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Calacattawi R, Alshahrani M, Aleid M, Aleid F, Basamih K, Alsugair G, Alqahtani R, AlKhabbaz N, Algaidi Y, Alrakayan L, Almohanna A, Madkhali A, Aljohani S, Alotibi N. Tranexamic acid as a therapeutic option for melasma management: meta-analysis and systematic review of randomized controlled trials. J DERMATOL TREAT 2024; 35:2361106. [PMID: 38843906 DOI: 10.1080/09546634.2024.2361106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/13/2024] [Indexed: 07/11/2024]
Abstract
Purpose: This study aimed to evaluate the efficacy of tranexamic acid (TXA) in treating melasma through a meta-analysis and systematic review of randomized controlled trials (RCTs). The study focused on identifying associated adverse effects and comparing TXA's effectiveness with other melasma treatments.Materials and methods: Following PROSPERO and PRISMA guidelines, an extensive electronic search was conducted across four databases for RCTs on TXA use in melasma. Inclusion criteria encompassed full-text English articles with specific outcome measures, while studies with high bias risk or non-English publications were excluded. Data were extracted from 22 relevant studies and analyzed using the RevMan software, with heterogeneity identified using I² statistics and forest plots.Results: A total of 22 studies with 1280 patients were included. TXA was administered orally, topically, or via injection, with treatment durations ranging from 8 weeks to nearly 2 years. TXA significantly reduced melasma severity, evidenced by reductions in MASI, mMASI, MI, and hemi-MASI scores. Oral TXA showed the most substantial decrease in MASI scores, followed by injections and topical applications. However, studies exhibited high heterogeneity, particularly in combined treatments. Adverse effects included gastrointestinal discomfort, skin irritation, and menstrual irregularities.Conclusions: TXA is effective in treating melasma, either alone or combined with other treatments. Despite significant reductions in melasma severity, further research is necessary to standardize TXA administration methods and address long-term effects. The high heterogeneity observed suggests a need for more consistent treatment protocols.
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Affiliation(s)
- Retaj Calacattawi
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | | | - Maryam Aleid
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah Aleid
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khalid Basamih
- College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ghada Alsugair
- College of Medicine, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | | | - Noor AlKhabbaz
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yaser Algaidi
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Latifa Alrakayan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz Almohanna
- College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | - Shaima Aljohani
- College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Naif Alotibi
- College of Medicine, Taif University, Taif, Saudi Arabia
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Liao X, Cheng F, Jiang Y. Efficacy and safety of mesotherapy with tranexamic acid versus vitamin C in the treatment of melasma: A meta-analysis and systemic review. J Cosmet Dermatol 2024; 23:2785-2792. [PMID: 38693699 DOI: 10.1111/jocd.16353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND The exact pathogenesis of melasma is not yet known, and its treatment remains challenging. Mesotherapy with tranexamic acid (TXA) and vitamin C was both reported to have certain effects on melasma. In spite of that several articles have compared the efficacy and safety of the two drugs on melasma, most of them were clinical study with small sample size. AIMS To evaluate the efficacy and safety of mesotherapy with TXA versus vitamin C in treating melasma through meta-analysis and systemic review. METHODS The authors searched PubMed, Web of Science, Springer, and ScienceDirect for studies that compared mesotherapy with TXA versus vitamin C as a treatment for melasma. Primary outcomes were change in melasma area and severity index (MASI) before and after the treatment. RESULTS Finally, five studies with a total of 127 patients were included in the systematic review. There was no statistic difference in the change in MASI score between the TXA and vitamin C groups (mean difference, 0.16; 95% CI, -0.79 to 1.11). CONCLUSIONS Mesotherapy with both TXA and vitamin C is safe and effective in the treatment of melasma.
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Affiliation(s)
- Xin Liao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. China
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. China
| | - Fengrui Cheng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. China
| | - Yunlan Jiang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. China
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Liang R, Luo H, Pan W, Yang S, Peng X, Kuang B, Huang H, Liu C. Comparative efficacy and safety of tranexamic acid for melasma by different administration methods: A systematic review and network meta-analysis. J Cosmet Dermatol 2024; 23:1150-1164. [PMID: 38059683 DOI: 10.1111/jocd.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/13/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Tranexamic acid (TA) is a new and promising drug for the treatment of melasma. OBJECTIVES This network meta-analysis aims to compare the efficacy and safety of various ways of administration of TA on melasma. METHODS We collected researches from PubMed, EMBASE, Cochrane Library and Web of Science. Melasma area severity index (MASI) is used to evaluate the severity of melasma. After treatment with different TA administration methods, a difference in MASI is named ΔMASI. We evaluate the curative effect by comparing the ΔMASI of different TA administration methods at a certain time point. RESULTS At the Weeks 4, 8, and 12 and the last follow-up, the ΔMASI of oral TA combined with routine topical agents (oTA + RTA) was higher than that of intradermal TA (iTA), topical TA (tTA) as well as microneedling TA (MNsTA), with statistical significance. At the 8th week, the ΔMASI of oTA was higher than that of iTA, with statistical significance. Compared with placebo, oTA showed statistically significant differences at Week 4, while tTA, iTA, and MNsTA showed statistically significant differences starting from Week 8. CONCLUSIONS Among various ways of administration of TA, oTA + RTA has the best effect on melasma. In the short term, the curative effect of oTA is better than that of iTA, and the onset time of oTA is faster than that of tTA, iTA and MNsTA. In the long run, the curative effect of TA alone has nothing to do with the mode of administration.
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Affiliation(s)
- Rongzhou Liang
- Department of Laser Cosmetology, The Sixth People's Hospital of Dongguan, Dongguan, Guangdong, China
| | - Haiyan Luo
- Department of Laser Cosmetology, The Sixth People's Hospital of Dongguan, Dongguan, Guangdong, China
| | - Wanwan Pan
- Department of Dermatology, The Sixth People's Hospital of Dongguan City, Dongguan, Guangdong Province, China
| | - Sifen Yang
- Department of Plastic and Cosmetology, The Sixth People's Hospital of Dongguan City, Dongguan, Guangdong Province, China
| | - Xiaoyun Peng
- Department of Plastic and Cosmetology, The Sixth People's Hospital of Dongguan City, Dongguan, Guangdong Province, China
| | - Baizeng Kuang
- Department of Plastic and Cosmetology, The Sixth People's Hospital of Dongguan City, Dongguan, Guangdong Province, China
| | - Hongyin Huang
- Department of Plastic and Cosmetology, The Sixth People's Hospital of Dongguan City, Dongguan, Guangdong Province, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, Hefei, China
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Ma W, Gao Q, Liu J, Zhong X, Xu T, Wu Q, Cheng Z, Luo N, Hao P. Efficacy and safety of laser-related therapy for melasma: A systematic review and network meta-analysis. J Cosmet Dermatol 2023; 22:2910-2924. [PMID: 37737021 DOI: 10.1111/jocd.16006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Melasma is a prevalent, persistent hyperpigmentation disorder that negatively affects the psychological health of patients. However, the treatment outcome remains unsatisfactory due to the complexity of pathogenesis, recurrence characteristics, and relatively high morbidity. OBJECTIVES To compare the performance of laser-related therapies in improving the melasma area severity index (MASI) score of melasma and the occurrence of adverse effects by network meta-analysis (NMA). METHODS From the inception to November 2022, eligible randomized controlled trials were identified. Two investigators independently searched relevant studies from PUBMED, EMBASE, and the Cochrane Library database. RESULTS A total of 39 clinical studies with 1394 participants were eligible for enrollment. For efficacy, the NMA demonstrated that Q-switched Nd: YAG laser + topical medications (QSND+TM) was superior to Q-switched Nd:YAG laser (QSND) [MD = -4.21 (-6.80, -1.63)], Er: YAG laser + topical medications (ERYL+TM) [MD = -3.52 (-6.84, -0.19)], and picosecond laser + topical medications (PICO+TM) [MD = -4.80 (-9.33, -0.27)]. The microneedling + topical medications (MN+TM) was superior to picosecond laser (PICO) [MD = -5.26 (-10.44, -0.08)] and topical medications (TM) [MD = -5.22 (-9.20, -1.23)]. The top five of the surface under the cumulative ranking curve value (SUCRA) are Q-switched Nd:YAG laser + topical medications (QSND+TM 85.9%), oral tranexamic acid (oTA 80.1%), microneedling + topical medications (MN+TM 79.7%), Q-switched Nd:YAG laser + intense pulse light (QSND+IPL 78.9%), and fractional carbon dioxide laser + topical medications (FCDL+TM 70.5%). CONCLUSIONS In conclusion, the Qs-Nd:YAG laser with topical medications is the first choice for treating melasma according to the SUCRA value. Among the three treatment modalities, namely MN + TM, PICO, and TM, our recommendation favors MN+TM as the superior choice for enhancing the curative efficacy in melasma. However, the actual clinical choice should also take into account the adverse effects, the skin type of the patient, the duration of the disease, and other relevant factors.
