Micro-needling With Full-concentration Versus Diluted Tranexamic Acid in The Treatment of Melasma

Background: Most cases of melasma, an acquired pigment condition characterized by hyperpigmentation and vasodilation, occur in women between the ages of 20 and 40. It shows up as patches and macules ranging in color from light brown to dark brown on parts of the face that are exposed to the sun. Family history, UV radiation exposure, drugs, and hormone imbalances are factors that have been implicated; however, the exact etiopathogenesis is yet unknown. Aim: To compare the efficacy of microneedling with full-concentration tranexamic acid to that of diluted 4% tranexamic acid in treating melasma. Subjects and methods: This comparative clinical investigation included thirty patients who had been diagnosed with facial melasma. The dermatology outpatient clinic at Cairo, Egypt's Al-Azhar University Hospitals, was the source for all participants. Results: The mMASI score decreased significantly (p-value<0.001) in the whole TXA-group and the 4% TXA-group after treatment compared to the mMASI score before treatment. There was no statistically significant difference (p=0.428) between the full TXA group and the 4% TXA group in terms of patient improvement in this study. In terms of the change percentage in mMASI (Δ MASI%), the full TXA-group had a median drop of 37.6% (IQR=0-50) and the 4% TXA-group 33.3% (IQR=7.8- 50), although there was no statistically significant difference between the two groups (p=0.935). With respect to adverse effects, no statistically significant difference was seen between the two groups (p=0.795). Conclusion: For the management of melasma, diluted tranexamic acid (4% concentration) is an economical and well-tolerated alternative to full-strength tranexamic acid because it is just as effective and has the same safety profile.