Topical tranexamic acid with microneedling versus microneedling alone in treatment of melasma: Clinical, histopathologic, and immunohistochemical study

Background Melasma is an acquired disorder of symmetrical hypermelanosis that involves sun-exposed areas of the skin. Although multiple therapeutic modalities have previously been tried, successful, truly effective treatment options for this condition have been few and quite elusive. Objectives To compare the therapeutic efficacy of topical tranexamic acid (TXA) with microneedling versus microneedling alone in the treatment of melasma and to evaluate the changes that occur clinically, histologically, and immunohistochemically. Patients and methods This study was conducted on 42 patients with melasma, randomly divided into two groups. In group I, each patient was subjected to a series of six sessions of skin microneedling and TXA application, whereas in group II, six sessions of microneedling alone were performed, with 2-week interval. Results Clinically, the mean melasma area and severity index (MASI) score was significantly decreased in both groups with statistically significant higher reduction scores in group I compared with group II. Histopathologically, epidermal hyperpigmentation and dermal melanophages were significantly reduced after treatment with more obvious reduction in group I. The number of melanoma antigen recognized by T cells-1-positive cells showed significant reduction in both groups; this reduction was statistically higher in group I than group II. Conclusions Although microneedling alone produced significant lightening effect, topical TXA combined with microneedling achieved more satisfactory results.