Efficacy of topical versus intradermal injection of Tranexamic Acid In Egyptian melasma Patients: A randomised clinical trial
The Australasian journal of dermatology. 2021
BACKGROUND Melasma is one of the common pigmentary problems affecting females in our community, owing to the frequent use of hormonal contraceptives as well as our sunny climate. A lot of treatment options are available but none of them is completely satisfactory. Many patients prefer the use of topical preparations and minimally invasive methods. Tranexamic acid (TA) is a potential treatment option for hyperpigmentation with different delivery routes. AIM: We designed the study in order to evaluate the efficacy of TA in melasma using 2 different routes of delivery. PATIENTS AND METHODS A randomised clinical trial was performed on 60 female patients with melasma, they randomly divided into three groups; A, B and C. Group (A) patients received TA (4 mg/mL) intradermal injections every 2 weeks with, group B received TA (10 mg/mL) intradermal injections every 2 weeks, group C received TA cream (10% concentration) twice daily, treatment continued for 12 weeks in all groups. Melasma Area and Severity Index (MASI) scores were measured for each patient before and after completion of treatment. RESULTS The percentage of MASI score reduction was highest in group B (62.7%) versus (39.1%) in group A, while the percentage of MASI reduction was the lowest in group C (4.2%). CONCLUSION Tranexamic acid is a safe effective and well-tolerated treatment option for melasma patients. Intradermal injection of TA leads to better results than the topical application. Topical TA cream (even in a high concentration) produce fair improvement of melasma.
The efficacy of oral versus different dilutions of intradermal Tranexamic acid microinjections in melasma, a randomized clinical trial
Dermatologic therapy. 2021;:e14924
BACKGROUND Melasma is a common acquired disorder of pigmentation, remains challenging despite numerous treatment modalities.Tranexamic acid (TXA) has emerged as a potential treatment for melasma. Different forms of TXA (oral, topical and intradermal microinjections) have shown promising results. OBJECTIVES To evaluate and compare the efficacy of oral versus different dilutions of intradermal TXA in melasma. MATERIAL & METHODS 45 female patients with melasma were randomly and equally assigned to three treatment groups. Group A (oral TXA 250 mg bid), Group B (100mg/ml intradermal TXA) & Group C (4mg./ml intradermal TXA ) every 2 weeks, treatment period was 8 weeks. RESULTS At 8 weeks, a significant reduction in the mMASIwas noted in group A, B and C (p value 0.002, 0.003, 0.005). Melanin index (MI) was significantly reduced in group A, B and C (pvalue 0.016, 0.005, 0.003). Erythema index (EI) showed significant improvement in group A (p value 0.028), however was statistically insignificant for groups B and C. No statistically significant difference was found between the 3 groups as regards changes in mMASI, MI and EI at 8 weeks. CONCLUSION Both oral and intradermal microinjections of TXA regardless dilution appear to be effective and safe in treatment of melasma with comparable results. This article is protected by copyright. All rights reserved.
Clinical observation and dermoscopy evaluation of fractional CO(2) laser combined with topical tranexamic acid in melasma treatments
Journal of cosmetic dermatology. 2021
Melasma is an acquired refractory pigmentary disorder, which is a skin disease that predominantly affects female. This investigation aims to assess the efficacy of a low-power fractional CO(2) laser combined with tranexamic acid (TXA) for melasma topical treatment with MASI and dermoscopy. A randomized comparative split-face study was performed. Each treatment interval was 3 weeks with four times in total. At the same time, we applied TXA solution twice a day. Assessments were made by the MASI score of the melasma area severity index, and the dermoscopy performance was collected and analyzed. After treatments, the patient MASI score decreased significantly. Compared with the baseline, the MASI score was significantly lower than that of control group (P < 0.05), and the decrease ratio was higher than that of controls. Dermoscopy examination results verified that all lesions performed reticuloglobular pattern, granular or punctate, with no structural pigmentation and obvious capillary dilation. After comprehensive treatments, the pigmentation area displayed lighter chroma, the follicle pore uniformity was completely improved, and the capillary dilation was significantly reduced. Low-power fractional CO(2) laser combined with topical TXA solution is a comparatively effective and safe method for melasma treatment. TXA could reduce the dilation of blood vessels.
Antifibrinolytic agents in plastic surgery: current practices and future directions
Plastic & Reconstructive Surgery. 141(6):937e-949e, 2018 Jun.. 2018;141((6):):937e-949e
BACKGROUND Prevention of blood loss is a chief consideration in plastic and reconstructive surgery. The antifibrinolytic drugs tranexamic acid and epsilon-aminocaproic acid have emerged as promising agents to reduce both perioperative blood loss and transfusion requirements. However, published reports in the plastic surgery literature are lacking. The authors sought to summarize the current knowledge of the use of antifibrinolytics in plastic surgery by reviewing the existing literature for clinical outcomes and recommendations. METHODS A systematic review of the PubMed, Cochrane, and Google Scholar databases was conducted for publications examining the use of antifibrinolytics in plastic surgery. Studies were abstracted for procedure type, antifibrinolytic dose, time and mode of administration, blood loss, transfusion requirements, and complications. RESULTS Thirty-three studies were deemed eligible for inclusion, comprising a total of 1823 patients undergoing plastic surgical procedures with tranexamic acid (n = 1328) and/or epsilon-aminocaproic acid (n = 495). CONCLUSIONS Tranexamic acid and epsilon-aminocaproic acid are widely used to reduce blood loss and transfusion requirements in craniofacial and orthognathic surgery, without an increased risk of adverse events. Intravenous administration is most commonly used, although topical formulations show similar efficacy with a reduced systemic distribution. Tranexamic acid has also emerged as a promising agent in aesthetic surgery and burn care, due to its favorable safety profile and role in reducing blood loss, achieving an improved surgical field, and reducing edema and ecchymosis. Further investigation of these agents in the fields of burn care, aesthetic surgery, and microsurgery is warranted to standardize protocols for clinical use.