Tranexamic acid versus topical mesolightening mixture using the dermaroller in the treatment of melisma

Abstract

Background Use of localized microinjection of tranexamic acid (TA) has been studied for the treatment of melasma and was proved to be effective, but transdermal delivery of this agent has not been well studied. The use of Dermaroller may increase the effective delivery of active ingredients in topical mesolightening mixture and TA. Aim The aim of this split-face study was to compare the safety and efficacy of transdermal delivery of TA versus topical mesolightening mixture using the Dermaroller in the treatment of melasma. Patients and methods This split-face study was carried out on 15 patients having melasma. For each patient, the following was done after taking an informed consent: history taking, dermatological examination, Wood’s light examination, Melanin Area and Severity Index (MASI) score calculation, photography, physician’s global assessment by independent investigators, patient’s global evaluation, eight sessions of transdermal delivery of TA and topical mesolightening mixture, with a session every week (mixture of kojic acid 3%, TA 0.01%, azelaic acid 4% (19,20), L-ascorbic acid 1 g, and water for injection), and recording of the adverse effects every session. This was followed by 3 months of follow-up. Results The initial (pre-4) reduction of MASI (after the first four sessions) on the left side (TA treated) was significantly higher than that on the right side. Similarly, the later (four to eight sessions) (upon comparing the second set with the first set of sessions) and overall reduction was higher on the left side compared with that on the right side; however, these differences were not statistically significant in terms of MASI. Conclusion TA and topical mesolightening mixture are individually effective in the treatment of melasma. TA is superior to mesolightening, as well as cost-effective in the treatment of melasma.