Intradermal injection of tranexamic acid versus platelet-rich plasma in the treatment of melasma: a split-face comparative study

Abstract

Millions of people throughout the world suffer from the acquired condition of hyperpigmentation known as melasma. Melasma is characterized by symmetrically oriented hyperpigmented macules and patches. Many treatment options are available with variable degrees of efficacy and tolerability. The aim of the work was to evaluate and compare the effectiveness and safety of intradermal tranexamic acid (TXA) versus intradermal platelet-rich plasma (PRP) in the treatment of various types of melasma. The current split-face prospective study included 40 cases with melasma. Tranexamic acid (TXA) was injected intradermally into the right side of the face by using a concentration of 4 mg/ml, while platelet-rich plasma (PRP) was injected intradermally into the left side. In both sides, a total of three sessions of treatment were provided, once every 4 weeks. Digital photographs were taken before each treatment session and 3 months after the last session. The modified melasma area severity index (mMASI) grading system and dermoscopy were used to assess the improvement in the condition. The disease severity and percentage of improvement were assessed by mMASI score before and after therapy across both sides of the face. along with determining the degree of satisfaction and side effects among the included cases. The mean mMASI score before therapy in the TXA side was 4.59 ± 2.87, while in the PRP side, the mean mMASI score before therapy was 4.72 ± 2.72 with no statistically significant difference between the two sides (p = 0.841). After 3 months of treatment, the mean mMASI score in the TXA-treated side was 2.49 ± 1.58 with a mean percentage of decrease of 45.67 ± 8.10%, while in the PRP side, the mean mMASI score after treatment was 2.17 ± 1.41 with a mean percentage of decrease of 53.66 ± 11.27%. There was a high statistically significant decrease in the mMASI score after treatment on both sides (p < 0.001); however, the percentage of score reduction in the PRP side compared to the TXA side was statistically higher. Intradermal injection with PRP revealed higher efficacy in the treatment of melasma as compared to TXA injection with no significant difference regarding the associated side effects.

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Archives of Dermatological Research (2023) 315:1763–1770
https://doi.org/10.1007/s00403-023-02580-y
STUDY PROTOCOL
Intradermal injection oftranexamic acid versusplatelet‑rich plasma
inthetreatment ofmelasma: asplit‑face comparative study
IsraaGomaaAbdElraouf1· ZakariaMahranObaid2· IbrahimFouda2
Received: 21 January 2023 / Revised: 11 February 2023 / Accepted: 13 February 2023 / Published online: 1 March 2023
© The Author(s) 2023
Abstract
Millions of people throughout the world suffer from the acquired condition of hyperpigmentation known as melasma. Mel-
asma is characterized by symmetrically oriented hyperpigmented macules and patches. Many treatment options are avail-
able with variable degrees of efficacy and tolerability. The aim of the work was to evaluate and compare the effectiveness
and safety of intradermal tranexamic acid (TXA) versus intradermal platelet-rich plasma (PRP) in the treatment of various
types of melasma. The current split-face prospective study included 40 cases with melasma. Tranexamic acid (TXA) was
injected intradermally into the right side of the face by using a concentration of 4mg/ml, while platelet-rich plasma (PRP)
was injected intradermally into the left side. In both sides, a total of three sessions of treatment were provided, once every
4weeks. Digital photographs were taken before each treatment session and 3months after the last session. The modified
melasma area severity index (mMASI) grading system and dermoscopy were used to assess the improvement in the condi-
tion. The disease severity and percentage of improvement were assessed by mMASI score before and after therapy across
both sides of the face. along with determining the degree of satisfaction and side effects among the included cases. The mean
mMASI score before therapy in the TXA side was 4.59 ± 2.87, while in the PRP side, the mean mMASI score before therapy
was 4.72 ± 2.72 with no statistically significant difference between the two sides (p = 0.841). After 3months of treatment, the
mean mMASI score in the TXA-treated side was 2.49 ± 1.58 with a mean percentage of decrease of 45.67 ± 8.10%, while in
the PRP side, the mean mMASI score after treatment was 2.17 ± 1.41 with a mean percentage of decrease of 53.66 ± 11.27%.
