Comparison of efficacy of oral and topical route of tranexamic acid in patients of melasma
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20232535Keywords:
Melasma, Oral tranexamic acid, MASIAbstract
Background: Melasma is a common pigmentary disorder which presents with brown coloured macules that occurs around the sun-exposed areas of the skin, particularly on the face. Many treatment modalities are present but often it is resistant to treatment. The aim of our study was to compare the therapeutic efficacy and safety of tranexamic acid administered by oral and topical route in patients of melasma.
Methods: Our study was a prospective, randomised study which consisted of 40 new melasma patients. 20 patients were given Oral Tranexamic acid 250 mg twice daily, classified as Group 1, other 20 patients were given topical Tranexamic acid (3%) twice a day (fully covering the lesion), classified as Group 2 for a period of 8 weeks and both were given broad spectrum sunscreen (SPF 50). MASI was determined before starting treatment (baseline), 4 weeks and 8 weeks. Based on the reduction in the mean MASI, the therapeutic response is graded and subjective response and adverse effects were also recorded at each visit.
Results: Mean percentage reduction in MASI scores was higher in oral (52.1%) as compared to topical (31.9%) group. In oral group, headache was the only adverse effect, however, in topical group, erythema, burning, acneiform eruptions were reported. At final assessment, fair improvement was seen in both groups.
Conclusions: Both oral as well as topical tranexamic acid were efficacious for treatment of melasma, however, of the two oral tranexamic acid was safer and provided a better proportional response.
References
Sachchidanand S. IADVL Textbook of Dermatology. 4th ed. Netherlands: Elsevier; 2018:781.
Sahu PJ, Singh AL, Kulkarni S, Madke B, Saoji V. Study of oral tranexamic acid,topical tranexamic acid, and modified Kligman’s regimen in treatment of melasma. J Cosmet Dermatol. 2020;19:1456-62.
Colferai MMT, Miquelin GM, Steiner D. Evaluation of oral tranexamic acid in the treatment of melasma. J Cosmet Dermatol. 2018;18(5):149-501.
Dashore S , Mishra K. Tranexamic acid in melasma: Why and how? Ind J Drugs Derm 2017; 3:61.
Wang JV, Jhawar N, Saedi N. Tranexamic acid for Melasma: Evaluating the various formulations. J Clin Aesthet Dermatol. 2019;12(8):E73-4.
Chauncey JM, Wieters JS. Tranexamic Acid. StatPearls, Treasure Island (FL): StatPearls Publishing; 2020.
Ebrahimi B, Naeini FF. Topical tranexamic acid as a promising treatment for melasma. J Res Med Sci. 2014;19(8):753-7
Kwon SH, Na JI, Choi J, Park K. Melasma: Updates and perspectives. Exp Dermatol. 2019;28:704-8.
Kwon S-H, Hwang Y-J, Lee S-K, Park K-C. Heterogeneous Pathology of Melasma and Its Clinical Implications. Int J Mol Sci. 2016;17:824.
Grimes PE. Melasma. Etiologic and therapeutic considerations. Arch Dermatol. 1995;131:1453.
Karn D, Kc S, Amatya A, Razouria E, Timalsina M. Oral tranexamic acid for the treatment of melasma. Kathmandu Univ Med J. 2012;10(4):40-3.
Lee HC, Thng TGS, Goh CL. Oral tranexamic acid (tranexamic acid) in the treatment of melasma: A retrospective analysis. J American Acad Dermatol. 2016;75:385-92.
Tan AWM, Sen P, Chua SH, Goh BK. Oral tranexamic acid lightens refractory melasma. Australas J Dermatol. 2017;58(3):e105-8.
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(7):728-34.
Del Rosario E, Florez-Pollack S, Zapata L, Hernandez K, Tovar- Garza A, Rodrigues M, et al. Randomized, placebo-controlled, double- blind study of oral tranexamic acid in the treatment of moderate-to- severe melasma. J Am Acad Dermatol. 2018;78(2):363-9.
Malik F, Hanif MM, Mustafa G. Combination of Oral Tranexamic Acid with Topical 3% Tranexamic Acid versus Oral Tranexamic Acid with Topical 20% Azelaic Acid in the Treatment of Melasma. J Coll Physicians Surg Pak. 2019;29(6):502-4.
Khurana VK, Misri RR, Agarwal S, Thole AV, Kumar S, Anand T. A randomized, open-label, comparative study of oral tranexamic acid and tranexamic acid microinjections in patients with melasma. Indian J Dermatol Venereol Leprol. 2019;85(1):39-43.
Karim AR, Sadeque SP, Ferdous A, Khan MAL, Rahman MH, Rafi A, Masum A. Treatment of Melasma Cases by Oral Tranexamic Acid: A Randomized Control Trial. J Armed Forces Med. 2020;14(2):148-51.
Bala HR, Nguyen J, Ross A, Wong C, Paul E, Rodrigues M. Randomised, Placebo-Controlled, Double-Blind Study of Oral Tranexamic Acid in the Treatment of Moderate-to-Severe Melasma in an Australian Cohort. Indian J Dermatol. 2022;67(4):454-8.
Nagaraju D, Bhattacharjee R, Vinay K, Saikia UN, Parsad D, Kumaran MS. Efficacy of oral tranexemic acid in refractory melasma: A clinico- immuno-histopathological study. Dermatol Ther. 2018;31(5):e12704.
Martinez-Rico JC, Chavez-Alvarez S, Herz-Ruelas ME, Sosa-Colunga SA, Ocampo-Candiani J, Suro-Santos Y, Vazquez Martinez O. Oral tranexamic acid with a triple combination cream versus oral tranexamic acid monotherapy in the treatment of severe melasma. J Cosmet Dermatol. 2022;21(8):3451-7.
Zhu CY, Li Y, Sun QN, Takada A, Kawada A. Analysis of the effect of different doses of oral tranexamic acid on melasma: a multicentre prospective study. Eur J Dermatol. 2019;29(1):55-8.
Patil SS, Deshmukh AR. Comparative study of efficacy of intradermal tranexamic acid versus topical tranexamic acid versus triple combination in melasma. Pigment Int 2019;6:84-95.
Marpaung HK, Theresia LT, Yuli K, Theodorus. Comparison of the Effectiveness 3% Tranexamic Acid Cream Versus 4% Hydroquinone Cream for Treatment of Epidermal Type Melasma. Bioscientia Medicina. J Biomed Translat Res. 2021;5(3):340-7.
Kanechorn Na Ayuthaya P, Niumphradit N, Manosroi A, Nakakes A. Topical 5% tranexamic acid for the treatment of melasma in Asians: a double-blind randomized controlled clinical trial. J Cosmet Laser Ther. 2012;14(3):150-4.
Kim SJ, Park JY, Shibata T, Fujiwara R, Kang HY. Efficacy and possible mechanisms of topical tranexamic acid in melasma. Clin Exp Dermatol. 2016; 41:480-5.
Na JI, Choi SY, Yang SH, Choi HR, Kang HY, Park KC. Effect of tranexamic acid on melasma: a clinical trial with histological evaluation. J Eur Acad Dermatol Venereol. 2013;27(8):1035-9.
