Split-face comparative study between intradermal tranexamic acid injection alone versus intradermal tranexamic acid injection combined with Q-switched Nd:YAG laser in melasma treatment: dermoscopic and clinical evaluation

Abstract

Melasma is a chronic, dark brown–pigmented patches and macules commonly on the face. Many treatment modalities for melasma have been used as hydroquinone, laser treatment, and recently tranexamic acid. Dermoscopy is used to diagnose and follow up the treatment of melasma and to detect underlying invisible vessels and their change with treatment. Melasma treatment evaluation by using combined Q-switched Nd:YAG laser with intradermal tranexamic acid injection versus tranexamic acid intradermal injection alone. This study was conducted on 40 female patients aged 35–45 years. It was a split-face study; for 12 weeks, the right side of the face was treated with low fluence Q-switched Nd:YAG laser combined with intradermal injection of tranexamic acid, while the left side was treated with an injection of tranexamic acid intradermal alone. The patients were clinically evaluated by using the modified melasma area and severity index (mMASI) score, and underwent dermoscopic evaluation before treatment, at the end of the treatment (12 weeks), and at (24 weeks) as follow-up. The efficacy, adverse effects, and recurrence after treatment were reported. There was a statistically significant decrease in mMASI score with combination treatment than with intradermal injection of tranexamic acid alone after treatment at 12 weeks and at the end of follow-up at 24 weeks. Combination of an injection of tranexamic acid intradermal and low fluence Q-switched Nd:YAG laser is an effective and safe treatment for melasma with minimal side effects more than the intradermal tranexamic acid injection alone.

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https://doi.org/10.1007/s10103-021-03483-y
ORIGINAL ARTICLE
Split‑face comparative study betweenintradermal tranexamic acid
injection alone versusintradermal tranexamic acid injection combined
withQ‑switched Nd:YAG laser inmelasma treatment: dermoscopic
andclinical evaluation
SohaAbdallaHawwam1 · MayadaIsmail2· YasminaAhmedEl‑Attar1,3
Received: 8 July 2021 / Accepted: 29 November 2021
© The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2021
Abstract
Melasma is a chronic, dark brown–pigmented patches and macules commonly on the face. Many treatment modalities for
melasma have been used as hydroquinone, laser treatment, and recently tranexamic acid. Dermoscopy is used to diagnose
and follow up the treatment of melasma and to detect underlying invisible vessels and their change with treatment. Mel-
asma treatment evaluation by using combined Q-switched Nd:YAG laser with intradermal tranexamic acid injection versus
tranexamic acid intradermal injection alone. This study was conducted on 40 female patients aged 35–45 years. It was a
split-face study; for 12 weeks, the right side of the face was treated with low fluence Q-switched Nd:YAG laser combined
with intradermal injection of tranexamic acid, while the left side was treated with an injection of tranexamic acid intradermal
alone. The patients were clinically evaluated by using the modified melasma area and severity index (mMASI) score, and
underwent dermoscopic evaluation before treatment, at the end of the treatment (12 weeks), and at (24 weeks) as follow-up.
The efficacy, adverse effects, and recurrence after treatment were reported. There was a statistically significant decrease in
mMASI score with combination treatment than with intradermal injection of tranexamic acid alone after treatment at 12
weeks and at the end of follow-up at 24 weeks. Combination of an injection of tranexamic acid intradermal and low fluence
Q-switched Nd:YAG laser is an effective and safe treatment for melasma with minimal side effects more than the intradermal
tranexamic acid injection alone.
Keywords Q-switched Nd:YAG laser· Tranexamic acid· Melasma
Introduction
Melasma is a common benign pigmentary acquired derma-
tosis due to a disorder in the function of the melanogenesis
process. Melasma often appears as symmetrical dark brown
irregular marginated macules and patches. Several factors
may contribute to the pathogenesis of melasma as genetic
background, pregnancy, oral contraceptive pills, sunlight,
ovarian tumors, anticonvulsant drugs, and steroids [1]. Mel-
asma has shown 4 different types by wood’s light examina-
tion, epidermal, dermal, mixed, and inapparent [2].
Interactions between the altered cutaneous vasculature
and melanocytes have an influence on melasma develop-
ment [3].
Dermoscopy, being noninvasive, is very useful in dif-
ferentiating melasma from its clinical differentials and may
also aid in choosing the appropriate biopsy site if needed
[4]. Also used in diagnosing and evaluating its severity, and
treatment follow-up, as it allows visualization of melanin
color intensity, pigment network regularity, and the density
of melanin and its localization [5].
The dermoscopic pattern in melasma has been described
as reticuloglobular pattern, perifollicular brown-black glob-
ules, and arcuate and honeycomb-like pattern [6].
* Soha Abdalla Hawwam
Soha_abdallah80@yahoo.com
1 Dermatology & Venereology Department, Faculty
ofMedicine, Tanta University, Tanta, Egypt
2 Dermatology & Venereology Department, Faculty
ofMedicine, Tanta University, Tanta, Egypt
3 Dermatology andVenereology, Armed Forces College
ofMedicine, Cairo, Egypt
/ Published online: 6 January 2022
Lasers in Medical Science (2022) 37:2193–2201
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