TY - JOUR ID - TI - The Efficacy of Intralesional Tranexamic Acid in the Treatment of Melasma in Iraqi Patients AU - Hayder RM. Al-Hamamy*, Roaa Mahir Aziz PY - 2020 VL - 19 IS - 2 SP - 127 EP - JO - Iraqi Postgraduate Medical Journal المجلة العراقية للاختصاصات الطبية SN - 83601608 98932708 AB - ABSTRACT:BACKGROUND:Melasma is an acquired hyperpigmentation of the skin. Exacerbating factors include pregnancy, useof oral contraceptives and sunexposure.OBJECTIVE:To study the effectiveness of intralesional tranexamic acid in the treatment of melasma.PATIENTS AND METHODS:This is an interventional single-blinded comparative outpatient study carried out at the Centerof Dermatology, Baghdad Teaching Hospital during the period from March 2017 to May 2018.Forty patients with melasma were included in the study. The patients were divided into threegroups. Group A was treated with tranexamic acid 4mg/ml delivered by microneedling approachat monthly interval for 3 months with topical hydroquinone 4% daily at night for 3 months. Group Bwas treated with intradermal injection of 4mg/ml of tranexamic acid by using insulin syringemonthly for 3 months with topical hydroquinone 4% daily at night. Group C was treated withtopical hydroquinone 4% daily at night for 3 months.The severity of melasma was assessed before, during and after treatment with the melasma area andseverity index (MASI) score. Every patient was instructed to apply a broad-spectrum sunscreenbefore sun exposure during the treatment period.RESULTS:Thirty-two patients with melasma completed the study. In group A: Eleven patients were included,the mean age and SD was 33.81 ± 4.55 years. The MASI score before treatment was 5.31 ±1.65,whereas after treatment it became 3.69± 1.79 (P value: 0.0001). The reduction of MASI score was32.39%. In group B: Eleven patients were included, the mean age and SD was 39.72 ±6.27 years.The MASI score before treatment was 4.52±1.79, whereas after treatment it became 3.50 ±1.61(P value: 0.002). The reduction of MASI score was 20.96%. In group C: Ten patients wereincluded, the mean age and SD was 37.20 ± 7.55 years. The MAI score before treatment was4.01±1.07 whereas after treatment became 3.13±0.17 (p value=0.002). The reduction in the MASIscore was 14.11. The percent reduction in the MASI score at follow up visits was significantlyhigher in group A than in groups B and C ( p value= 0.026) while there were no significantdifference between group B and C.CONCLUSION:Tranexamic acid is an effective drug when it used with other conventional treatments of melasma,and the microneedling approach of delivering tranexamic acid showed better response than theother modes of drug delivery and this may be due to uniform delivery of the drug through themicrochannels.

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