Melasma Treatment, Comparing Topical Tranexamic Acid Vs Microneedling

What is Melasma?

Melasma is a common skin condition characterized by dark, discolored patches on the skin. It's particularly prevalent among women, especially during hormonal fluctuations such as pregnancy or when using oral contraceptives. The condition typically appears on sun-exposed areas of the face, including the cheeks, bridge of the nose, forehead, chin, and above the upper lip.

How do we recognize what type of melasma it is?

Melasma is primarily classified into three types based on the depth of pigment deposition:

• Epidermal Melasma: Characterized by dark brown coloration, with well-defined borders, visible under UV light, and responsive to treatment.
• Dermal Melasma: Shows as light brown or bluish patches, with diffuse borders. This type is deeper in the skin and can be more challenging to treat.
• Mixed Melasma: A combination of both epidermal and dermal types, appearing as brown patches with a bluish tint.

Which is the Best Method for Melasma Treatment?

We compare the effectiveness of topical tranexamic acid applications with more invasive methods like microneedling and microinjections. As a skin specialist, Lennis Denis, I aim to provide both estheticians and clients with a clear understanding of these treatment modalities backed by scientific research.

Topical Tranexamic Acid:

• Ease of Use: Topical applications are non-invasive and can be easily integrated into daily skincare routines.
• Effectiveness: While effective for some, topical tranexamic acid often shows slower and less pronounced results in reducing melasma, as noted by Badran et al. (2021), who observed the lowest reduction in Melasma Area and Severity Index (MASI) scores with topical treatments.

Microneedling and Microinjections:

• Direct Delivery: These methods involve the direct delivery of tranexamic acid into the dermal layers, potentially enhancing its efficacy.
• Increased Effectiveness: Studies like those by Lee et al. (2006) and Badran et al. (2021) have shown that microinjections can lead to a more significant decrease in MASI scores, suggesting a more potent effect on melasma compared to topical applications.

Pros and Cons:

Pros:

• Topical Application: Non-invasive, safer with minimal side effects, suitable for long-term use.
• Microneedling/Microinjections: Faster results, more significant reduction in pigmentation.

Cons:

• Topical Application: Slower results may be less effective for severe melasma.
• Microneedling/Microinjections: More invasive, potential for side effects, requires clinical supervision.

Conclusion:

While topical tranexamic acid offers a safer and easier approach to managing melasma, the use of microneedling and microinjections may provide more dramatic and quicker improvements in skin pigmentation. Combining these treatments, as I advocate, can potentially offer comprehensive benefits, ensuring both surface-level and deeper skin improvements.

Citations:

• Badran, A. Y., Ali, A. U., & Gomaa, A. S. (2021). Efficacy of topical versus intradermal injection of Tranexamic Acid in Egyptian melasma Patients: A randomised clinical trial. Australasian Journal of Dermatology, 62(3), e373-e379. https://doi.org/10.1111/ajd.13575
• Lee, J. H., Park, J. G., Lim, S. H., Kim, J. Y., Ahn, K. Y., Kim, M.-Y., & Park, Y. M. (2006). Localized intradermal microinjection of tranexamic acid for treatment of melasma in Asian patients: a preliminary clinical trial. Journal of Dermatological Treatment, 17(4), 223-227. https://doi.org/10.1111/j.1524-4725.2006.32133.x