Title : A split face randomised control trial comparing the efficacy between topical hydroquinone versus intradermal 5% tranexamic acids via microneedling for the treatment of melasma.
Abstract:
Background: Melasma is a chronic, relapsing hyperpigmentary disorder that poses significant therapeutic challenges. Tranexamic acid (TA), an antifibrinolytic agent with anti-melanogenic and anti-angiogenic properties, has recently gained attention as an effective treatment option, either alone or in combination with other modalities.
Aim & Objective: To compare the efficacy and safety of topical tranexamic acid (TA) after microneedling with topical hydroquinone (HQ) 4% monotherapy in patients with melasma.
Material and Methods: A randomized, split-face comparative trial was conducted on 52 patients with clinically diagnosed melasma. One half of the face received nightly application of HQ 4% cream (Group A), while the other half underwent microneedling followed by topical TA 4% application every two weeks (Group B). Efficacy was assessed using the Hemi-MASI score, dermoscopic evaluation, and Dermatology Life Quality Index (DLQI) at baseline and after 12 weeks.
Results: After 12 weeks, the mean Hemi-MASI score decreased from 5.96 ± 2.53 to 3.41 ± 2.05 (42.7% reduction; p < 0.001) on the HQ side and from 5.85 ± 2.49 to 2.66 ± 1.88 (54.5% reduction; p < 0.001) on the TA + microneedling side. Both modalities were safe and effective, with greater clinical improvement and patient satisfaction observed on the TA-treated side, although the intergroup difference was not statistically significant.
Conclusion: Both regimens are safe and effective in melasma. However, microneedling-assisted tranexamic acid offers enhanced clinical response, better patient satisfaction, and minimal adverse effects—making it a valuable, non-hydroquinone-based alternative for refractory or relapsing melasma.
Limitation: Limited time span causing small sample size in each group.