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Affiliation(s)
- Wenyi Ma
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian Gao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jinghua Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaojing Zhong
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tongtong Xu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qinyao Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zilin Cheng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Nana Luo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Pingsheng Hao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Chang YJ, Lin YH, Wang PL, Lin HC. Efficacy of local infiltration of tranexamic acid in subcutaneous surgery: A protocol from a single medical center. Medicine (Baltimore) 2023; 102:e34900. [PMID: 37657042 PMCID: PMC10476745 DOI: 10.1097/md.0000000000034900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/03/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The purpose of this study was to explore efficacy of locally injected tranexamic acid (TXA) at a concentration of 1 mg/mL for reduction perioperative bleeding and postoperative complications in subcutaneous tumor excisions. We present the protocol and also compare results between the group of use antithrombotic group and not used. METHODS This is a retrospective study. Fifty-three patients were divided into 3 groups. Group 1 (n = 14): using antithrombotic drugs (antiplatelet or anticoagulants) with locally injected TXA. Group 2 (n = 17): using antithrombotic drugs without locally injected TXA. Group 3 (n = 22): not using antithrombotic drugs but with locally injected TXA. TXA was diluted to 1 mg/mL for use based on our experience. All patients were operated by 1 surgeon in 1 single medical center in Taipei from March 1st, 2020, to March 31st 2022. Outcomes such as the quality of perioperative surgical field and postoperative surgical complications were evaluated and compared. The quality of field was intraoperatively recorded by an assessment and photos from the surgeon. The statistical relationships between the complication rates were analyzed using χ2 test and a 1-way ANOVA by SPSS 25. RESULTS From Groups 1 and 3, a total of 36 patients, 29 patients had a clear surgical field during procedure. When comparing Groups 1 and 2, use of locally injected TXA had greater positive advantage in terms of a clearer vision whilst surgery (P = .031). Group 2 had more minor complications such as hematoma, severe ecchymosis, wound dehiscence, wound infection. By postoperatively reducing hematomas for 24 hours, it significantly reduce the incidence of abovementioned minor complications (P = .036). With the help of locally injected TXA, shorter time was required to remove drain, hence reducing duration of in-hospital stay. CONCLUSION The use of locally injected TXA whilst performing subcutaneous surgery on patients taking antithrombotic drugs is cost-effective. It could reduce bleeding and provide a more effective surgical field. In our study, favorable results were obtained from the use of diluted tranexamic acid (1 mg/mL) mixed with lidocaine, namely in clearing the surgical field as well as reducing postoperative surgical complications.
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Affiliation(s)
- Yao-Jen Chang
- Division of Plastic Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Shilin District, Taipei, Taiwan
| | - Yu-Hsien Lin
- Division of Plastic Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Shilin District, Taipei, Taiwan
| | - Pao-Lo Wang
- Division of Plastic Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Shilin District, Taipei, Taiwan
| | - Hwang-Chi Lin
- Division of Plastic Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Shilin District, Taipei, Taiwan
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Abd Elraouf IG, Obaid ZM, Fouda I. Intradermal injection of tranexamic acid versus platelet-rich plasma in the treatment of melasma: a split-face comparative study. Arch Dermatol Res 2023; 315:1763-1770. [PMID: 36856856 PMCID: PMC10338558 DOI: 10.1007/s00403-023-02580-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
Millions of people throughout the world suffer from the acquired condition of hyperpigmentation known as melasma. Melasma is characterized by symmetrically oriented hyperpigmented macules and patches. Many treatment options are available with variable degrees of efficacy and tolerability. The aim of the work was to evaluate and compare the effectiveness and safety of intradermal tranexamic acid (TXA) versus intradermal platelet-rich plasma (PRP) in the treatment of various types of melasma. The current split-face prospective study included 40 cases with melasma. Tranexamic acid (TXA) was injected intradermally into the right side of the face by using a concentration of 4 mg/ml, while platelet-rich plasma (PRP) was injected intradermally into the left side. In both sides, a total of three sessions of treatment were provided, once every 4 weeks. Digital photographs were taken before each treatment session and 3 months after the last session. The modified melasma area severity index (mMASI) grading system and dermoscopy were used to assess the improvement in the condition. The disease severity and percentage of improvement were assessed by mMASI score before and after therapy across both sides of the face. along with determining the degree of satisfaction and side effects among the included cases. The mean mMASI score before therapy in the TXA side was 4.59 ± 2.87, while in the PRP side, the mean mMASI score before therapy was 4.72 ± 2.72 with no statistically significant difference between the two sides (p = 0.841). After 3 months of treatment, the mean mMASI score in the TXA-treated side was 2.49 ± 1.58 with a mean percentage of decrease of 45.67 ± 8.10%, while in the PRP side, the mean mMASI score after treatment was 2.17 ± 1.41 with a mean percentage of decrease of 53.66 ± 11.27%. There was a high statistically significant decrease in the mMASI score after treatment on both sides (p < 0.001); however, the percentage of score reduction in the PRP side compared to the TXA side was statistically higher. Intradermal injection with PRP revealed higher efficacy in the treatment of melasma as compared to TXA injection with no significant difference regarding the associated side effects.