There was a high statistically significant decrease in the mMASI score after treatment on both sides (p < 0.001); however,
the percentage of score reduction in the PRP side compared to the TXA side was statistically higher. Intradermal injection
with PRP revealed higher efficacy in the treatment of melasma as compared to TXA injection with no significant difference
regarding the associated side effects.
Keywords Melasma· mMASI· PRP· Tranexamic
Introduction
Melasma is a common acquired disorder characterized by
hyperpigmented macules or patches that are most frequently
found on the mandibular, malar, and centrofacial regions—
forehead, nose, upper lip, and chin [1].
Melasma pathogenesis is complex and poorly understood.
Various underlying risk factors for developing melasma have
been described, including oral contraceptives, sun exposure,
hormonal changes during pregnancy, and genetic predis-
position. Moreover, to transfer melanosomes to keratino-
cytes through the tyrosinase enzyme, which controls the
production of melanin, the pathogenesis of melasma could
be caused by melanogenesis dysfunction, either through
increased exposure to melanogenic factors or through
increased sensitivity to risk factors [2, 3].
Managing melasma started by prevention using sun-
screens. Therapeutic approaches of melasma utilizing chem-
ical peel and topical drugs such as hydroquinone, azelaic
acid, retinoids, corticosteroids and arbutin either alone or in
* Ibrahim Fouda
ifouda77@gmail.com
1 Dermatology, Venereology andAndrology Department, Itay
Elbaroud General Hospital, Albehira, Egypt
2 Dermatology, Venereology andAndrology Department,
Damietta Faculty ofMedicine, Al-Azhar University,
Damietta, Egypt
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1764 Archives of Dermatological Research (2023) 315:1763–1770
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combinations have been commonly employed as the main
lines of treatment [4].
Tranexamic acid is a synthetic lysine derivative that
inhibits plasminogen activation and has anti-fibrinolytic
effects by blocking lysine binding sites on plasminogen
molecules, which prevents plasminogen from interacting
with formed plasmin and fibrin and stabilizes the preformed
fibrin meshwork created by secondary hemostasis. It acts on
melasma by preventing keratinocytes' plasmin activity after
exposure to UV light. Therefore, inhibiting plasminogen's
ability to bind to keratinocytes will reduce the amount of
free arachidonic acid, which is essential for the formation of
prostaglandins and improve tyrosinase activity [5, 6].
Platelet-rich plasma (PRP) is described as a tiny volume
of autologous plasma with a high concentration of plate-
lets, obtained by centrifuging autologous blood and then
suspending the platelets to release platelet-derived growth
factor, which increases skin volume as a result of angio-
genesis and collagen synthesis and also improves melasma.
Transforming growth factor beta (TGF-β1) released from
α-granules in platelets has been shown to cause significant
inhibition of melanin synthesis through delayed extracellular
signal-regulated kinase activation [7–9].
Many studies have been conducted to evaluate and com-
pare platelet-rich plasma and tranexamic acid. This study
aimed to evaluate the efficacy of intralesional PRP versus
TXA in the treatment of melasma through dermoscopic and
clinical evaluation by using the mMASI score.
Patients andmethods
This is a split-face prospective study that was conducted
on 65 clinically diagnosed patients with melasma randomly
selected from an outpatient clinic; 25 cases were excluded
from the study by exclusion criteria and 40 cases received
treatment and follow-up with no dropout.
The study included 40 cases with Fitzpatrick skin types
III and IV, from both genders with all types and degrees
of facial melasma. Tranexamic acid intradermal injections
were administered to the right side of the face, whereas PRP
intradermal injections were administered to the left side.
Pregnant and breastfeeding females, those who were tak-
ing contraceptive pills, those of any known bleeding prob-
lems or concurrent anticoagulant usage at the time of the
research, patients who had used any form of melasma treat-
ment, whether oral or topical, within the previous 3months,
patients with established platelet dysfunction syndrome,
patients with critical thrombocytopenia (< 50,000/ul), and
patients on any hormonal therapy (as in the case of hormone
replacement therapy for menopausal females and treatment
of endometriosis) were excluded from the study.
All patients underwent a full history-taking including
personal history (age, marital status, occupation, and fam-
ily history), history of the lesion (duration of the lesion,
predisposing factors), and dermatological examination to
assess the type and severity of the melasma.
Assessment ofdisease severity
Digital photographs were taken for the lesions before and
after the end of treatment by using Apple iPhone 11 Pro
Max- camera 12 MP.
