Evaluation of therapeutic efficacy of tranexemic acid compared to kligman formula in the management of melasma

Abstract

Facial melanoses (FM) are a common presentation in Indian patients, causing cosmetic disfigurement with considerable psychological impact. Melasma is an acquired non-inflammatory hypermelanosis of multifactorial etiology with significant cosmetic deformity. Different treatment modalities have been utilized in different studies with varying outcomes. Recent clinical trials with Tranexamic acid are promising. : To compare the therapeutic efficacy of Tranexamic acid (TXA) in 2 different modalities with Modified Kligman formula in the management of melasma. : This is a prospective, randomised, open‑label study with a sample size of 45 patients of melasma fulfilling inclusion and exclusion criteria were randomly divided into 3 groups, 15 in each group. Group A: At home, daily applicatioin of modified kligman formula at night for 3 months. Group B: 12 sittings of microneedling followed by Tranexamic acid application was done weekly. Group C: 12 sittings of intralesional tranexamic acid (4mg/ml) was done weekly. Clinical images and dermoscopic images were taken at each visit including modified Melasma Area Severity Index (MASI) scoring, patient global assessment and physician global assessment to assess the clinical response. : Modified kligman formula group showed 42% improvement in MASI score by the end of 12 weeks, where as intralesional Tranexamic acid group showed 36% improvement followed by 30% improvement in microneedling with Tranexamic acid group. When statistically compared with Analysis of variance (ANNOVA) test, there was no significant difference (p=0.62) between three groups. But in individual groups there was significant difference (p<0.05) in MASI at 0 weeks and 12 weeks. Dermoscopic images showed perilesional hypopigmentation and telangiectasias with modified kligman formula, which was not seen with Tranexamic acid. Patient assessment score revelaed satisfaction with modified kligman formula in view of home application and pain during microneedling and microinjections which was not there in this group. : Modified kligman formula is found to be superior in the treatment of melasma, because of the synergistic activity of its components. But it has its own demerits of long term usage. Hence, Tranexamic acid which showed comparable results with kligman formula can be used either as a primary modality or as an adjuvant supportive therapy for maintanence.