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Affiliation(s)
- Israa Gomaa Abd Elraouf
- Dermatology, Venereology and Andrology Department, Itay Elbaroud General Hospital, Albehira, Egypt
| | - Zakaria Mahran Obaid
- Dermatology, Venereology and Andrology Department, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Ibrahim Fouda
- Dermatology, Venereology and Andrology Department, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
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Zhang Q, Yang L, Yang F, Liu L, Jiang X. Mesotherapy-Induced Cutaneous Foreign Body-Type Granulomatous Reaction in the Face Treated with Minocycline: Case Report and Literature Review. Clin Cosmet Investig Dermatol 2023; 16:861-867. [PMID: 37033786 PMCID: PMC10081525 DOI: 10.2147/ccid.s403601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Abstract
Mesotherapy is a popular treatment that delivers substances deep into the skin but induces foreign body-type granulomatous reactions. However, such reactions caused by unauthorized use of topical tranexamic acid products in mesotherapy have never been reported before. We herein demonstrated a case of a 33-year-old woman with multiple mesotherapy-induced foreign body-type granulomas disseminated across her face. The patient was diagnosed with echo-color Doppler (ECD) and successfully treated with medications including minocycline hydrochloride. Then, we reviewed the differential diagnosis and current treatment for foreign body-type granulomatous reaction.
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Affiliation(s)
- Qian Zhang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Lihua Yang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Fengjuan Yang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Lian Liu
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Correspondence: Xian Jiang, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, 610041, People’s Republic of China, Tel +86-028-85423315, Fax +86-028-85422560, Email
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Oral Supplementation and Systemic Drugs for Skin Aging: A Narrative Review. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:114-124. [PMID: 36206809 DOI: 10.1016/j.ad.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
Skin aging is influenced by intrinsic and extrinsic factors and involves multiple pathogenic mechanisms. The most widely used treatments are topical products and minimally invasive procedures. Evidence on the benefits of systemic therapy is limited for several reasons: Reliance on mostly small and predominantly female samples, short study durations, methodologic heterogeneity, and a lack of consensus on which outcome measures are clinically relevant. Furthermore, systemic drugs and oral supplements are not without adverse effects. Oral hydrolyzed collagen and oral hyaluronic acid are well tolerated, and numerous clinical trials show they can mitigate some signs of skin aging. Low-dose oral isotretinoin is another option, but it has a higher risk of adverse effects. Evidence is lacking on the effects of the many dietary supplements on offer, such as vitamins, flavonoids, plant extracts, and trace elements. The future of skin aging management would appear to lie in the use of senolytic and senomorphic agents targeting senescent cells in the skin.
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Ko D, Wang RF, Ozog D, Lim HW, Mohammad TF. Disorders of hyperpigmentation. Part II. Review of management and treatment options for hyperpigmentation. J Am Acad Dermatol 2023; 88:291-320. [PMID: 35158001 DOI: 10.1016/j.jaad.2021.12.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/15/2021] [Accepted: 12/31/2021] [Indexed: 01/17/2023]
Abstract
Key challenges in the management of pigmentary disorders such as melasma and postinflammatory hyperpigmentation are their resistance to treatment, tendency to recur after treatment, and the risk of exacerbating hyperpigmentation with many treatment modalities. The second article in this 2-part continuing medical education series on pigmentary disorders focuses on the evidence behind medical and procedural treatments of dyschromias, including photoprotection, topical lightening agents, oral agents, chemical peels, and laser therapy.
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Affiliation(s)
- Dayoung Ko
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Rebecca F Wang
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - David Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
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[Translated article] Oral Supplementation and Systemic Drugs for Skin Aging: A Narrative Review. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T114-T124. [PMID: 36464003 DOI: 10.1016/j.ad.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022] Open
Abstract
Skin aging is influenced by intrinsic and extrinsic factors and involves multiple pathogenic mechanisms. The most widely used treatments are topical products and minimally invasive procedures. Evidence on the benefits of systemic therapy is limited for several reasons: reliance on mostly small and predominantly female samples, short study durations, methodologic heterogeneity, and a lack of consensus on which outcome measures are clinically relevant. Furthermore, systemic drugs and oral supplements are not without adverse effects. Oral hydrolyzed collagen and oral hyaluronic acid are well tolerated, and numerous clinical trials show they can mitigate some signs of skin aging. Low-dose oral isotretinoin is another option, but it has a higher risk of adverse effects. Evidence is lacking on the effects of the many dietary supplements on offer, such as vitamins, flavonoids, plant extracts, and trace elements. The future of skin aging management would appear to lie in the use of senolytic and senomorphic agents targeting senescent cells in the skin.
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Manfreda V, Eleonora DM, Luca B. Efficacy and safety of Politranexamide® liposomal emulsion on facial melasma: A comparative study. J Cosmet Dermatol 2023; 22:1780-1785. [PMID: 36718844 DOI: 10.1111/jocd.15648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/18/2022] [Accepted: 12/28/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Melasma is a human melanogenesis dysfunction that results in localized, chronic acquired hypermelanosis of the skin difficult to treat. METHODS This prospective, randomized, single-blind, study aimed to compare the efficacy and tolerability of a liposomal emulsion based on Politranexamide® (SAMPLE A) with that of a competitor based on acetylglucosamine, ethyl linoleate and phenyl ethyl resorcinol (SAMPLE B) in patients affected by facial melasma on 26 patients. Disease severity was assessed by the Melasma Area Severity Index (MASI) at baseline and after 6 and 12 weeks of therapy. All patients were subjected to photo documentation using DermaView camera and Antera 3D camera. RESULTS The mean MASI score at baseline was 10.93 ± 7 in the group A and 9.34 ± 6.29 in the group B, respectively. A significant decrease in MASI score from baseline was noted in both treatment groups as early as 6 weeks of follow-up (p = 0.00096 for SAMPLE A and p = 0.0049 for SAMPLE B) and was confirmed at the end of the treatment (p = 0.0006 for SAMPLE A and p = 0.00039 for SAMPLE B). Intergroup comparison revealed a greater improvement of melasma among patients in group A compared to those in group B that was quite statistically significant at weeks 6 (p = 0.055009) and significant after 12 weeks of follow-up (p = 0.032942). Both treatment groups experienced an improvement in Antera average level of melanin. CONCLUSION Our results suggested Politranexamide® to be a useful and safe therapeutic option in treating melasma, more effective than competitor used in this study.
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Affiliation(s)
- Valeria Manfreda
- Dermatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Di Matteo Eleonora
- Dermatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Bianchi Luca
- Dermatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Chevala NT, Dsouza JA, Saini H, Kumar L. Design and development of tranexamic acid loaded film-forming gel to alleviate melasma. J Cosmet Dermatol 2022; 21:6863-6874. [PMID: 36181344 DOI: 10.1111/jocd.15426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Melasma is a skin condition that causes increased epidermal pigmentation, enlarged melanocytes, increased melanosomes, solar elastosis, dermal blood vessels, and, occasionally, perivascular lymph histiocytic infiltrates. OBJECTIVE To develop the film-forming gel to alleviate melasma. Tranexamic acid was used as a model drug to evaluate the suitability of formulation to prevent symmetric hyperpigmentation. METHODS FFG is a hydrophilic polymeric cross-linked system loaded with an active moiety. Nine different formulations of 2% TXA were formulated using polyvinyl alcohol and hydroxypropyl methylcellulose 50 cP as film-forming polymers. Sodium carboxymethylcellulose, methylcellulose, and carbopol were used as gelling agents. RESULTS F7, F8, and F9 showed shorter DT, that is, 11, 8, and 12 min, respectively. The folding endurance of F7, F8, and F9 was >100 folds, and the pH of F7, F8, and F9 was >6. Among three formulations, F8 was further analyzed for in vitro drug diffusion, which showed >95% drug diffusion within 48 h. In vivo, the skin irritation potential of F8 was estimated using BAL/C mice, which confirmed the absence of skin irritation. CONCLUSION From the obtained results, we conclude that the FFG can be a strategic attempt to deliver the cosmeceutical drugs like TXA to alleviate Melasma with improved sustainability of the drug.
