Melasma is a chronic skin pigmentation disorder, and intradermal injection of tranexamic acid (TXA) is an effective treatment option for melasma with limited comparative efficacy studies.
Objectives:
To compare the effectiveness of TXA injections with other treatment modalities for patients with melasma, as measured by Melasma Area and Severity Index (MASI).
Methods:
A total of 17 eligible randomized controlled trials were included in the meta-analysis. The MASI and the modified MASI served as the primary outcome measures of treatment effectiveness. Patient satisfaction was also evaluated.
Results:
Among the various administration routes for TXA, intradermal injection and microneedling demonstrated superior effectiveness, followed by oral administration and topical application. As for patient satisfaction, oral administration outperformed the injection method, whereas topical administration significantly underperformed injection. Furthermore, TXA injections were more effective than the majority of non-TXA standard treatments for melasma.
Conclusions:
This meta-analysis and systematic review suggested that intradermal TXA injection is an effective alternative for melasma treatment, with potential advantages over other administration routes.
Get full access to this article
View all access options for this article.
References
1.
MiotLD, MiotHA, SilvaMG, et al.Fisiopatologia do melasma [Physiopathology of melasma]. An Bras Dermatol. 2009; 84(6):623–635; doi: 10.1590/s0365-05962009000600008
HalderRM, GrimesPE, McLaurinCI, et al.Incidence of common dermatoses in a predominantly black dermatologic practice. Cutis., 1983; 32(4):388–390.
4.
SpieringsNMK. Melasma: A critical analysis of clinical trials investigating treatment modalities published in the past 10 years. J Cosmet Dermatol. 2020; 19(6):1284–1289; doi: 10.1111/jocd.13182
5.
DunnCJ, GoaKL. Tranexamic acid: A review of its use in surgery and other indications. Drugs., 1999; 57(6):1005–1032; doi: 10.2165/00003495-199957060-00017
6.
KimSJ, ParkJY, ShibataT, et al.Efficacy and possible mechanisms of topical tranexamic acid in Melasma. Clin Exp Dermatol. 2016; 41(5):480–485; doi: 10.1111/ced.12835
7.
PerperM, EberAE, FayneR, et al.Tranexamic acid in the treatment of Melasma: A review of the literature. Am J Clin Dermatol. 2017; 18(3):373–381; doi: 10.1007/s40257-017-0263-3
8.
KhuranaVK, MisriRR, AgarwalS, et al.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; doi: 10.4103/ijdvl.IJDVL_801_16
9.
El HadidiH, MosaadR, RagabN. The efficacy of oral vs different dilutions of intradermal tranexamic acid microinjections in melasma-A randomized clinical trial. Dermatol Ther. 2021; 34(3):e14924; doi: 10.1111/dth.14924
10.
ShamseerL, MoherD, ClarkeM, et al.PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ. 2015; 350:g7647; doi: 10.1136/bmj.g7647
11.
PandyaAG, HynanLS, BhoreR, et al.Reliability assessment and validation of the Melasma Area and Severity Index (MASI) and a new modified MASI scoring method. J Am Acad Dermatol. 2011; 64(1):78–83; doi: 10.1016/j.jaad.2009.10.051e832
12.
HigginsJPT, PageMJ, et al.S.J Chapter 8: Assessing risk of bias in a randomized trial. In: Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023), ed. (T.JHigginsJPT, ChandlerJ, CumpstonM, LiT, PageMJ, WelchVA eds). Cochrane, 2023.
13.
ChiKY, LiMY, ChenC, et al.Cochrane Taiwan. Ten circumstances and solutions for finding the sample mean and standard deviation for meta-analysis. Syst Rev. 2023; 12(1):62; doi: 10.1186/s13643-023-02217-1
14.
BehrangiE, ShemshadiM, GhassemiM, et al.Comparison of efficacy and safety of tranexamic acid mesotherapy versus oral tranexamic acid in patients with melasma undergoing Q-switched fractional 1064-nm Nd:YAG laser: A blinded RCT and follow-up. J Cosmet Dermatol. 2022; 21(1):279–289; doi: 10.1111/jocd.14496
15.
SharmaR, MahajanVK, MehtaKS, et al.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; doi: 10.1111/ced.13164
16.
JiaZ, TianK, ZhongY, et al.Effectiveness of combination therapy of broadband light and intradermal injection of tranexamic acid in the treatment of chloasma. J Cosmet Dermatol. 2023; 22(5):1536–1544; doi: 10.1111/jocd.15632
17.
PoostiyanN, AlizadehM, ShahmoradiZ, et al.Tranexamic acid microinjections versus tranexamic acid mesoneedling in the treatment of facial Melasma: A randomized assessor-blind split-face controlled trial. J Cosmet Dermatol. 2023; 22(4):1238–1244; doi: 10.1111/jocd.15580
18.
SteinerD, et al.Study evaluating the efficacy of topical and injected tranexamic acid in treatment of Melasma. Surg Cosme Dermatol., 2009; 1:174–177.
19.
BadranAY, AliAU, GomaaAS. Efficacy of topical versus intradermal injection of Tranexamic Acid in Egyptian Melasma patients: A randomised clinical trial. Australas J Dermatol. 2021; 62(3):e373–e379; doi: 10.1111/ajd.13575
20.
