The efficacy of topical 5% tranexamic acid (TXA) with 30% glycolic acid (GA) peel for the treatment of melasma found support in results from a clinical trial published in Dermatologic Therapy. Compared with GA peel alone, combination treatment with TXAand GA appeared to accelerate improvement in melasma.
This prospective, open-label randomized trial was conducted from 2017 to 2018 at a tertiary care center in North India. Adults with epidermal melasma were randomly assigned to either combination therapy with 30% GA and 5% TXA or 30% GA alone. GA peels were administered by a clinician every 2 weeks; TXA solution was applied by the patient twice daily. Total therapy duration was 12 weeks. The primary outcome was improvement in melasma, assessed using the Melasma Area Severity Index (MASI). Melasma- and health-related quality of life were also captured using the Hindi language versions of the Melasma Quality of Life and Health-Related Quality of Life scales. Patients were asked to report any adverse events.
A total of 60 patients were enrolled: 30 to each treatment arm. Baseline demographic and clinical characteristics were comparable between groups. Mean age was 34.0 ± 5.7 years in the combination therapy group and 32.4 ± 6.2 years in the GA monotherapy group. Mean disease duration was 4.1 ± 3.1 and 3.1 ± 2.6 years in the combination and control groups, respectively. The majority of all patients were women. Patients receiving combination therapy experienced substantial reductions in MASI by week 4 (P =.002 vs baseline), and patients in the control group did not display significant improvements until week 6 (P <.001). At 12 weeks, mean MASI score was lower in the combination therapy group, although the between-group difference was not statistically significant (P =.186), it was noted. Quality of life scores were comparable in study groups throughout the trial duration. Side effects occurred more commonly with combination therapy, but were all mild in severity. No major adverse events were observed.
Based on these results, the researchers believe that a combination of topical 5% TXA with a 30% GA peel may result in quicker melasma resolution than GA peel alone. However, the small study cohort and short follow-up period limit data generalizability. More extensive study is necessary to confirm the safety and utility of combination therapy for melasma, particularly in the long term.
“The combination of topical TXA with 30% GA peel was safe and tolerable with minimal side effects such as slight burning, tingling sensation and itching observed in some of our patients,” investigators wrote. “Thus, 30% GA peel can be safely combined with topical TXA for attaining the therapeutic response earlier.”
Sahu P, Dayal S, Bhardwaj N. Topical 5% tranexamic acid with 30% glycolic acid peel: an [sic] useful combination for accelerating the improvement in melasma. Dermatol Ther. Published online August 22, 2021. doi:10.1111/dth.15107