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Affiliation(s)
- Naga Thirumalesh Chevala
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Udupi, India
| | - Jenica Alwin Dsouza
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Udupi, India
| | - Hitesh Saini
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Udupi, India
| | - Lalit Kumar
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Udupi, India.,Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
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13
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Simpson J, Peng L, Ting W. Evaluation of oral tranexamic acid as a novel treatment for melasma with a high benefit-risk ratio. J Cosmet Dermatol 2022; 21:6393-6399. [PMID: 35972476 DOI: 10.1111/jocd.15305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/25/2022] [Accepted: 08/12/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Melasma is an acquired melanogenesis dysfunction resulting in chronic hyperpigmentation commonly affecting the face and other frequently sun-exposed areas of the body. Melasma typically presents in women of reproductive age and can significantly impact self-esteem, negatively affecting one's quality of life. In the United States, melasma is often treated with application of topical agents that interfere with melanin synthesis, lasers, or chemical peels; however, in some East Asian countries, oral tranexamic acid (TXA) is widely administered to alleviate hyperpigmentation during and after childbirth. TXA is currently only FDA-approved to treat hypermenorrhea and reduce blood loss in surgery but may offer women in the United States an additional therapeutic option to treat melasma. AIMS The aim of this paper is to evaluate the safety and baseline efficacy of oral transmexic acid as a treatment for melasma. METHODS We retrospectively surveyed 42 patients of Fitzpatrick skin types III-VI that were prescribed 650 mg of TXA ½ tablet to be taken twice daily by mouth. RESULTS We found majority of patients saw noticeable improvement in their melasma. Of the 42 patients, only seven experienced side effects. The side effects noted were headaches, malaise and nausea, gastrointestinal upset, congestion, numbness in legs, hypomenorrhea, and hypermenorrhea. Patients who experienced unpleasant side effects discontinued taking oral TXA and were relieved of their symptoms. No long-term side effects were discovered, and the side effects experienced may be due to other confounding factors. CONCLUSION From this data, we concluded oral TXA is a safe and effective treatment option for patients with persistent melasma.
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Affiliation(s)
| | - Lucy Peng
- California Dermatology Care, San Ramon, California, USA
| | - William Ting
- California Dermatology Care, San Ramon, California, USA
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14
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Prudovsky I, Kacer D, Zucco VV, Palmeri M, Falank C, Kramer R, Carter D, Rappold J. Tranexamic acid: Beyond antifibrinolysis. Transfusion 2022; 62 Suppl 1:S301-S312. [PMID: 35834488 DOI: 10.1111/trf.16976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/30/2022]
Abstract
Tranexamic acid (TXA) is a popular antifibrinolytic drug widely used in hemorrhagic trauma patients and cardiovascular, orthopedic, and gynecological surgical patients. TXA binds plasminogen and prevents its maturation to the fibrinolytic enzyme plasmin. A number of studies have demonstrated the broad life-saving effects of TXA in trauma, superior to those of other antifibrinolytic agents. Besides preventing fibrinolysis and blood loss, TXA has been reported to suppress posttraumatic inflammation and edema. Although the efficiency of TXA transcends simple inhibition of fibrinolysis, little is known about its mechanisms of action besides the suppression of plasmin maturation. Understanding the broader effects of TXA at the cell, organ, and organism levels are required to elucidate its potential mechanisms of action transcending antifibrinolytic activity. In this article, we provide a brief review of the current clinical use of TXA and then focus on the effects of TXA beyond antifibrinolytics such as its anti-inflammatory activity, protection of the endothelial and epithelial monolayers, stimulation of mitochondrial respiration, and suppression of melanogenesis.
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Affiliation(s)
- Igor Prudovsky
- Maine Medical Center Research Institute, Maine Medical Center, Scarborough, Maine, USA
| | - Doreen Kacer
- Maine Medical Center Research Institute, Maine Medical Center, Scarborough, Maine, USA
| | - Victoria Vieira Zucco
- Maine Medical Center Research Institute, Maine Medical Center, Scarborough, Maine, USA
| | - Monica Palmeri
- Maine Medical Center Cardiovascular Institute, Maine Medical Center, Portland, Maine, USA
| | - Carolyne Falank
- Department of Trauma, Maine Medical Center, Maine Medical Center, Portland, Maine, USA
| | - Robert Kramer
- Maine Medical Center Cardiovascular Institute, Maine Medical Center, Portland, Maine, USA
| | - Damien Carter
- Department of Trauma, Maine Medical Center, Maine Medical Center, Portland, Maine, USA
| | - Joseph Rappold
- Maine Medical Center Research Institute, Maine Medical Center, Scarborough, Maine, USA.,Department of Trauma, Maine Medical Center, Maine Medical Center, Portland, Maine, USA
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15
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Sarah OTB, Tawfik AA, Soliman M, Shaarawy E, Abdallah N. A Dermoscopic Evaluation of Melasma Treated with Tranexamic Acid. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background:
Melasma is a great challenge to the dermatologist. Choosing the proper treatment and the evaluation method are hard issues. Tranexamic acid [TA] injections showed promising results. The dermoscope is a non -invasive hand held tool
Objective:
To evaluate the efficacy of TA injections in the management of melasma and to assess a new dermoscopic score for assessment of melasma severity.
Patients & Methods:
Twenty-seven patients were enrolled in the study. They were assessed clinically, and by dermoscopy. An intradermal tranexamic acid was injected on the melasma. Melasma Area and Severity Index [MASI] was used to assess the melasma.
Results: high significant difference was found between pre [4.700±2.1213] and post [2.811±2.0870] treatment values of MASI score [p= 0.0001]. Clinically TA treatment showed a dramatic improvement in MASI.
Conclusion:
The intradermal usage of TA can actually decrease improved the melasma. This was confirmed by the MASI scores and the dermoscope. The dermoscope could be considered as a useful objective score for melasma.
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16
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Hawwam SA, Ismail M, El-Attar YA. Split-face comparative study between intradermal tranexamic acid injection alone versus intradermal tranexamic acid injection combined with Q-switched Nd:YAG laser in melasma treatment: dermoscopic and clinical evaluation. Lasers Med Sci 2022; 37:2193-2201. [PMID: 34988730 DOI: 10.1007/s10103-021-03483-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
Melasma is a chronic, dark brown-pigmented patches and macules commonly on the face. Many treatment modalities for melasma have been used as hydroquinone, laser treatment, and recently tranexamic acid. Dermoscopy is used to diagnose and follow up the treatment of melasma and to detect underlying invisible vessels and their change with treatment. Melasma treatment evaluation by using combined Q-switched Nd:YAG laser with intradermal tranexamic acid injection versus tranexamic acid intradermal injection alone. This study was conducted on 40 female patients aged 35-45 years. It was a split-face study; for 12 weeks, the right side of the face was treated with low fluence Q-switched Nd:YAG laser combined with intradermal injection of tranexamic acid, while the left side was treated with an injection of tranexamic acid intradermal alone. The patients were clinically evaluated by using the modified melasma area and severity index (mMASI) score, and underwent dermoscopic evaluation before treatment, at the end of the treatment (12 weeks), and at (24 weeks) as follow-up. The efficacy, adverse effects, and recurrence after treatment were reported. There was a statistically significant decrease in mMASI score with combination treatment than with intradermal injection of tranexamic acid alone after treatment at 12 weeks and at the end of follow-up at 24 weeks. Combination of an injection of tranexamic acid intradermal and low fluence Q-switched Nd:YAG laser is an effective and safe treatment for melasma with minimal side effects more than the intradermal tranexamic acid injection alone.
