Study of the therapeutic efficacy and safety of intralesional tranexamic acid (25 mg/ml) for the treatment of melasma in male patients: A single centered “before-after” observational study
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20214209Keywords:
Male melasma, Intralesional tranexamic acid, Mean MASIAbstract
Background: Melasma is a common and difficult to treat hypermelanosis of poorly understood etiopathogenesis with great tendency to relapse. Tranexamic acid (TA) has been used in various formulations for its treatment, but there is paucity of studies/data and no consensus on the optimum dosage of intradermal TA, especially among the male patients. To study the efficacy and safety of intralesional TA 25 mg/ml for the treatment of melasma in male patients.
Methods: Total 58 males were enrolled for study from July 2019 to June 2020. TA in 25 mg/ml strength injection and about 0.05 ml was injected intradermally at 1 cm apart on the entire melasma lesion, not exceeding 50 mg per visit and repeated every 4 weekly for 12 weeks. The percentage reduction in MASI was the primary outcome measure. It was determined every 4th week till 12 weeks and finally at 24 weeks for recurrence.
Results: Mean MASI decreased from baseline score of 8.42±5.63 to 6.71±4.65, 5.09±3.59 and 3.41±3.06 at the follow up week 4, 8 and 12 respectively with a significant decrease from 8th week onwards. Majority of the patients were satisfied with their improvement after treatment (67.2%) without any significant adverse effects.
Conclusions: However, the TA was found to effective in all the three histopathological types of melasma but the dermal melasma was least responsive as well as earliest to relapse. We recommend monthly therapy at 25 mg/ml as more efficacious, time saving and cost effective to all the three types of melasma.
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References
Chowdhary B, Mahajan VK, Mehta KS, Chauhan PS, Sharma V, Sharma A, Vashist S, Kumar P. Therapeutic efficacy and safety of oral tranexamic acid 250 mg once a day versus 500 mg twice a day: a comparative study. Arch Dermatol Res. 2021;313(2):109-17.
Pichardo R, Vallejos Q, Feldman SR, Schulz MR, Verma A, Quandt SA, et al. The prevalence of melasma and its association with quality of life in adult male: Latino migrant workers. Int J Dermatol. 2009;48(1):22-6.
Sarkar R, Puri P, Jain R, Singh A, Desai A. Melasma in men: a clinical, aetiological and histological study. J Eur Acad Dermatol Venereol. 2010;24(7):768-72.
Sialy R, Hassan I, Kaur I, Dash R. Melasma in men: A hormonal profile. J Dermatol. 2000;27(1):64-5.
Pawaskar MD, Parikh P, Markowski T, McMichael AJ, Feldman SR, Balkrishnan R. Melasma and its impact on health-related quality of life in Hispanic women. J Dermatol Treat. 2007;18(1):5-9.
Kaur A, Bhalla M, Sarkar R. Tranexamic acid in melasma: a review. Pigment Int. 2020;7:12-25.
Zhu HJ, Yang XH. The clinical study of acidum tranexamicum on melasma. Pharm Prog. 2001;3:178-81.
Takashima A, Yasuda S, Mizuno N. Determination of the action spectrum for UV-induced plasminogen activator synthesis in mouse keratinocytes in vitro. J Dermatol Sci. 1992;4(1):11-7.
Nakano T, Fujita H, Kikuchi N, Arita H. Plasmin converts pro-form of group I phospholipase A2 into receptor binding, active forms. Biochem Biophys Res Commun. 1994;198(1):10-5.
Falcone DJ, McCaffrey TA, Haimovitz-Friedman A, Vergilio JA, Nicholson AC. Macrophage and foam cell release of matrix-bound growth factors. Role of plasminogen activation. J Biol Chemi. 1993;268(16):11951-58.
Maeda K, Tomita Y. Mechanism of the inhibitory effect of tranexamic acid on melanogenesis in cultured human melanocytes in the presence of keratinocyte-conditioned medium. J Health Sci. 2007;53(4):389-96.
Maeda K, Naganuma M. Topical trans-4-aminomethylcyclohexanecarboxylic acid prevents ultraviolet radiation-induced pigmentation. J Photochem Photobiol. 1998;47(2-3):136-41.
Tse TW, Hui E. Tranexamic acid: an important adjuvant in the treatment of melasma. J Cosmet Dermatol. 2013;12(1):57-66.
Pistor M. What is mesotherapy ? Chir Dent Fr. 1976;46:59-60.
Budamakuntla L, Loganathan E, Suresh DH, Shanmugam S, Suryanarayan S, Dongare A, Venkataramiah LD et al. A Randomised, Open-label, Comparative Study of Tranexamic Acid Microinjections and Tranexamic Acid with Microneedling in Patients with Melasma. J Cut Aesthet Surg. 2013;6(3):139-43.
Sharma R, Mahajan VK, Mehta KS, Chauhan PS, Rawat R, Shiny TN. Therapeutic efficacy and safety of oral tranexamic acid and that of tranexamic acid local infiltration with microinjections in patients with melasma: a comparative study. Clin Exp Dermatol. 2017;42:728-34.
Khurana VK, Misri RR, Agarwal S, Thole AV, Kumar S, Anand T. A randamised open level comparative study of oral and intralesonal microinjections of in patients of melasma. Indian J Dermatol Venereol Leprol. 2019;85:39-43.
Prapalpitch W, Punyaphat S. The effectiveness of localized intradermal microinjection of 50mg/ml of tranexamic acid for melasma treatment in thai patients: A pilot study. Thai J Pharm Sci. 2018;(S):140-44.
Kimbrough-Green CK, Griffiths CEM, Finkel LJ, Hamilton TA, Bulengo-Ransby SM, Ellis CN et al. Topical retinoic acid for melasma in black patients. Arch Dermatol. 1994;130:727-33.
Sanchez NP, Pathak MA, Sato S, Fitzpatrick TB, Sanchez JL, Mihm Jr MC. Melasma: A clinical, light microscopic, ultrastructural, and immunofluorescence study. J Am Acad Dermatol. 1981;4(6):698-710.
Khurana VK, Misri RR, Agarwal S, Thole AV, Kumar S, Anand T. A randamised open level comparative study of oral and intralesonal microinjections in patients of melasma. Indian J Dermatol Venereol Leprol. 2019;85:39-43.
Lueangarun S, Sirithanabadeekul P, Wongwicharn P, Namboonlue C, Juntongjin P, Pacharapakornpong S, et al. Intradermal Tranexamic Acid Injection for the Treatment of Melasma: A Pilot Study with 48-week Follow-up. J Clin Aesth Dermatol. 2020;13(8):36-9.
Lee JH, Park JG, Lim SH, Kim JY, Ahn KY, Kim MY, et al. Localized intradermal microinjection of tranexamic acid for treatment of melasma in Asian patients: a preliminary clinical trial. J Dermatol Surg. 2006;32(5):626-31.
Elfar N, El-Maghraby G. Efficacy of intradermal injection of tranexamic acid, topical silymarin and glycolic acid peeling in treatment of melasma: A comparative study. J Clin Exp Dermatol Res. 2015;6:3-9.
Patil SS, Deshmukh AR. Comparative study of efficacy of intradermal tranexamic acid versus topical tranexamic acid versus triple combination in melasma. Pigment Int. 2019;6(2):84-95.
Raheem AT, Nassar M, Elgamil M. Comparative study between topical tranexamic acid and intradermal tranexamic acid injection in treatment of melasma. J Fayo Univers Med. 2019;4(1):93-102.