Comparative study of efficacy of intradermal tranexamic acid versus topical tranexamic acid versus triple combination in melasma

• Main Authors: Shruti S Patil (Author), Ashish R Deshmukh (Author)
• Format: Book
• Published: Wolters Kluwer Medknow Publications, 2019-01-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 2349-5847; 2349-5782; 10.4103/Pigmentinternational.Pigmentinternational_19_19
• Keywords: masi; melasma; tranexamic acid; triple combination; Dermatology; RL1-803
• Source: Pigment International, Vol 6, Iss 2, Pp 84-95 (2019)

Background: Melasma, a hypermelanotic disorder, is challenging to treat as it needs long-term management. Intradermal tranexamic acid (TA), a plasmin inhibitor, has been tried for melasma in Korean and Iranian patients but not studied in skin type of Indian patients. TA cream topically as well as fluocinolone-based triple combination along with intradermal TA have not been studied in the literature so far in melasma. Objective: This study is designed to study the efficacy of intradermal TA vs topical TA vs triple combination (hydroquinone 2%, tretinoin 0.025%, fluocinolone acetonide 0.01%) for the treatment of melasma. Materials and Methods: A total of205 patients of melasma attending Dermatology OPD were enrolled in the study and randomly assigned into three groups. Groups A, B, and C were given intradermal TA, topical 3% TA, and triple combination, respectively, from November 2016 to May 2018 and asked to follow-up every month for 6 months. Total 180 patients completed the study and clinical evaluation was done using melasma area severity index (MASI) score. The results were analyzed using SPSS-22 and comparison of three groups were assessed by applying analysis of variance. Results: The MASI score at baseline and at 6 months for Groups A, B, and C was 15.4 and 2.2, 15.4 and 6.4, and 15.3 and 5.4, respectively. MASI score decreased in all three groups but it was statistically significant in Group A (TA group) that had the least MASI score followed by triple combination therapy. Conclusion: On the basis of these results, TA can be used as potentially a new, effective, safe, and promising therapeutic agent in melasma.