Comparison of Efficacy of Intradermal Tranexamic Acid Versus Oral Tranexamic Acid in the Treatment of Melasma

Efficacy of Intradermal vs Oral Tranexamic Acid in Melasma Treatment

Abstract

Background: Melasma, a common hyperpigmentation disorder, affects women and is triggered by genetics, hormones, and sun exposure. Tranexamic acid (TXA), used in oral and intradermal forms, has shown promise in treatment. This study compares the efficacy of intradermal versus oral TXA in reducing melasma severity and pigmentation. Objective: To compare the efficacy of intradermal Tranexamic Acid (TXA) and oral TXA in the treatment of melasma, assessing improvements in melasma severity and pigmentation as measured by the modified Melasma Area and Severity Index (mMASI) and Melanin Index (MI). Study Design: Retrospective study. Settings: Department of Dermatology, MTI Khyber Teaching Hospital, Peshawar, Pakistan. Duration: March 2022 to August 2022. Methods: A total of 80 patients with melasma were randomly randomized to either intradermal TXA (4 mg/mL) or oral TXA (250 mg twice daily). Patients were treated for 12 weeks, and mMASI scores and MI were measured at baseline, weeks 4, 8, and 12. Patient satisfaction was also evaluated. We used independent t-tests to analyze the data, setting the level of statistical significance at p < 0.05. Results: Both treatment groups showed significant reductions in mMASI scores and MI over time. The intradermal group showed a decrease in mMASI from 15.8 ± 4.2 to 5.4 ± 2.0 (week 12), and MI from 34.2 ± 5.4 to 18.4 ± 3.9. The oral group showed a decrease in mMASI from 14.9 ± 3.8 to 5.9 ± 2.1, and MI from 33.8 ± 5.2 to 19.2 ± 4.0. However, no statistically significant difference was found between the two groups (p > 0.05 for both mMASI and MI at all-time points). Conclusion: Both intradermal and oral TXA are effective treatments for melasma, with no significant differences in their efficacy. Future research with longer follow-up is needed to confirm these findings.