Comparison of Efficacy of 5% Tranexamic Acid vs 20% Azelaic Acid in Patients of Melasma
Article Sidebar
Main Article Content
Abstract
Background: Melasma is a significant cosmetic concern globally, affecting individuals across various ethnic backgrounds, particularly in South Asian populations. The condition's etiology is complex, involving genetic, hormonal, and environmental factors such as sun exposure. Despite numerous treatment options, melasma remains challenging to manage effectively. Recent studies have explored the efficacy of tranexamic acid and azelaic acid, both of which target the melanin synthesis pathway but through different mechanisms.
Objective: The aim of this study was to compare the effectiveness of topical 5% tranexamic acid versus 20% azelaic acid in the treatment of melasma, with a focus on changes in the Melasma Area and Severity Index (MASI) scores.
Methods: This prospective comparative study was conducted at the Dermatology department of PIMS Hospital, Pakistan, over six months from August 2023 to January 2024. A total of 200 patients with melasma were enrolled and randomly assigned to two groups: Group A received 5% tranexamic acid cream, and Group B received 20% azelaic acid cream, both applied twice daily. Inclusion criteria included men and women aged 18 to 50 years with a diagnosis of melasma for at least six months. Pregnant women, patients with a history of Systemic Lupus Erythematosus (SLE) or Discoid Lupus Erythematosus (DLE), and those on hormonal therapy were excluded. The primary outcome measure was the change in MASI scores from baseline to the end of the study period. Data were analyzed using SPSS Version 25.
Results: The study found significant differences in treatment efficacy between the two groups. Group A (tranexamic acid) showed a reduction in MASI scores from 7.94 ± 1.88 at baseline to 5.50 ± 1.61 post-treatment. Group B (azelaic acid) demonstrated a decrease from 8.21 ± 1.96 to 5.89 ± 1.49. The proportion of patients experiencing excellent response was higher in Group A (36.0%) compared to Group B (19.0%), with a statistically significant difference in overall treatment efficacy (P<0.0001).
Conclusion: Topical 5% tranexamic acid was more effective than 20% azelaic acid in improving MASI scores in patients with melasma. This study supports the inclusion of tranexamic acid as a preferable treatment option for melasma, offering a promising alternative for those not responding to conventional therapies.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Grimes PE, Alexis AF. Melasma: Epidemiology, pathogenesis, clinical presentation, and diagnosis. UpToDate Waltham, MA: Wolters Kluwer. 2019.
Sonthalia S, Sarkar R. Etiopathogenesis of melasma. Pigment International. 2015;2(1):21-7.
Abdalla MA. Melasma Clinical Features, Diagnosis, Epidemiology and Etiology: An Update Review. Siriraj Medical Journal. 2021;73(12):841-50.
Handel AC, Miot LDB, Miot HA. Melasma: a clinical and epidemiological review. Anais brasileiros de dermatologia. 2014;89:771-82.
Espósito ACC, Cassiano DP, da Silva CN, Lima PB, Dias JA, Hassun K, et al. Update on Melasma—Part I: Pathogenesis. Dermatology and Therapy. 2022;12(9):1967-88.
Kang HY, Ortonne J-P. What should be considered in treatment of melasma. Annals of Dermatology. 2010;22(4):373-8.
McKesey J, Tovar-Garza A, Pandya AG. Melasma treatment: an evidence-based review. American journal of clinical dermatology. 2020;21:173-225.
Abd Elraouf IG, Obaid ZM, Fouda I. Intradermal injection of tranexamic acid versus platelet-rich plasma in the treatment of melasma: a split-face comparative study. Archives of Dermatological Research. 2023:1-8.
Fahim M, Khoso H, Khan J, Gul H, Bakhtiar R. Efficacy of Intradermal Tranexamic acid versus topical 5% Magnesium ascorbyl phosphate in the treatment of melasma: A head-to-head comparison. Journal of Pakistan Association of Dermatologists. 2023;33(4):1412-20.
Ogbechie-Godec OA, Elbuluk N. Melasma: an up-to-date comprehensive review. Dermatology and therapy. 2017;7:305-18.
Dessinioti C, Lotti TM, Stratigos AJ, Damevska K, Katsambas AD. Melasma. European Handbook of Dermatological Treatments: Springer; 2023. p. 651-61.
Ausen K. Topical tranexamic acid to reduce bleeding from surgical wounds. 2020.
Taraz M, Niknam S, Ehsani AH. Tranexamic acid in treatment of melasma: A comprehensive review of clinical studies. Dermatologic therapy. 2017;30(3):e12465.
Kavitha V. A Comparative study of Efficacy of Oral Tranexamic Acid in Combination with Modified Kligmans Regimen and Modified Kligmans Regimen alone in Melasma Patients: Government Mohan Kumaramangalam Medical College, Salem; 2020.
Godse K, Sarkar R, Mysore V, Shenoy MM, Chatterjee M, Damisetty R, et al. Oral tranexamic acid for the treatment of melasma: evidence and experience-based consensus statement from Indian experts. Indian Journal of Dermatology. 2023;68(2):178.
King S, Campbell J, Rowe R, Daly ML, Moncrieff G, Maybury C. A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma and skin aging. Journal of cosmetic dermatology. 2023;22(10):2650-62.
Ramzan F, Malik K, Bashir B, Naseer Z, Shehzad A, Malik L, et al. Efficacy of 5% tranexamic acid in melasma. Journal of Pakistan Association of Dermatologists. 2023;33(4):1257-62.
Sobhan M, Talebi-Ghane E, Poostiyan E. A comparative study of 20% azelaic acid cream versus 5% tranexamic acid solution for the treatment of postinflammatory hyperpigmentation in patients with acne vulgaris: A single-blinded randomized clinical trial. Journal of Research in Medical Sciences. 2023;28(1):18.
Komal S, Mashhood AA, Farooq M, Qayyum N. A comparison of efficacy of intradermal tranexamic acid with topical 20% azelaic acid in the treatment of melasma. Pakistan Armed Forces Medical Journal. 2021;71(2):494-97.
Malik F, Hanif MM, Mustafa G. Combination of oral tranexamic acid with topical 3% tranexamic acid versus oral tranexamic acid with topical 20% azelaic acid in the treatment of melasma. J Coll Physicians Surg Pak. 2019;29(6):502-4.
Saki N, Darayesh M, Heiran A. Comparing the efficacy of topical hydroquinone 2% versus intradermal tranexamic acid microinjections in treating melasma: a split-face controlled trial. Journal of Dermatological Treatment. 2018;29(4):405-10.
Trifitriana M, Kurniawati Y, Mulawarman R. Assessment Assessment the efficacy of tranexamic acid for reduce melasma using MASI/mMASI score: A systematic review and meta-analysis of randomized controlled trials. Journal of Pakistan Association of Dermatologists. 2024;34(1):255-61.