STUDY ON “EFFECTIVENESS AND SAFETY OF COMBINATION OF DAILY 10% TRANEXAMIC ACID GEL APPLICATION AND WEEKLY IONTOPHORESIS VERSUS DAILY 10% TRANEXAMIC ACID GEL ALONE (RANDOMIZED SPLIT FACE STUDY) IN TREATMENT OF MELASMA”
Journal Title: INTERNATIONAL JOURNAL OF ADVANCED MEDICINE - Year 2019, Vol 3, Issue 1
Abstract
rine factors associate with mild ovarian dysfunction in women and reticular resistance in men [2]. The thyroid dysfunction and medications including anticonvulsants and photosensitizing agents have also been implicated [4]. The pathogenesis of melasma is still unknown. The common denominator of melasma irrespective of the pathophysiology is an increase in the number and activity of melanocytes. This results in the transfer of large number of melanosomes to the epidermis and dermis. The objectives of melasma therapy are protection from sunlight and depigmentation. First-line treatment usually consists of topical compounds that interfere with the melanin synthesis, broad-spectrum photo protection, and camouage. Chemical peels are often added to second-line therapy. Laser and light therapies represent potentially promising options for patients who are refractory to other modalities but also carry a signicant risk of worsening the disease [5]. In recent times, some researchers found that tranexamic acid (TA), a traditional haemostatic drug, has hypo pigmentary effect on melasma lesions and prevents UV-induced pigmentation [6-9].The intracellular release of arachidonic acid (AA), a precursor of prostanoid, and the level of alpha- melanocyte-stimulating hormone increase as the result of plasmin activity. These two substances can activate melanin synthesis. Therefore, the antiplasmin activity of TA is thought as the main mechanism of hypo pigmented effect of this agent [10-12]. The result of a clinical trial of localized microinjection of TA proved to be promising. A signicant decrease in the Melasma Area and Severity Index (MASI) score with OBJECTIVES OF THE STUDY: To compare the effectiveness of the combination of daily 10% tranexamic acid gel application and weekly iontophoresis versus daily 10% tranexamic acid gel alone (randomized split-face study) in the treatment of melasma and to compare the safety of the combination of daily 10% tranexamic acid gel application and weekly iontophoresis versus daily 10% tranexamic acid gel alone (randomized split-face study) in the treatment of melasma. MATERIALS AND METHODS: A prospective, randomized and evaluator blind split face study was conducted at tertiary care center. The study population was included patients presenting with melasma to Dermatology out-patient (OPD) of tertiary care center. INCLUSION CRITERIA: Patients willing to participate in the study, age more than 18 years and newly diagnosed untreated cases of Melasma were included in the study. After getting approval from the ethical committee, written informed consent was obtained from all participants before enrolment, procedures were explained and patients were acknowledged about all potential risks, benets and side effects. Masi Score: A subjective measurement based on the area and severity of the hyperpigmentation determined by Kimbrough-Green et al. was used for clinical assessment. RESULTS: All the participants were followed at weekly intervals till 12 weeks. The primary parameters considered to assess the efficacy of the treatment were area of the melasma and the darkness of melasma, both were graded on a scale of 1 to 4. As per the study ndings, the iontophoresis combination treatment has resulted in reduction in the area of the melasma early at about 5 weeks, as compared to topical th tranexamic acid alone, which has resulted in area of the melasma only after 7 week of treatment. However, there was only marginal reduction in the area. CONCLUSION: The most common type of melasma was type 1 melasma as seen in 80.00% of patients. The combined therapy resulted in faster reduction in the size of the melasma, but the reduction in size is comparable between both treatment groups as the time progresses. Both therapies achieved statistically signicant reduction in area and darkness. However, this response was slight. Results obtained with modalities were comparable and no therapy was superior than other in this split face randomized trial. Both topical TXA and topical TXA plus iontophoresis therapy was well tolerated and were found to be safe.
Authors and Affiliations
Dr. Riddi Arora, Dr. Ramesh Sharma
Keywords
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- EP ID EP631535
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STUDY ON “EFFECTIVENESS AND SAFETY OF COMBINATION OF DAILY 10% TRANEXAMIC ACID GEL APPLICATION AND WEEKLY IONTOPHORESIS VERSUS DAILY 10% TRANEXAMIC ACID GEL ALONE (RANDOMIZED SPLIT FACE STUDY) IN TREATMENT OF MELASMA”
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