Wood’s lamp (Lumio®UV 3Gen- dermlite) and dermo-
scopic (by DermLite DL4 dermoscope) examinations were
conducted on all patients before the treatment to determine
the type of melasma (epidermal, dermal, and mixed) as well
as the vascular and pigmentation components of melasma.
The disease severity was assessed using the modified mel-
asma area and severity index (mMASI).
The study was conducted in accordance with Helsinki
standards as revised in 2013. The study was conducted after
obtaining the approval from the Ethics Committee of Dami-
etta Faculty of Medicine IRB (00,012,367), Al-Azhar Uni-
versity, Egypt, and after obtaining an oral informed consent
from the included cases.
Treatment regimen
Method ofpreparation andTXA injection
The right side of the face received intradermal injection with
tranexamic acid using 100U/ml insulin syringe,Tranexamic
acid was collected from Kapron® Ampoules, Amoun Phar-
maceutical Company, with a concentration of 100 mg/
ml. The concentration of 4mg/ml of tranexamic acid was
obtained by drawing about 4mg of the drug into a 100U/
ml insulin syringe and diluting it with saline to a volume of
1ml. A topical anesthetic cream (Emla 5% cream, AstraZen-
eca Pharmaceutical Company) was applied to the face and
left for 30min. About 0.05ml was injected intradermally
into the lesions at 1cm interval to a maximum 8mg to the
entire affected area.
Method ofpreparation andPRP injection
The left side of the face received intradermal injection of
PRP: 10mL of venous blood was drawn from the antecubital
vein and placed in tubes containing sodium citrate 3.2% as
an anticoagulant (sodium citrate 9NC, VACO MED) under
completely aseptic conditions before being double spun. The
second centrifugation was quicker at 4000rpm for 5min
after the first one which was slower at 3000rpm for 7min.
A concentration of activated PRP was then obtained by
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1765Archives of Dermatological Research (2023) 315:1763–1770
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aspirating the resulting plasma and activating it with calcium
chloride (CaCl2) in a ratio of 0.1mL of CaCl2 to 0.9mL of
PRP. A 30-gauge needle was used for the injection, with a
session limit of 1mL.
Clinical assessment andfollow‑up
• The procedure was repeated three times at monthly inter-
vals (0, 1, and 2months), and then the patients were
followed up every month for another 3months to detect
any recurrence.
• Patients were counseled to limit their exposure to the sun
and use a broad-spectrum sunscreen with a sun protec-
tion factor above 30 during daytime throughout the entire
treatment period.
• Assessment was done by two blinded investigators.
Statistical analysis ofdata
The data collected were coded, processed, and analyzed
with SPSS version 27 for Windows® (Statistical Package
for Social Sciences) (IBM, SPSS Inc., Chicago, IL, USA).
Qualitative data as number (frequency) and percent were
presented. The Chi-square test (or Monte Carlo test) made
the comparison between groups.
The Kolmogorov–Smirnov test tested quantitative data
for normality. To compare two independent groups with
parametric quantitative variables, independent samples t test
was used and Mann–Whitney U test was used if the data
were non-parametric. To compare two dependent groups
with parametric quantitative variables, paired samples t test
was used and Wilcoxon-signed rank test was used if the data
were non-parametric. For all tests, P values < 0.05 are con-
sidered significant.
Results
As shown in Table1, there were 39 females among the
included cases (97.5%) and 1 male (2.5%). The mean age
of the cases was 39.20 ± 5.22years with range between 28
and 52years. The highest percentage of the cases showed a
gradual onset (97.5%) and a progressive course (70%). The
mean duration of the disease among the included cases was
4.54 ± 3.02years with range between 8months and 12years.
Regarding the site, the malar region was affected in 39
cases (97.5%), mustache in 24 cases (60%), and then the
frontal area in 22 cases (55%). Sun exposure was the most
common risk factor in 37.5% of the cases, followed by
hormonal causes in 25% of the cases. Positive family his-
tory was reported in 35% of the cases. One case showed
associated skin disease (adult hormonal acne) and also one
case showed other associated chronic diseases (diabetes
mellitus).
