Intradermal tranexamic acid versus PRP for melasma: A comparative randomized trial

Objectives: The objectives of the study are to compare the efficacy, safety, and recurrence rates of intradermal tranexamic acid (TXA) versus intradermal platelet-rich plasma (PRP) in the treatment of melasma. Material and Methods: In this prospective, open-label, randomized controlled study, 48 patients with melasma were randomized into two groups. Group A ( n = 24) received intradermal TXA (4 mg/mL), and Group B ( n = 24) received intradermal PRP prepared by a double-spin method. Four treatment sessions were administered at 4-week intervals. Patients were followed up for 3 months after the final session. Efficacy was assessed using the modified Melasma area and severity index (mMASI) and patient global assessment at baseline and weeks 4, 8, 12, and 24. Dermoscopic images were compared on the first and last visit. Results: Both groups showed a statistically significant reduction in mMASI scores. TXA demonstrated a faster onset of improvement at week 4 (14.8% vs. 8.1%; p = 0.014). PRP showed better efficacy at week 24 (44.7% vs. 35.6%; p = 0.037) with no recurrences during follow-up, whereas the TXA group showed a recurrence rate of 20.8% ( n = 5, p = 0.018). Conclusion: Intradermal TXA provides early improvement in melasma, while intradermal PRP offers comparatively better efficacy and remission.