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Affiliation(s)
- Soha Abdalla Hawwam
- Dermatology & Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Mayada Ismail
- Dermatology & Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Yasmina Ahmed El-Attar
- Dermatology & Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Dermatology and Venereology, Armed Forces College of Medicine, Cairo, Egypt
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17
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Xing X, Xu Z, Chen L, Jin S, Zhang C, Xiang L. Tranexamic acid inhibits melanogenesis partially via stimulation of TGF-β1 expression in human epidermal keratinocytes. Exp Dermatol 2021; 31:633-640. [PMID: 34862827 DOI: 10.1111/exd.14509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 09/08/2021] [Accepted: 12/02/2021] [Indexed: 12/13/2022]
Abstract
Oral tranexamic acid (TA) has been an effective treatment for melasma with unclear mechanism. The present study aimed to demonstrate the effect of TA on melanogenesis via regulation of TGF-β1 expression in keratinocytes. We firstly determined the expression level of TGF-β1 in TA-treated keratinocyte-conditioned medium (KCM). Then, the mRNA and protein levels of microphthalmia-associated transcription factor (MITF), tyrosinase (TYR) and tyrosinase-related protein 1 (TRP-1) of human epidermal melanocytes (NHEMs) in the presence of TA-treated KCM were evaluated via RT-PCR and western blot analysis. Moreover, melanin content and tyrosinase activity were quantified. TGF-β1 gene was knocked down by small interfering RNA (siRNA) in keratinocytes. The mRNA and protein levels of TGF-β1 in keratinocytes were significantly increased after TA treatment. Melanin contents, tyrosinase activity, protein and mRNA levels of TYR, MITF and TRP-1 were downregulated in NHEMs in the presence of TA-treated KCM. Knockdown of TGF-β1 in keratinocytes could attenuate the inhibitory effect of TA-treated KCM on melanogenesis. TA could stimulate TGF-β1 expression in keratinocytes, which further inhibits melanogenesis through the paracrine signalling.
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Affiliation(s)
- Xiaoxue Xing
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhongyi Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shanglin Jin
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Leihong Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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18
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Supasiri T, Salakshna N, Pongpirul K. Short Practical Regimen of Acupuncture for Melasma: A Prospective Cohort Study in a Tertiary Hospital in Thailand. Front Public Health 2021; 9:761017. [PMID: 34805076 PMCID: PMC8599154 DOI: 10.3389/fpubh.2021.761017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Acupuncture shows benefits for patients with melasma, although no optimal number of sessions have been determined. Methods: The prospective observational study was conducted in melasma patients who were treated with acupuncture procedures two times a week and were evaluated after the 5th and the 10th sessions of acupuncture, with a 1-week follow-up after the last session. Participants Groups A and B received five and 10 acupuncture sessions, respectively. Melasma was assessed by using the melanin index (MI), melasma area and severity index (MASI), patient-reported improvement scores, and acupuncture-related adverse events. Results: Out of 113 participants, 67 received five sessions of acupuncture treatment while 39 received 10 sessions. At 1 week after five sessions of acupuncture in Group A, the mean MI decreased by 28.7 (95% CI −38.5 to −18.8, p < 0.001), whereas the median MASI decreased by 3.4 (95% CI −6.9 to −1.2, p < 0.001) points. At 1 week after ten sessions of acupuncture in Group B, the mean MI decreased by 31.3 (95% CI −45 to −17.6, p < 0.001), whereas the median MASI decreased by 5.4 (95%CI −9.9 to −3, p < 0.001) points. The first five sessions of acupuncture had a higher incremental effect than the last five sessions, although there was no statistically significant difference. Twenty-nine participants reported minor side effects. Group B had a risk ratio (RR) of having adverse events 1.8 times (95% CI 1.0–3.4, p = 0.05) compared with Group A. Conclusion: Short acupuncture regimens of 5–10 sessions in melasma seem to be effective and practical with minor side effects.
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Affiliation(s)
- Thanan Supasiri
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nuntida Salakshna
- Samitivej Esthetics Institute, Samitivej Sukhumvit Hospital, Bangkok, Thailand.,Science Division, Mahidol University International College, Nakhon Pathom, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of International Health and Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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19
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Behrangi E, Shemshadi M, Ghassemi M, Goodarzi A, Dilmaghani S. Comparison of efficacy and safety of tranexamic acid mesotherapy versus oral tranexamic acid in patients with melasma undergoing Q-switched fractional 1064-nm Nd:YAG laser: A blinded RCT and follow-up. J Cosmet Dermatol 2021; 21:279-289. [PMID: 34724323 DOI: 10.1111/jocd.14496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/30/2021] [Accepted: 09/17/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Melasma is a common hyperpigmentation disorder. This study aimed to compare the efficacy of Nd-Yag fractional 1064 plus microinjection of tranexamic acid versus Nd-Yag fractional 1064 plus oral tranexamic acid in patients with melasma. MATERIALS AND METHODS This is a prospective, randomized study with a sample size of 40 patients, 20 in each treatment arm, which was done six times with 2-week intervals. Twenty patients were administered localized microinjections (4 mg/ml) of tranexamic acid and Q-switched 1064 laser every 2 weeks in one arm, while in the other arm, 20 were given oral tranexamic acid 250 mg three times a day and Q-switched 1064 laser every 2 weeks per visit. RESULTS Twenty-one patients with mean SD 40.52+-4.95 y/o were treated with oral tranexamic acid, and 20 patients with 43.3+-5.87 y/o treated with microinjection of tranexamic acid were analyzed. There was no statistically significant difference between the two groups in terms of demographic and clinical characteristics at the baseline (p > 0.05). The patients MASI score and ∆E decrease over the study period in both treatments significantly (p < 0.001). However, patient's MASI score (p = 0.99) and ∆E (p = 0.53) did not differ significant between the two group over the time. Satisfaction (p = 0.41) and complication during the study period (p = 0.09) were not significantly different between the two group. CONCLUSION The combination treatment method can be a viable option for Middle Eastern patients having melasma disorder, and tranexamic acid appears to be an effective and safe treatment for melasma, irrespective of its route of administration. Tranexamic acid can increase the permeability locally by non-invasive methods such as microneedling which is less painful than microinjection and can also increase patient satisfaction. Although the oral method is more tolerable for the patient, it may have systemic side effects, and its combination with Q-switch laser increases its effect regardless of the type of prescription. Therefore, it is recommended to use of this drug topically (cream or lotion) by non-invasive methods like microneedling to reduce pain and laser treatment in future studies.
