Comparison of Micro Needling with Topical Teanexamic Acid and Mesotherapy with Intradermal Tranexamic Acid in Treatment of Melasma

Melasma is a common hyperpigmentation disorder that poses therapeutic challenges due to its recurrent and resistant nature. Microneedling showed superior and faster pigmentation reduction, with significant MASI score improvement and no adverse effects. Objective: To compare the effectiveness of intradermal Tranexamic Acid (TA) via mesotherapy versus topical TA delivered through microneedling in the treatment of melasma. Methods: In this prospective comparative study, 100 patients were divided into two equal groups. Group A received intradermal injections of TA (100 mg/mL), and Group B was treated with the same concentration of TA via microneedling using the Dr. PEN A6 device. Each group received three treatments at two-week intervals. Outcomes were assessed at Weeks 4, 8, 12, 16, and 20 using the Melasma Area and Severity Index (MASI) and standardized clinical photography. Statistical analysis was performed using repeated measures ANOVA, with a significance threshold of p ≤ 0.05. Results: The mean age was 37.7 ± 6.1 years. Group B showed greater improvement in MASI scores compared to Group A, with a 32.5% vs 18.4% reduction at Week 4 (p = 0.17). Group B consistently showed statistically significant improvement at Weeks 12, 16, and 20 (p < 0.05), and a strong trend by Week 8 (p = 0.001). No adverse events were reported. Conclusion: TA is an effective treatment for melasma. Microneedling significantly enhances its efficacy, providing faster and greater pigmentation reduction with minimal side effects.