The Effect of Platelet Rich Plasma (PRP) Plus Microneedling Versus Tranexamic Acid Plus Microneedling in the Biometric Characteristics of Melasma: A Before-After, Assessor Analysis, Blinded, Clinical Trial

Background: Melasma is a chronic, acquired, focal pigment disorder showing symmetrical hyperpigmentation or hypermelanosis of photo-exposed areas on the face. Tranexamic acid (TXA) is a treatment for melasma. The regression of melasma after platelet-rich plasma (PRP) treatment is an interesting finding. Objectives: To evaluate the effect of PRP plus microneedling vs. tranexamic acid plus microneedling on the quality of melasma. Methods: This is a left-right split-face comparison study with 18 patients with melasma. The patients underwent four sessions of PRP plus microneedling and tranexamic acid (5%) plus microneedling on right and left sides of the face, respectively, at monthly intervals. Evaluations were performed before the start of treatment and one month after the last treatment session. Results: Totally, 20 female patients with melasma were included with a mean age of 41 years (range: 34-49 years). Five participants had Fitzpatrick phototype II, eleven had phototype III, and others had phototype IV skin. Both TXA + microneedling and PRP + micro-needling caused a significant reduction in the Tewameter measurement (mean difference PRP =-3.33, P=0.003, and mean difference TXA =-2.15, P=0.003). In addition, the median delta E in the patients who received both treatments was significantly decreased after the treatment (mean difference =6.66, P<0.001 in TXA + microneedling group; mean difference =1.90, P<0.001 in PRP + microneedling group). The patients who received TXA + microneedling showed a significant reduction in melanin mexameter measurement. The patients were satisfied with both treatments. Conclusion: This study showed that PRP and tranexamic acid with microneedling have a significant effect in reducing the MASI score and are considered an effective treatment. Although none of these two methods was superior over the other one, they can be a good combination or alternative for the treatment of melasma because they have good efficacy, safety, tolerability, and satisfaction among patients.