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Affiliation(s)
- Elham Behrangi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mahsa Shemshadi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mohammadreza Ghassemi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Sara Dilmaghani
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
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20
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Gharib K, Mostafa FF, Ghonemy S. Therapeutic Effect of Microneedling with Platelet-rich Plasma Versus Microneedling with Tranexamic Acid for Melasma. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:44-48. [PMID: 34840657 PMCID: PMC8570658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Melasma is a chronic acquired focal pigment disorder showing symmetrical hyperpigmentation or hypermelanosis of photoexposed areas on the face. Tranexamic acid (TXA) is a treatment for melasma. The regression of melasma after platelet-rich-plasma (PRP) treatment is an interesting finding. OBJECTIVE We investigated the effect of microneedling followed by PRP versus microneedling followed by tranexamic acid in the treatment of patients with melasma. METHODS The study included 26 patients with melasma divided into two groups of 13 patients each. Group 1 was treated with microneedling and PRP, and Group 2 was treated with microneedling and tranexamic acid. RESULTS The response to treatment was assessed using the Melasma Area and Severity Index scoring system before and after treatment. At the start of the study and at the first session, there were no statistically significant differences (p>0.05). At the second and third treatment sessions, there were statistically significant differences (p<0.05). There were no statistically significant differences between the two groups regarding side effects of pain, erythema and postinflammatory hyperpigmentation. CONCLUSION Microneedling with PRP offers better results than microneedling with TXA in treating melasma.
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Affiliation(s)
- Khaled Gharib
- All authors are with the Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Fawzia Farag Mostafa
- All authors are with the Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Soheir Ghonemy
- All authors are with the Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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21
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Feng X, Su H, Xie J. Efficacy and safety of tranexamic acid in the treatment of adult melasma: An updated meta-analysis of randomized controlled trials. J Clin Pharm Ther 2021; 46:1263-1273. [PMID: 33959984 DOI: 10.1111/jcpt.13430] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 03/28/2021] [Accepted: 04/15/2021] [Indexed: 02/05/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Tranexamic acid (TXA) is a novel treatment option for melasma; however, no consensus exists on its use. This study evaluates the efficacy and safety of TXA for melasma. METHODS A comprehensive literature review was conducted to search for randomized controlled trials comparing TXA alone, TXA as adjuvant to routine treatment and placebo. Changes in the Melasma Area Severity Index (MASI)/modified MASI (mMASI) between pre- and post-treatment and between a certain melasma treatment and TXA were the primary outcomes. Twenty-four trials comparing oral, topical or intradermal TXA with routine treatment were included in the meta-analysis. RESULTS AND DISCUSSION The change in MASI/mMASI scores at 4 (MD, 3.58; 95% confidence interval (CI), 2.15-5.01), 8 (MD, 5.08; 95% CI, 3.34-6.81), 12 (MD, 4.89; 95% CI, 3.80-5.97) and 16 (MD, 6.55; 95% CI, 2.62-10.48) weeks after treatment was all less than the baseline scores, regardless of the delivery route. The reduction in the MASI/mMASI scores between TXA adjuvant and routine treatment at 4 (MD, -0.43; 95% CI, -0.79 to -0.08), 8 (MD, -0.81; 95% CI, -1.09 to -0.54), 12 (MD, -1.10; 95% CI, -1.78 to -0.43) and 16 (MD, -1.12; 95% CI, -1.51 to -0.74) weeks was significant. However, the superiority of TXA was not detected when the topical or intradermal route was adopted. No serious adverse events occurred with the use of TXA. WHAT IS NEW AND CONCLUSION These results suggest that oral TXA is an available, effective and safe alternative treatment for melasma.
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Affiliation(s)
- Xiaowei Feng
- Department of Dermatovenerology, Chengdu First People's Hospital, Chengdu, China
| | - Hong Su
- Department of Dermatovenerology, Chengdu First People's Hospital, Chengdu, China
| | - Jinwei Xie
- Department of Orthopedics surgery, West China Hospital, Sichuan University, Chengdu, China
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22
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Badran AY, Ali AU, Gomaa AS. Efficacy of topical versus intradermal injection of Tranexamic Acid In Egyptian melasma Patients: A randomised clinical trial. Australas J Dermatol 2021; 62:e373-e379. [PMID: 33782959 DOI: 10.1111/ajd.13575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/19/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Melasma is one of the common pigmentary problems affecting females in our community, owing to the frequent use of hormonal contraceptives as well as our sunny climate. A lot of treatment options are available but none of them is completely satisfactory. Many patients prefer the use of topical preparations and minimally invasive methods. Tranexamic acid (TA) is a potential treatment option for hyperpigmentation with different delivery routes. AIM We designed the study in order to evaluate the efficacy of TA in melasma using 2 different routes of delivery. PATIENTS AND METHODS A randomised clinical trial was performed on 60 female patients with melasma, they randomly divided into three groups; A, B and C. Group (A) patients received TA (4 mg/mL) intradermal injections every 2 weeks with, group B received TA (10 mg/mL) intradermal injections every 2 weeks, group C received TA cream (10% concentration) twice daily, treatment continued for 12 weeks in all groups. Melasma Area and Severity Index (MASI) scores were measured for each patient before and after completion of treatment. RESULTS The percentage of MASI score reduction was highest in group B (62.7%) versus (39.1%) in group A, while the percentage of MASI reduction was the lowest in group C (4.2%). CONCLUSION Tranexamic acid is a safe effective and well-tolerated treatment option for melasma patients. Intradermal injection of TA leads to better results than the topical application. Topical TA cream (even in a high concentration) produce fair improvement of melasma.
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Affiliation(s)
- Aya Y Badran
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut, Egypt
| | - Ahmed U Ali
- Department of Pharmaceutics, Faculty of Pharmacy and Industrial Pharmacy, Sinai University, Arish, Egypt
| | - Ahmed S Gomaa
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut, Egypt
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23
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Novel dissolving microneedles preparation for synergistic melasma therapy: Combined effects of tranexamic acid and licorice extract. Int J Pharm 2021; 600:120406. [PMID: 33711468 DOI: 10.1016/j.ijpharm.2021.120406] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/02/2021] [Accepted: 02/13/2021] [Indexed: 02/07/2023]
Abstract
The aim of this study was to prepare dissolving microneedles (DMNs) patches containing tranexamic acid (TA) for the treatment of melasma. Polyvinyl alcohol (PVA) and polyvinylpyrrolidone (PVP) were preferred as matrix materials through the compatibility experiment. In the in vitro permeation study, the transdermal amount of TA was significantly promoted through dissolving microneedles with the cumulative release was 44.43 ± 6.55%. By comparison, the release of TA solution assisted with solid microneedles (SMNs) was merely 11.31 ± 2.30% (p < 0.05). Pharmacokinetics study indicated the bioavailability of dissolving microneedles was more than 1.3 times compared with oral administration. In pharmacodynamics investigation, TA dissolving microneedles obviously reduced melanin deposition in the skin of melasma guinea pigs after 8 consecutive administrations. In particular, the combination of tranexamic acid and licorice extract (LIC) dissolving microneedles worked better than tranexamic acid alone. Accelerated stress conditions including high temperature, high humidity, as well as photostability were designed to prove that TA microneedles maintained good pharmaceutical stability. In conclusion, tranexamic acid dissolving microneedles showed reliable quality and remarkable effect. Moreover, the combination of tranexamic acid and licorice extract had a synergistic therapy in melasma.