As shown in Table2, the median (IQR) of mMASI score
before treatment in the TXA group was 4.20 (2.18–6.60),
while in the PRP group, the median (IQR) of mMASI score
before treatment was 3.59 (2.73–7.085) with no statistically
significant difference between the two groups (p = 0.841).
After treatment, the median (IQR) of mMASI score in the
TXA-treated group was 2.10 (1.30–3.38) with mean per-
centage of decrease of 45.67 ± 8.10%, while in the PRP
group, the median (IQR) mMASI score after treatment was
1.725 (1.025–3.15) with mean percentage of decrease of
53.66 ± 11.27%,.
There was high statistically significant decrease in the
mMASI score in each of the two sides (p < 0.001), but the
percentage of score reduction in the PRP side compared to
the TXA side was statistically higher (Fig.1and 2).
Regarding the degree of satisfaction (Table3), in the
TXA side, poor satisfaction was reported in 5% of the cases,
Table 1 Baseline characteristics of the studied patients (n = 40)
No %
Sex
Male 1 2.5
Female 39 97.5
Age (years)
Min.–Max 28.0–52.0
Mean ± SD 39.20 ± 5.22
Median (IQR) 38.50 (36.0–41.50)
Onset
Gradual 39 97.5
Sudden 1 2.5
Course
Progressive 28 70.0
Stationary 12 30.0
Duration (years)
Min.–Max 0.67–12.0
Mean ± SD 4.54–3.02
Median (IQR) 4.50 (2.0–6.50)
Site
Malar 39 97.5
Mustache 24 60.0
Frontal 22 55.0
Risk factor
Negative 15 37.5
Sun exposure 15 37.5
Hormonal 10 25.0
Family history 14 35.0
Associated skin disorders 1 2.5
Systemic disease 1 2.5
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1766 Archives of Dermatological Research (2023) 315:1763–1770
1 3
slight satisfaction in 37.5%, and satisfaction in 57.5%, while
in the PRP side, poor satisfaction was reported in 17.5%
of the cases, slight satisfaction in 45%, and satisfaction in
37.5% with no statistically significant difference.
The reported side effects in the TXA side included pain in
62.5% and erythema in 55%, while in the PRP side, pain was
reported in 7.5% and erythema in 32.5%. No statistically sig-
nificant difference was found with regard to the side effects.
Regarding dermoscopic assessment on both treated
sides, the dermoscopic characteristics showed a significant
decrease of granular pigmentation, pseudo-network pigmen-
tation, arcuate or annular perifollicular pigmentation, and
light brown reticular networks, erythema, and telangectasia,
which becameless evident with treatment (Fig.1b and 2b).
Discussion
Melasma is regarded as one of the more difficult to treat
diseases despite having a variety of treatment options, none
of which are regrettably totally effective.
This split-face study included 40 cases with melasma,
in which the right side of the face received intradermal
tranexamic acid injection, while the left side received intra-
dermal PRP injection.
In France, Pistor invented the mesotherapy technique,
which is now widely used in medicine [10]. It is a mini-
mally invasive method of drug delivery that consists of mul-
tiple intradermal or subcutaneous injections of a mixture
of compounds “mélange” in minute doses. Plant extracts,
homeopathic agents, pharmaceuticals, vitamins, and other
bioactive substances can be used, but alcohol- or oil-based
substances should not be used for mesotherapy because of
the risk of cutaneous necrosis. [11].
In 2006, Lee etal. published the first study demonstrat-
ing the viability of localized microinjections of TXA for
melasma. While in 2014, Cayrili and colleagues published
the first description of the advantageous benefits of PRP as
a standalone therapy for melasma. [12, 13]
In the current study, there were 39 females among the
included cases who represented 97.5% of the cases.
This was in agreement with Fawzy Ewaiss et al.’s study,
which showed that all the included cases in their study were
females [14], and the studies by Serra et al. (2018) [15]and
Jin et al. (2019) [16].
In this study, the mean mMASI score after treatment did
not reveal a difference between the two sides that is statisti-
cally significant (2.49 ± 1.58 and 2.17 ± 1.41 in the TXA
side and PRP side, respectively). However, the percentage of
score reduction was higher in the PRP side (53.66 ± 11.27)
as compared with the TXA side (45.67 ± 8.10) (p = 0.014).
Our results agreed with those of Mumtaz et al., who
showed that Intradermal PRP was significantly better than
intradermal tranexamic acid in the management of melisma.
