EVALUATION OF INTRADERMAL TRANXEMIC ACID INJECTION IN TREATMENT OF MELASMA

Abstract

Background: Melasma is an acquired skin disorder characterized by light to dark brown macules and patches occurring in the sun-exposed areas of the face. The major etiological factors include genetic influences, pregnancy, sex hormones, exposure to ultraviolet rays (UVR) radiation and cosmetics. The treatment of melasma remains a challenge. Numerous treatment options as topical agents, systemic depigmenting therapy, chemical peeling and laser have been included in melasma treatment. No single therapy has proven to be of benefit to all patients, combination of modalities can achieve more control especially in difficult cases. Objective: To evaluate the efficacy of intradermal tranexamic acid injection in treatment of melasma. Patients and Methods: Sixty Egyptian patients presented with melasma were enrolled into our study and divided into 2 equal groups: group A with intradermal injection of tranexamic acid, and group B were injected with intradermal saline. The patients were recruited from the Dermatology Outpatient Clinic of Al-Azhar University Hospitals during the period from August 2019 to October 2019. Results: All patients were females. The mean age was 41.87 ± 7.79 years, and the median of duration of melasma among the patients were 7 years. Gravidity and pregnancy (96.7%) were the most common precipitating factors while family history was positive in 46.7%. According to the efficacy of the therapy in melasma patients, intradermal injection of tranexamic acid showed that the percentage of change of mMASI score after treatment was 58.123%. Response to therapy in melasma, showed very good response in 18.3%, moderate response in 13.3%%, good response in 16.7%%, no response in 51.7%. As regard the side effects, tranexamic acid side effects were mild burning and transient edema at the site of injection in whole 60 patients. Five patients showed post inflammatory hyperpigmentation (8.3%). Conclusion: Intradermal tranexamic acid is safe, well tolerated and effective therapy in the treatment of melasma. Tranexamic acid solution is available therapy, not expensive and easy to be prepared and applied. Tranexamic acid is preferred in dark skin phototypes than as it is more safe and less liable to cause PIH. Tranexamic acid prevents the rapid relapse of melasma after stoppage of treatment.