TawficSO, Abdel HalimDM, AlbarbaryA, et al.Assessment of combined fractional CO2 and tranexamic acid in melasma treatment. Lasers Surg Med. 2019; 51(1):27–33; doi: 10.1002/lsm.23032
21.
TehranchiniaZ, SaghiB, RahimiH. Evaluation of therapeutic efficacy and safety of tranexamic acid local infiltration in combination with topical 4% hydroquinone cream compared to topical 4% hydroquinone cream alone in patients with Melasma: A split-face study. Dermatol Res Pract. 2018; 2018:8350317; doi: 10.1155/2018/8350317
22.
PazyarN, DezfulyMB, HadibarhaghtalabM, et al.Intradermal injection of 100mg tranexamic acid versus topical 4% hydroquinone for the treatment of Melasma: A randomized, controlled trial. J Clin Aesthet Dermatol. 2023; 16(1):35–40.
23.
KarrabiM, MansourniaMA, SharestanakiE, et al.Clinical evaluation of efficacy and tolerability of cysteamine 5% cream in comparison with tranexamic acid mesotherapy in subjects with Melasma: A single-blind, randomized clinical trial study. Arch Dermatol Res. 2021; 313(7):539–547; doi: 10.1007/s00403-020-02133-7
24.
ZhaoH, LiM, ZhangX, et al.Comparing the efficacy of Myjet-assisted tranexamic acid and vitamin C in treating Melasma: A split-face controlled trial. J Cosmet Dermatol. 2020; 19(1):47–54; doi: 10.1111/jocd.13112
25.
GuptaP, PoojaryS, DubeyL. A randomized comparative study of intralesional tranexemic acid and kligman’s regimen in Indian patients with Melasma. J Cutan Aesthet Surg. 2022; 15(2):135–141; doi: 10.4103/JCAS.JCAS_1_21
26.
RaoSK, RajashekarTS, AshrafA. Efficacy of intralesional tranexamic acid in Melasma: Assessment with Melasma area severity index and dermatology quality of life index. Turkderm Turkish Archives Dermatol Venereol Name., 2022; 56(2):58–63; doi: 10.4274/turkderm.galenos.2022.42709
27.
BudamakuntlaL, LoganathanE, SureshDH, et al.A randomised, open-label, comparative study of tranexamic acid microinjections and tranexamic acid with microneedling in patients with Melasma. J Cutan Aesthet Surg. 2013; 6(3):139–143; doi: 10.4103/0974-2077.118403
28.
PatilNK, BubnaAK. A comparative evaluation of the efficacy of intralesional tranexamic acid versus platelet rich plasma in the treatment of Melasma. Dermatol Ther. 2022; 35(7):e15534; doi: 10.1111/dth.15534
29.
ZhangL, TanWQ, FangQQ, et al.Tranexamic Acid for Adults with Melasma: A Systematic Review and Meta-Analysis. Biomed Res Int. 2018; 2018:1683414; doi: 10.1155/2018/1683414
30.
KoniskyH, BalazicE, JallerJA, et al.Tranexamic acid in Melasma: A focused review on drug administration routes. J Cosmet Dermatol. 2023; 22(4):1197–1206; doi: 10.1111/jocd.15589
31.
KhanQA, AbdiP, FarkouhC, et al.Effectiveness of laser and topical tranexamic acid combination therapy in Melasma: An updated systematic review and meta-analysis of randomized controlled trials. Lasers Med Sci. 2023; 38(1):139; doi: 10.1007/s10103-023-03810-5
32.
FengJ, ShenS, SongX, et al.Efficacy and safety of laser-assisted delivery of tranexamic acid for the treatment of Melasma: A systematic review and meta-analysis. J Cosmet Laser Ther. 2022; 24(6–8):73–79; doi: 10.1080/14764172.2022.2148186
33.
FengX, SuH, XieJ. Efficacy and safety of tranexamic acid in the treatment of adult Melasma: An updated meta-analysis of randomized controlled trials. J Clin Pharm Ther. 2021; 46(5):1263–1273; doi: 10.1111/jcpt.13430
34.
OtbS, ShaarawyE, SadekA, et al.A split face comparative study between intradermal tranexamic acid and Erbium-YAG laser in treatment of Melasma. J Dermatolog Treat. 2022; 33(1):555–559; doi: 10.1080/09546634.2020.1771259
35.
EbrahimHM, Said AbdelshafyA, KhattabF, et al.Tranexamic acid for Melasma treatment: A split-face study. Dermatol Surg. 2020; 46(11):e102–e107; doi: 10.1097/DSS.0000000000002449
36.
ZhuCY, LiY, SunQN, et al.Analysis of the effect of different doses of oral tranexamic acid on Melasma: A multicentre prospective study. Eur J Dermatol. 2019; 29(1):55–58; doi: 10.1684/ejd.2018.3494
37.
WangWJ, WuTY, TuYK, et al.The optimal dose of oral tranexamic acid in Melasma: A network meta-analysis. Indian J Dermatol Venereol Leprol. 2023; 89(2):189–194; doi: 10.25259/IJDVL_530_2021
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
