Topical Tranexamic Acid Versus Topical Ascorbic Acid in the Treatment of Melasma: Randomized Clinical Trial

Abstract

Background: Melasma is an acquired hypermelanosis characterized by symmetrical, irregular light-to-dark-brown macules & patches on sun-exposed area, especially on the face. Tranexamic acid is a plasmin inhibitor which inhibits UV induced plasmin activity & subsequently reduces melanogenesis in melanocyte. Ascorbic acid affects the monopherase activity of tyrosinase thus reducing melanin synthesis. In addition, ascorbic acid has a photoprotective effect, preventing the absorption of ultraviolet radiation (UVA &UVB). The aim of this study is to evaluate & compare the clinical efficacy plus adverse effects of topical tranexamic acid and topical Ascorbic acid in the treatment of melasma. Materials and Methods: A total of fifty eight (58) Egyptian female patients are enrolled in this study. This is left-right randomized clinical trial. The total duration of the study was 12 weeks. At baseline, a photo will be taken and the patients will be instructed to use, at night, a wet dressing using TA solution (3 ampoules, total 15 ml of Tranexamic Acid® (500 mg/5 ml), was applied on the left side of the face. and Ascorbic acid cream once daily on the right side of the face. Results: We found no statistical significance differences between Rt side (Ascorbic acid treated side) and Lt side (Tranexamic acid treated side) in MASI score at any times of treatment also there were no statistical significance differences between them in % of change in MASI score. Regarding change in the same side there were statistical significant reduction in MASI score in both Rt side (Ascorbic acid treated side) and Lt side (Tranexamic acid treated side). Side effects were burning sensation and erythema which subside quickly on both sides.