title: A Randomised, Open-label, Comparative Study of Tranexamic Acid Microinjections and Tranexamic Acid with Microneedling in Patients with Melasma.
abstract: BACKGROUND
  Melasma is a common cause of facial hyperpigmentation with significant cosmetic deformity. Although several treatment modalities are available, none is satisfactory.
  
  
  OBJECTIVE
  To compare the therapeutic efficacy and safety of tranexamic acid (TA) microinjections versus tranexamic acid with microneedling in melasma.
  
  
  METHODS
  This is a prospective, randomised, open-label study with a sample size of 60; 30 in each treatment arms. Thirty patients were administered with localised microinjections of TA in one arm, and other 30 with TA with microneedling. The procedure was done at monthly intervals (0, 4 and 8 weeks) and followed up for three consecutive months. Clinical images were taken at each visit including modified Melasma Area Severity Index MASI scoring, patient global assessment and physician global assessment to assess the clinical response.
  
  
  RESULTS
  In the microinjection group, there was 35.72% improvement in the MASI score compared to 44.41% in the microneedling group, at the end of third follow-up visit. Six patients (26.09%) in the microinjections group, as compared to 12 patients (41.38%) in the microneedling group, showed more than 50% improvement. However, there were no major adverse events observed in both the treatment groups.
  
  
  CONCLUSIONS
  On the basis of these results, TA can be used as potentially a new, effective, safe and promising therapeutic agent in melasma. The medication is easily available and affordable. Better therapeutic response to treatment in the microneedling group could be attributed to the deeper and uniform delivery of the medication through microchannels created by microneedling.
authors.affiliation: Department of Dermatology, Bowring and Lady Curzon Hospital and Research Institute Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.
authors.forename: Leelavathy
authors.initials: L
authors.lastname: Budamakuntla
authors.forename: Eswari
authors.initials: E
authors.lastname: Loganathan
authors.forename: Deepak Hurkudli
authors.initials: DH
authors.lastname: Suresh
authors.forename: Sharavana
authors.initials: S
authors.lastname: Shanmugam
authors.forename: Shwetha
authors.initials: S
authors.lastname: Suryanarayan
authors.forename: Aparna
authors.initials: A
authors.lastname: Dongare
authors.forename: Lakshmi Dammaningala
authors.initials: LD
authors.lastname: Venkataramiah
authors.forename: Namitha
authors.initials: N
authors.lastname: Prabhu
keywords: Melasma; microinjections; microneedling; tranexamic acid