The mean mMASI score at baseline was 29.84 ± 5.14 vs.
29.56 ± 4.39 in the intradermal platelet-rich plasma (PRP)
group and tranexamic acid group, respectively, with no
statistically significant difference between the two groups
(p = 0.21). mMASI was significantly better in the PRP
group at 4weeks in which p = 0.01. Mean mMASI was
12.81 ± 1.78 vs. 18.38 ± 3.50, p = 00,001 at 12weeks and
8.72 ± 3.40 vs. 14.97 ± 4.33, p = 0.02 at 24weeks in the PRP
group and tranexamic acid group, respectively [17].
Our results were in line with those of Gharieb et al., who
showed that there was a statistically significant difference, as
evidenced by the mean difference in mMASI scores between
the two groups (p = 0.017). Patients who were treated with
PRP saw more improvement. As a result, microneedling
with PRP has a more potent effect than microneedling with
TXA [18].
In the current study, the mean mMASI score decreased
from 4.59 ± 2.87 before treatment to 2.49 ± 1.58 after treat-
ment in the TXA with high statistically significant difference
(p < 0.001).
Table 2 Comparison between
TXA and PRP according to
mMASI score before and after
treatment
#Mann–Whitney U test
^Independent samples (Student’s t test)
a Wilcoxon signed-rank test
*Statistically significant (p < 0.05)
TXA PRP P
mMASI score before treatment
Median (IQR) 4.20 (2.18–6.60) 3.59 (2.73–7.085) 0.841#
mMASI score after treatment
Median (IQR) 2.10 (1.30–3.38) 1.725 (1.025 – 3.15) 0.350#
P1 (comparison to baseline value in
each group)a
< 0.001 < 0.001
Percent of score reduction (%) 45.67 ± 8.10 53.66 ± 11.27 0.005* ^
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1767Archives of Dermatological Research (2023) 315:1763–1770
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Similar results were reported by Badran et al. who used
two different concentrations of TXA (4mg/mL and 10mg/
mL). Their findings indicated that the intradermal injection
of TA (in both concentrations) leads to significant improve-
ment of melisma, and a higher concentration of TXA injec-
tion results in better improvement, but the difference is non-
significant [19].
In this study, the mean mMASI score decreased from
4.72 ± 2.72 before treatment to 2.17 ± 1.41 after treatment
in the PRP with high statistically significant difference
(p < 0.001).
This was in accordance with the results of Hofny et al.,
who reported that the use of PRP is linked to a considerable
to outstanding improvement in melasma patients, as demon-
strated by the significant decline in the baseline MASI and
mMASI scores, and in accordance with the levels of patients'
satisfaction. Only two patients (8.7%) were unsatisfied with
their improvement, whereas 39.1% of patients were very sat-
isfied, 39.1% were satisfied, 13.1% were slightly satisfied,
and 39.1% were satisfied overall [20].
In the study by Gamea et al., who compared the efficacy
of topical tranexamic acid 5% in liposome base alone versus
its combination with intradermal platelet-rich plasma (PRP)
for melasma treatment, patients of the combined TXA + PRP
group were more satisfied with the treatment outcome than
those of the TXA group and the difference was statistically
significant [21].
In a study by Zhang etal., who investigated the effect of
platelet-rich plasma (PRP) combined with tranexamic acid
(TXA) in the treatment of melasma and its effect on the
serum levels of vascular endothelial growth factor (VEGF),
endothelin-1 (ET-1), and melanin-stimulating hormone
(MSH), they reported that PRP combined with TXA can
improve the treatment outcome, maintaining normal levels
of VEGF, ET-1 and MSH, and reducing the recurrence rate
[22].
Our study was concordant with the study of Patil and
Bubna, who investigated the intradermal injection of
Fig. 1 A 40 years old female skin type IV, suffered from mixed
melisma, A the right side of the face before treatment with mMASI
score = 4.8. B Right side after treatment with tranexamic acid intra-
dermal injection in mMASI score = 1.5, C Right side dermoscopic
features before treatment showing scattered island of dark brown
pseudo-reticulate pattern, with sparing of the follicular region. D
Right side dermoscopy after treatment showing decrease in intensity
of pigmentation darkness to light brown. E The left side of the face
before treatment with mMASI score = 5.1. F The left side after treat-
ment with PRP intradermal injection showing marked improvement
and decrease in mMASI score = 1.2, G The left side dermoscopic
features showing scattered island of dark brown pseudo-reticulate
pattern, with sparing of the perifollicular region and telangectasia.