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24
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Qu Y, Wang F, Liu J, Xia X. Clinical observation and dermoscopy evaluation of fractional CO 2 laser combined with topical tranexamic acid in melasma treatments. J Cosmet Dermatol 2021; 20:1110-1116. [PMID: 33565243 DOI: 10.1111/jocd.13992] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/25/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Melasma is an acquired refractory pigmentary disorder, which is a skin disease that predominantly affects females. This investigation aims to assess the efficacy of a low-power fractional CO2 laser combined with tranexamic acid (TXA) for melasma topical treatment with MASI and dermoscopy. MATERIALS AND METHODS A randomized comparative split-face study was performed. Each treatment interval was 3 weeks with four times in total. At the same time, we applied TXA solution twice a day. Assessments were made by the MASI score of the melasma area severity index, and the dermoscopy performance was collected and analyzed. RESULTS After treatments, the patient MASI score decreased significantly. Compared with the baseline, the MASI score was significantly lower than that of control group (P < .05), and the decrease ratio was higher than that of controls. Dermoscopy examination results verified that all lesions performed reticuloglobular pattern, granular, or punctate, with no structural pigmentation and obvious capillary dilation. After comprehensive treatments, the pigmentation area displayed lighter chroma, the follicle pore uniformity was completely improved, and the capillary dilation was significantly reduced. CONCLUSIONS Low-power fractional CO2 laser combined with topical TXA solution is a comparatively effective and safe method for melasma treatment. TXA could reduce the dilation of blood vessels.
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Affiliation(s)
- Yan Qu
- Department of Dermatology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, Yantai, Shandong, China
| | - Fengjuan Wang
- Dongying District People's Hospital of Dongying City, Dongying, China
| | - Junru Liu
- Yantai Yuhuangding Hospital Laishan Branch, Yantai, China
| | - Xiujuan Xia
- Department of Dermatology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, Yantai, Shandong, China
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25
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Nguyen J, Rajgopal Bala H, Ross A, Wong CC, Paul E, Rodrigues M. Effect of oral tranexamic acid on erythema index in patients with melasma. Australas J Dermatol 2020; 62:206-209. [PMID: 33125702 DOI: 10.1111/ajd.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/30/2020] [Accepted: 09/05/2020] [Indexed: 11/28/2022]
Abstract
Melasma is a common disorder of hyperpigmentation that presents a therapeutic challenge for clinical dermatologists. The pathogenesis is complex, but previous studies have demonstrated vascular proliferation is a key factor in the development of the classic hyperpigmented patches. Studies have revealed reduction of erythema by oral tranexamic acid; however, there has been no direct comparison to placebo. This 24-week randomised placebo-controlled trial demonstrates oral tranexamic acid may improve erythema in melasma. This mechanism of action may be the reason for the success of tranexamic acid in complex and difficult to treat melasma.
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Affiliation(s)
- Jennifer Nguyen
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
| | - Harini Rajgopal Bala
- Department of Dermatology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Angelique Ross
- Emergency Department, Monash Health, Clayton, Victoria, Australia
| | - Celestine C Wong
- Chroma Dermatology, Pigment and Skin of Colour Centre, Wheelers Hill, Victoria, Australia.,Department of Dermatology, Monash Health, Clayton, Victoria, Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michelle Rodrigues
- Chroma Dermatology, Pigment and Skin of Colour Centre, Wheelers Hill, Victoria, Australia.,Department of Dermatology and Department of Paediatrics, Royal Children's Hospital & Melbourne University, Melbourne, Victoria, Australia
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26
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Nisticò SP, Tolone M, Zingoni T, Tamburi F, Scali E, Bennardo L, Cannarozzo G. A New 675 nm Laser Device in the Treatment of Melasma: Results of a Prospective Observational Study. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:560-564. [PMID: 32833576 DOI: 10.1089/photob.2020.4850] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: This study evaluates the efficacy and safety of a new 675 nm laser source system on melasma. Background: Melasma is an acquired circumscribed hyperpigmented disorder that has a negative impact on patients' life quality. Different treatments are currently available. This study evaluates this new 675 nm laser source system, on melasma with the use of established parameters that guarantee minimum pain, the absence of side effects, and simplifying posttreatment management. Materials and methods: A total of 25 subjects (all women, 21-50 years old), with facial melasma and Fitzpatrick skin types I-III, were treated with three sessions of a new 675 nm laser system. Efficacy of treatment was evaluated using Melasma Severity Index (MSI) score before and 3 months after the last session. The appearance of side effects has also been monitored to evaluate safety. A preclinical study was executed to evaluate laser effectiveness on sheep skin. Results: All 25 subjects treated with the 675 nm laser had significant improvement in melasma according to MSI score (mean baseline MSI 26.4 ± 19.2; mean 3-month follow-up MSI 17.3 ± 15, p: 0.003). Histology in preclinical study showed selective damage of melanin-rich areas. No side effects have been observed except some minor erythematous reactions in two patients. Conclusions: Due to its high affinity with melanin, and its minimal interaction with the vascular component, novel 675 nm laser may be considered promising when treating benign pigmented lesions with a low risk of side effects and simple posttreatment management.
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Affiliation(s)
- Steven Paul Nisticò
- Unit of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Martina Tolone
- Unit of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Tiziano Zingoni
- Unit of Dermatology, University of Rome, Tor Vergata, Rome, Italy
| | - Federica Tamburi
- Unit of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Elisabetta Scali
- Unit of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Luigi Bennardo
- Unit of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
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27
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Gamea MM, Kamal DA, Donia AA, Hegab DS. Comparative study between topical tranexamic acid alone versus its combination with autologous platelet rich plasma for treatment of melasma. J DERMATOL TREAT 2020; 33:798-804. [DOI: 10.1080/09546634.2020.1781755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Mohamed Mahmoud Gamea
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Doha Ali Kamal
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Atef Donia
- Pharmaceutical Technology Department, Faculty of Pharmacy, Menoufia University, Shibin el Kom, Egypt
| | - Doaa Salah Hegab
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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28
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Litaiem N, Daadaa N, Karray M, Chamli A, Zeglaoui F. Hypopigmentation as a side effect of melasma treatment with tranexamic acid intradermal microinjections. Dermatol Ther 2020; 33:e13503. [DOI: 10.1111/dth.13503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Noureddine Litaiem
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
- Faculty of Medicine of Tunis University of Tunis El Manar Tunis Tunisia
| | - Najla Daadaa
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
- Faculty of Medicine of Tunis University of Tunis El Manar Tunis Tunisia
| | - Manel Karray
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
- Faculty of Medicine of Tunis University of Tunis El Manar Tunis Tunisia
| | - Amal Chamli
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
- Faculty of Medicine of Tunis University of Tunis El Manar Tunis Tunisia
| | - Faten Zeglaoui
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
- Faculty of Medicine of Tunis University of Tunis El Manar Tunis Tunisia
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29
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Kaleem S, Ghafoor R, Khan S. Comparison of efficacy of Tranexamic Acid Mesotherapy versus 0.9% normal Saline for Melasma; A split face study in a Tertiary Care Hospital of Karachi. Pak J Med Sci 2020; 36:930-934. [PMID: 32704266 PMCID: PMC7372652 DOI: 10.12669/pjms.36.5.2379] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: To compare the efficacy of tranexamic acid mesotherapy versus 0.9% normal saline for melasma by split-face study. Methods: It was a non-randomized clinical trial performed at the Dermatology ward of JPMC from September 2018 to June 2019 after getting approval from the Ethical Committee. A total of sixty patients were recruited in the study, who had symmetrical melasma on their faces. Both halves of the face were treated by Injection Tranexamic Acid (TA) with a dose of 4mg/ml and Normal Saline (NS) two weekly for twelve weeks. Hemi Modified Melasma Area and Severity Scoring (H-mMASI) was calculated at the start and end of the study. Analyses were done by SPSS version 23. P < 0.05 was taken as significant. Results: Mean of H-mMASI score was compared on both sides at the end of study, which showed significant reduction in mean score from 3.19 ±2.57 to 1.52 ± 1.2 (P < 0.05) on A side as compared to decline in scores on NS side from 3.46 ± 2.7 to 3.45 ± 2.6 (P > 0.05). Erythema, swelling, and burning were documented as temporary side effects on both sides. Conclusion: Tranexamic Acid (TA) mesotherapy can be considered as the most cost-effective, safe and directly observed therapy for melasma which showed significant improvement when old prior therapies have failed.
