The following article is part of conference coverage from the 2019 American Academy of Dermatology Annual Meeting in Washington, DC. Dermatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in dermatology. Check back for the latest news from AAD 2019.

Both intradermal microinjection of tranexamic acid (TA) and platelet-rich plasma (PRP) are effective and safe treatment modalities for melasma, but TA appears to produce more significant, rapid results. These findings were reported at the 2019 American Academy of Dermatology Annual Meeting, held March 1-5, in Washington, DC.

Previous research on both modalities has demonstrated promising results. This study included 23 women age 32 to 50 with varying types and degrees of melasma.  Patients underwent intralesional injection of TA (max 8 mg) on the right side of the face and PRP injection (approximately 1 mL) on the left side of the face at 0, 4, and 8 weeks and followed up for 3 months after the last injection. Patients were evaluated for adverse effects after 1 week and were advised to avoid excessive sun exposure and use at least SPF 30 sunscreen during daylight hours.

Almost 74% of the participants had no family history of melasma. Distribution of melasma patterns was 34.8% centrofacial, 60.9% malar, and 4.3% mandibular.

Upon evaluating the TA-treated side, investigators found a statistically significant difference in Modified Melasma Area and Severity Index (MMASI) from baseline to post-treatment (standard deviation [SD] 6.92±5 to SD 2.83±2.97). Of the patients, 4 (17.4%) demonstrated moderate improvement, 8 (34.8%) showed good improvement, and 11 patients (47.8%) showed excellent improvement. Patients with a shorter disease duration and with a malar melasma distribution appeared to respond better to treatment. Of note, there was no correlation observed between age, melasma type, skin type, and degree of improvement. Adverse effects were similar across both treatments and included transient pain at the injection site (78.3%) and transient pain and erythema (21.7%)

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On the PRP-treated side, investigators noted a statistically significant difference in MMASI from baseline to post-treatment (SD 7.54±4.67 to SD 4.6±3.41). Of the patients, 2 (8.7%) showed no improvement, 3 (13%) showed poor improvement, 8 (34.8%) showed moderate improvement, 7 (30.4%) showed good improvement, and 3 (13%) showed excellent improvement. As in the TA-treated side, patients with a malar melasma distribution were more likely to have excellent improvement.

The percent change in MMASI was statistically significant when comparing the TA-treated side of the face with the PRP-treated side. A similar result was observed for degree of improvement and frequency of excellent or good response to treatment on the TA-treated side. Adverse effects were similar across both treatments and included transient pain at the injection site (78.3%) and transient pain and erythema (21.7%)

Given its relatively rapid results and ease of use, treatment with TA “may be used as part of melasma treatments, especially for dermal and mixed melasma,” the researchers concluded.

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Reference

Abdelshafy AS. Intralesional tranexamic acid versus platelet rich plasma in melasma treatment. A split face comparative study. Presented at: 2019 American Academy of Dermatology Annual Meeting; March 1-5, 2019; Washington, DC.