Split-face Comparative Study to Assess Therapeutic Efficacy of Intradermal Tranexamic Acid and Platelet-rich Plasma in Melasma

Objectives: Melasma is an acquired hyperpigmentary disorder for which various treatment modalities are available. Intradermal tranexamic acid (TXA) and platelet-rich plasma (PRP) are the 2 emerging options. We aimed to compare the therapeutic efficacy of intradermal TXA 10 mg/mL and PRP in melasma. Materials and Methods: A split-face prospective study was conducted on 50 female patients with facial melasma. Six sessions of injections with intradermal TXA 10 mg/mL on the right side and PRP on the left side of the face were given at 2-week intervals. Reduction in modified melasma area and severity index (mMASI) score was assessed at each visit. Patient satisfaction score was calculated at the end of the sixth session using the Likert scale. Mean differences, standard deviation and P values were calculated for the reduction of melasma severity scores. Results: A total of 47 patients completed the study, out of which 82% of those patients had malar type of melasma and the rest had involvement of the chin and forehead also. The mean mMASI score of patients treated with TXA decreased from 3.7 ± 2.1 at baseline to 1.4 ± 1.13 at 12 weeks which was statistically significant from the side treated with PRP where mMASI decreased from 3.6 ± 2.21 to 2.0 ± 1.18 ( P < 0.05). Dermoscopic changes showed partial resolution of telangiectasias and background erythema with TXA and reduction in the number of arcuate, annular and blotch patterns of pigmentation with TXA and PRP. No significant adverse effects were seen in any patient during the study period. Conclusion: Both TXA and PRP are promising treatment modalities; however, outcomes with intradermal TXA (10 mg/mL) were better than with PRP which yielded an overall ‘feel good’ response.