DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20202658

A comparative study between micro needling with modified Kligman regimen versus micro needling with tranexamic acid in melasma patients

Anjum M. Momin, Ankita A. Mistry, Jignesh B. Vaishnani

Abstract


Background: Melasma is common, acquired disorder of hyperpigmentation, with female predominance and occurrence of facial involvement mostly. Various modalities of treatment are available including topical, oral and procedural therapies.

Methods: Total 46 patients of melasma were studied. They were divided in two groups A and B. Micro needling with derma roller 1.5mm was done once in a month for 3 months. Group A patients received topical Modified Kligman regimen daily at night, while group B patients were advised topical tranexamic acid daily. Topical sunscreen was advised in both group patients. Patients were evaluated clinically and by Modified MASI score, and followed up for 3 more months after completion of treatment.

Results: Female predominance was noted with most common age group being 25-40 years. Epidermal type of melasma was common. Centro-facial type of distribution was found mostly in patients. Significant decrease was noted in modified MASI score (p<0.05) which was more and rapid in group A patients.

Conclusions: Modified Kligman regimen has better efficacy but tranexamic acid is safer with lesser side effects. Inspite of various treatment arms, melasma is still challenging.


Keywords


Melasma, Micro needling, Modified Kligman regimen, Tranexamic acid

Full Text:

PDF

References


Grimes P, Kelly AP, Torok H, Willis I. Community-based trial of a triple-combination agent for the treatment of facial melasma. Cutis. 2006;77:177-84.

Sanchez NP. Melasma: A clinical, light microscopic, ultrastructural and immune-fluorescence study. J Am Academy Dermatol. 1981;4:698-710.

Cayce KA, McMichael AJ, Feldman SR. Hyperpigmentation: An overview of the common afflictions. Dermatol Nursing. 2004;16:401-16.

Gilchrest BA. Localization of melanin pigmentation in the skin with wood’s lamp. British J Dermatol. 1977;96:245-8.

Falabella AF, Falanga V. Wound healing. In: Freinkel RK, Woodley DT, editors. The Biology of the Skin. New York: Parethenon; 2001:28199.

Piamphongsant T. Treatment of melasma: a review with personal experience. Int J Dermatol. 1998;37: 897-903.

Budamakuntla L. A randomized, open-label, Comparative study of Tranexamic Acid Microinjections and Tranexamic Acid with Micro needling in patients with melasma. J Cutaneous Aesthetic Surg. 2013;6:139-43.

Maeda K, Naganuma M. Topical trans-4-aminomethylcyclohexanecarboxylicacid prevents ultraviolet radiation induced pigmentation. J Photochemistry Photobiology. 1998;47:136-41.

Kim SJ. Efficacy and possible mechanisms of topical tranexamic acid in melasma. Clinical Experimental Dermatol. 2016;41:480-5.

Taylor SC, Torok H, Jones T. Efficacy and safety of a new triple-combination agent for the treatment of facial melasma. Cutis. 2003;72(1):67-73.

Pandya AG, Hynan LS, Bhore R. Reliability assessment and validation of the Melasma Area and Severity Index (MASI) and a new modified MASI scoring method. J Am Acad Dermatol. 2011;64(1):78-83.

Serrano G, Almudever P, Serrano JM, Cortijo J, Faus C, Reyes M, et al. Micro needling dilates the follicular infundibulum and increases trans follicular absorption of liposomal sepia melanin. Clin Cosmet Investig Dermatol. 2015;8:313-8.

Tse TW, Hui E. Tranexamic acid: An important adjuvant in the treatment of melasma. J Cosmet Dermatol. 2013;12:57-66.

Calapai G, Gangemi S, Mannucci C, Miniullo PL, Casciaro M, Calapai F. Systematic review of tranexamic acid adverse reactions. J Pharmacovigil. 2015;3:1-7.

Takashima A, Yasuda S, Mizuno N. Determination of the action spectrum for UV induced plasminogen activator synthesis in mouse keratinocytes in vitro. J Dermatol Sci. 1992;4:11-7.

Malathi M, Thappa DM. Systemic skin whitening/lightening agents: What is the evidence. Indian J Dermatol Venereol Leprol. 2013;79:842-6.

Karn D, Kc S, Amatya A, Razouria EA, Timalsina M. Oral tranexamic acid for the treatment of melasma. Kathmandu Univ Med J. 2012;10:40-3.

Wu S, Shi H, Wu H, Yan S, Guo J, Sun Y, et al. Treatment of melisma with oral administration of tranexamic acid. Aesthetic Plast Surg. 2012;36:964-70.

Khuraiya S, Kachhawa D, Chouhan B, Dua M, Rao P. A comparative study of topical 5% tranexamic acid and triple combination therapy for the treatment of melasma in Indian population. Pigment Int. 2019;6:18-23.

Achar A, Rathi SK. Melasma: a clinico-epidemiological study of 312 cases. Indian J Dermatol. 2011;56(4):380-2.

Oluwatobi A, Godec O, Elbuluk N. Melasma: An Up-to-Date Comprehensive Review. Dermatol Ther. 2017;7:305-18.

Menon A, Eram H, Kamath PR, Goel S, Babu AM. A split face comparative study of safety and efficacy of micro needling with tranexamic acid versus micro needling with Vitamin C in the treatment of melasma. Indian Dermatol Online J. 2020;11:41-5.

Yang XU. Efficacy of functional microarray of microneedles combined with topical tranexamic acid for melasma: A randomized, self-controlled, split-face study. Med Wolters Kluwer Health. 2017;96(19):6897.

Sharma R. Therapeutic efficacy and safety of oral tranexamic acid and that of tranexamic acid local infiltration with microinjections in patients with melasma: a comparative study. Clin Experimental Dermatol. 2017;42:728-34.

Lima. Assessment of the effects of skin micro needling as adjuvant therapy for facial melasma: a pilot study. BMC Dermatol. 2017;17:14.

Fabbrocini G, Vita DV, Fardella N, Pastore F, Annunziata MC, Mauriello MC, et al. Skin needling to enhance depigmenting serum penetration in the treatment of melasma. Plastic Surg Int. 2011;158241.

Chan R, Park KC, Lee MH, Lee ES, Chang SE, Leow YH, et al. A randomized controlled trial of the efficacy and safety of a fixed triple combination (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%) compared with hydroquinone 4% cream in Asian patients with moderate to severe melasma. Br J Dermatol. 2008;159(3):697-703.

Kondou S. Clinical study of effect of tranexamic acid emulsion on melasma and freckles. Skin Res. 2007;6:309-15.

Ebrahimi B, Naeini FF. “Topical tranexamic acid as promising treatment for melasma”. J Res Med Sci. 2014;19:753-7.