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Affiliation(s)
- Sana Kaleem
- Dr. Sana Kaleem, MBBS, FCPS II Trainee., Department of Dermatology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Rabia Ghafoor
- Dr. Rabia Ghafoor, MBBS, FCPS. Assistant Professor, Department of Dermatology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Sidra Khan
- Dr. Sidra Khan, MBBS, FCPS II Trainee., Department of Dermatology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
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30
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Ng SP, Marcant M, Davis AF. In vitro human skin concentrations following topical application of 2% tranexamic acid in co‐enhancer cream and branded cream formulations. J Cosmet Dermatol 2020; 19:2656-2662. [DOI: 10.1111/jocd.13301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/28/2019] [Accepted: 12/09/2019] [Indexed: 01/13/2023]
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31
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Eltania F, Lesmana R, Sudigdoadi S, Sudigdoadi S, Khairani AF, Goenawan H, Citrawan A, Armina Yuniarti R, Wahyudianingsih R, Gunadi JW, Supratman U. Tranexamic Acid Cream Protects Ultraviolet B-induced Photoaging in Balb/c Mice Skin by Increasing Mitochondrial Markers: Changes Lead to Improvement of Histological Appearance. Photochem Photobiol 2019; 96:863-869. [PMID: 31788813 DOI: 10.1111/php.13189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/02/2019] [Indexed: 12/12/2022]
Abstract
Tranexamic acid (TSA) is widely used as an antiaging treatment for reducing melasma and wrinkles. There are various mechanisms for wrinkle formation, and one of them is due to damage of the mitochondria. Research on mitochondria in the skin is very limited, so we are interested to see the changes that occur after application of TSA cream. We explored the effect of TSA on mitochondrial protein levels (PGC1α, Tom20, COX IV), which had affected to skin histological structure. Thirty male, 6-week-old, Balb/C mice were divided into five groups (negative control, positive control, TSA 3%, TSA 4% and TSA 5%). After 10 days of acclimatization, four groups of mice were exposed to UVB light, of which three groups were given TSA cream for 10 weeks. The skin tissue was excised for protein and histological studies. H&E staining was performed for evaluating histological changes in epidermal thickness and dermal elastosis. TSA treatment on the mice skin increased mitochondrial marker levels and epidermal thickness while decreasing dermal elastosis for all the treatment groups. Topical application of TSA significantly increased mitochondrial biogenesis which may cause alteration in epidermal thickness and reduced dermal elastosis in the histology of mice skin.
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Affiliation(s)
- Fransiska Eltania
- Department of Pharmacology, Faculty of Medicine, Maranatha Christian University, Bandung, Indonesia.,Graduate Programme of Antiaging and Aesthetics Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ronny Lesmana
- Physiology Division, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia.,Division of Biological Activity, Central Laboratory, Universitas Padjajaran, Bandung, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjajaran, Bandung, Indonesia
| | - Sunaryati Sudigdoadi
- Graduate Programme of Antiaging and Aesthetics Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Microbiology Division, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Sudigdoadi Sudigdoadi
- Graduate Programme of Antiaging and Aesthetics Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Astrid Feinisa Khairani
- Graduate Programme of Antiaging and Aesthetics Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Division of Cell Biology, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Hanna Goenawan
- Physiology Division, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia.,Division of Biological Activity, Central Laboratory, Universitas Padjajaran, Bandung, Indonesia
| | - Andrew Citrawan
- Luminos Aestethic Clinic, Telogorejo Hospital, Semarang, Indonesia
| | | | - Roro Wahyudianingsih
- Department of Pathology Anatomy, Faculty of Medicine, Maranatha Christian University, Bandung, Indonesia
| | - Julia Windi Gunadi
- Department of Physiology, Faculty of Medicine, Maranatha Christian University, Bandung, Indonesia
| | - Unang Supratman
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjajaran, Bandung, Indonesia.,Department of Chemistry, Faculty of Mathematics and Natural Sciences, Universitas Padjadjaran, Jatinangor, Indonesia
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32
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Anwar AI, Wahab S, Widita W, Nurdin AR, Budhiani S, Seweng A. Randomized control trial outcomes of tranexamic acid combination serum as a depigmenting agent for the use in healthy individuals. Dermatol Ther 2019; 32:e13146. [PMID: 31664751 DOI: 10.1111/dth.13146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/23/2019] [Accepted: 10/26/2019] [Indexed: 11/30/2022]
Abstract
To compare the effectiveness of tranexamic acid (TA) combination serum with hydroquinone, the gold standard in whitening agents for healthy populations. This was a three-arm randomized controlled trial. The subjects were divided into three groups: the first group received 3% TA combination serum (3% TA, 4% galactomyces ferment filtrate, 2% niacinamide, and 4% alpha arbutin), the second group received 2% TA combination serum, and the third group received 4% hydroquinone. One milliliter of each serum was applied on three holes: Hole A, which was located 4 cm from the left cubital fossa, Hole B, which was located 4 cm from the first hole, and Hole C, which was located 4 cm from the right cubital fossa. The skin brightness and pigmentation intensity were evaluated each week for 4 weeks using a chromameter. A total of 44 subjects were recruited for this study. All groups showed a significant improvement in skin brightness and pigmentation intensity after 4 weeks (p < .001). There were no differences between the treatment groups and hydroquinone (p > .05). TA serum (2 and 3%) combined with 4% galactomyces ferment filtrate, niacinamide, and alpha arbutin is an effective depigmenting agent.
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Affiliation(s)
- Anis I Anwar
- Department of Dermatology and Venereology, Medical Faculty, Hasanuddin University, Makassar, Indonesia
| | - Siswanto Wahab
- Department of Dermatology and Venereology, Medical Faculty, Hasanuddin University, Makassar, Indonesia
| | - Widya Widita
- Department of Dermatology and Venereology, Medical Faculty, Hasanuddin University, Makassar, Indonesia
| | - Airin R Nurdin
- Department of Dermatology and Venereology, Medical Faculty, Hasanuddin University, Makassar, Indonesia
| | - Suci Budhiani
- Department of Dermatology and Venereology, Medical Faculty, Hasanuddin University, Makassar, Indonesia
| | - Arifin Seweng
- Medical Faculty, Hasanuddin University, Makassar, Indonesia
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