 weeks of treatment was 7.10 ± 2.94 and 5.27 ± 2.44, respectively. The mean Melasma area severity index score in group B (topical azelaic acid) before and at 6 weeks of treatment was 7.56 ± 2.57 and 5.76 ± 2.89, respectively. Efficacy of intradermal tranexamic acid, as poor response, good response and excellent response was 27.6%, 41.4% and 31% respectively. While, efficacy of topical azelaic acid group as poor response, good response and excellent response was 62.1%, 20.7% and 17.2% respectively. The difference was statistically significant, (p=0.001).
 Conclusion: It can be concluded that intradermal tranexamic acid is more effective as compared to topical 20% azelaic acid in..................
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