Microneedling with tranexamic acid may improve outcomes for patients with melasma

1. Among patients with melasma, microneedling with tranexamic acid was superior to microneedling with metformin or the control treatment in reducing melasma severity and improving patient satisfaction.

Evidence Rating Level: 2 (Good)

Melasma is an acquired hyperpigmentation disorder most commonly affecting women. Its chronicity and high recurrence rate make it difficult to treat. Microneedling has emerged as a promising technique to improve transdermal delivery and efficacy of topical agents by enabling deeper skin penetration. Tranexamic acid (TXA), a synthetic antifibrinolytic agent, has demonstrated clinical efficacy in the treatment of melasma, while metformin, an antidiabetic agent, has more recently emerged as a novel therapeutic option. This study compared the therapeutic efficacy and safety of microneedling with topical metformin versus microneedling with topical TXA in melasma patients. This randomized, prospective, parallel-group clinical trial included female patients aged 20-50 years with facial melasma. Participants were randomized 1:1:1 into one of three groups: metformin group: microneedling + topical metformin solution, TXA group: microneedling + topical TXA solution, control group: topical modified Kligman’s formula (hydroquinone 4%, tretinoin 0.05%, mometasone 0.1%) once daily. Metformin and TXA groups underwent four biweekly sessions for 8 weeks, whereas the control group applied Kligman’s formula daily for 8 weeks. The study included 45 participants, with 15 in each group (mean [SD] ages: metformin group = 36.33 [8.1] years; TXA group = 35.73 [9.41] years, control group = 37.07 [10.11] years). After 8 weeks of treatment, all groups showed significant reductions in the modified Melasma Area and Severity Index (mMASI), with the greatest reduction in the TXA group (mean [SD] 45.28% [9.29%]), followed by the control group (38.21% [12.11%]) and metformin group (22.11% [16.13%]) (p < 0.001 between groups). Satisfaction scores were highest in the TXA group, with 33.3% reporting marked improvement (≥ 75% improvement), compared to 0% in the metformin group and 20% in the control group (p = 0.001 between groups). All groups experienced minimal adverse events, with no serious side effects. Overall, this study found that microneedling with TXA was superior to microneedling with metformin or to Kligman’s regimen in reducing melasma severity and improving patient satisfaction. These findings suggest that microneedling is a safe and effective adjunct for transdermal delivery in melasma management. Future longitudinal studies in larger cohorts are needed to validate study findings.

Click to read the study in EJMR

Image: PD

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