A study of intradermal tranexamic acid for treatment in melasma patients

Authors

  • Haritha Samanthula Department of Dermatology Venerealogy Leprology, Dr PSIMS & RF, Gannavaram, Andhra Pradesh, India
  • Manaswitha Koganti Department of Dermatology Venerealogy Leprology, Dr PSIMS & RF, Gannavaram, Andhra Pradesh, India
  • Neethu Chowdary Department of Dermatology Venerealogy Leprology, Dr PSIMS & RF, Gannavaram, Andhra Pradesh, India
  • Aruna Sree Kurapati Department of Dermatology Venerealogy Leprology, Dr PSIMS & RF, Gannavaram, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20203746

Keywords:

Intralesional, Melasma, Tranexamic acid

Abstract

Background: Melasma is a common acquired pigmentary dermatosis due to a disorder in the melanogenesis process. Although several treatments are currently used, it remains a great challenge. It was recently reported that intradermal tranexamic acid (TA- plasmin inhibitor) is an effective treatment for melasma. Aims of the study were to assess the efficacy and side-effects of localized microinjection of TA for the treatment of melasma.

Methods: A total of 30 patients with melasma, who did not respond to topical therapy were included in the study, after taking informed consent. The severity and extent of pigmentation was assessed by modified melasma area severity index (MASI). Patients were then administered localized microinjections (10 mg/ml) of TA weekly for 6 weeks. The response to treatment was assessed by MASI and clinical photographs at each session and after 3 months of stopping treatment.

Results: Among 30 patients significant decrease in the MASI from baseline was observed. 36.6% patients showed >75% improvement, 43.3% showed 50-75% improvement, 6.8% showed 30-49% improvement, and 13.3% showed <30% improvement at the end of 6 weeks. Side effects were minimal, and all the patients tolerated the treatment well. At 12 weeks 32% of patients developed mild recurrences and the rest of the patients maintained the same MASI.

Conclusion: Based on our results, intradermal TA (10 mg/ml) can be used as potentially new, effective and safe treatment for melasma.

Author Biography

Haritha Samanthula, Department of Dermatology Venerealogy Leprology, Dr PSIMS & RF, Gannavaram, Andhra Pradesh, India

MD DVL

References

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;85:39-43.

Zhang L, Tan WQ, Fang QQ, Zhao WY, Zhao QM, Gao J et al. Tranexamic Acid for Adults with Melasma: A Systematic Review and Meta-Analysis. BioMed Research International. 2018;10.1155;1683414.

Lee AY. Recent progress in melasma pathogenesis. In: Pigment Cell & Melanoma Research. 201;28(6):648-660.

Dashore S, Mishra K. Tranexamic acid in melasma: Why and how? Indian J Drugs Dermatol. 2017;3:61-3.

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. Dermatol Surg. 2006;32:626-31.

Kondou S, Okada Y, Tomita Y. Clinical study of effect of tranexamic acid emulsion on melasma and freckles. Skin Res. 2007;6:309-15.

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;53:389-96.

Bala HR, Lee S, Wong C, Pandya A, Rodrigues M. Oral Tranexamic Acid for the Treatment of Melasma. In: Dermatologic Surgery. 2018;44(6)814-825.

Tse TW, Hui E. Tranexamic acid: An important adjuvant in the treatment of melasma. J Cosmet Dermatol. 2013;12:57-66.

Ando H, Matsui MS, Ichihashi M. Quasi-drugs developed in Japan for the prevention or treatment of hyperpigmentary disorders. Int J Mol Sci. 2010;11(6):2566-2575.

Li D, Shi Y, Li M, Liu J, Feng X. Tranexamic acid can treat ultraviolet radiation-induced pigmentation in guinea pigs. Eur J Dermatol. 2010;20(3):289-292.

Kim EH, Kim YC, Lee ES, Kang HY. The vascular characteristics of melasma. J Dermatol Sci. 2007;46(2):111-116.

Na JI, Choi SY, Yang SH, Choi HR, Kang HY, Park KC. Effect of tranexamic acid on melisma: a clinical trial with histological evaluation. J Eur Acad Dermatol Venerol. 2013 (8):1035-1039.

Shetty VH, Shetty M. Comparative study of localised intradermal microinjection of tranexamic acid and oral tranexamic acid for the treatment of melasma. Int J Res Dermatol. 2018;4(3):363-367.

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):728-734.

Saki N, Darayesh M, Heiran A. Comparing the efficacy of topical hydroquinone 2% versus intradermal tranexamic acid microinjections in treating melasma: a split-face controlled trial. J Dermatol Treat. 2018;29(4):405-410.

Comparison of the efficacy of intradermal injected tranexamic acid vs hydroquinone cream in the treatment of melasma. Clin Cosm Investig Dermatol. 2019;12:115-122.

Downloads

Published

2020-08-26

Issue

Section

Original Research Articles