H The left side after treatment showing decrease in the intensity of
pigmentation darkness and telangectasia. Wood’s lamp examination
showing accentuation of pigmentation (Mixed melasma)
▸
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1768 Archives of Dermatological Research (2023) 315:1763–1770
1 3
TXA and PRP in the treatment of melisma in two groups,
with 18 in the TXA group and 15 in the PRP group. On
comparing the mean reduction for each therapy in both
scoring systems (MASI and mMASI), it was observed to
be slightly greater for the PRP treatment arm. However,
p values were not statistically significant (mean mMASI:
p = 0.3, mean mMASI: p = 0.4) [23].
Polat and Sarac studied 60 melasma patients. 30 were
treated with oral TA and 30 were treated by intradermal
injection of PRP for 3months. A statistically significant
improvement was found in the mMASI score consistent
with the literature and it was observed that the mMASI
score decreased by 65.7% in the TXA group and 54.6%
in the PRP group [24].
Due of its autologous nature, PRP therapy has a higher
safety profile. A further benefit is that the abundance of
growth factors which facilitate a number of mechanisms
that result in facial rejuvenation.
In this study, the reported side effects in the TXA
group included pain in 62.5% and erythema in 55%,
while in the PRP group pain was reported in 7.5% and
erythema in 32.5%, with no statistically significant dif-
ference between the two groups.
Unlike the previous studies, the advantages of this
study are that it is a split-face comparative study, so each
subject acts as his or her own control. This can minimize
the risk of confounding because all interventions were
measured on the same participants and a smaller number
of patients were required in comparison to parallel-group
studies. Furthermore, intradermal injections of TXA
(rather than oral or topical administration) and dermos-
copy-based evaluation of the severity and improvement
of melasma were the contrasting features observed in our
study.
Fig. 2 A 48years old female skin type III, suffered from mixed mel-
asma: A the right side of the face before treatment with mMASI
score = 6.1. B Right side after treatment with tranexamic acid intra-
dermal injection showing mild improvement and decrease in mMASI
score = 3.1, C Right side dermoscopic features before treatment
showing both epidermal features in the form of reticulate and pseudo-
reticulate pattern and dermal features in the form of light brown
patches and archiform structures. D Right side dermoscopy after
treatment showing decrease in the intensity of pigmentation darkness.
E The left side of the face before treatment with mMASI score = 4.6.
F The left side after treatment with PRP intradermal injection show-
ing marked improvement and decrease in mMASI score = 1.6. G The
left side dermoscopic features showing both epidermal features in the
form of reticulate and pseudo-reticulate pattern and dermal features in
the form of light brown patches and archiform structures. H The left
side after treatment showing marked decrease in the intensity of pig-
mentation darkness from dark to light brown. Wood’s lamp examina-
tion showing minimal accentuation of pigmentation (Mixed melasma)
▸
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1769Archives of Dermatological Research (2023) 315:1763–1770
1 3
Conclusion
Due to the fact that melasma is a localized condition of
hyperpigmentation, we believe intradermal TXA injec-
tions should be considered over an oral route.
Based on our findings, it could be concluded that intra-
dermal injection of both TXA and PRP was associated
with high statistically significant decrease in the disease
severity. The efficacy of PRP in decreasing the disease
severity was superior to TXA with no statistically signifi-
cant difference with regard to the associated side effects.
Therefore, if there are no contraindications to PRP
administration, we believe PRP could be a good alterna-
tive for treating melasma.
Limitations ofthestudy
• Absence of long follow-up periods.
• Evaluation of mMASI score between the first and last
session.
• Great number of treatment sessions.
Author contributions GAE wrote the main manuscript text and
prepped figures. All authors reviewed, discussed the results and cin-
tributed to thefinal manuscript.
Funding Open access funding provided by The Science, Technology &
Innovation Funding Authority (STDF) in cooperation with The Egyp-
tian Knowledge Bank (EKB). None.
Data Availability The datasets generated during and/or analysed dur-
ing the current study are available from the corresponding author on
reasonable request.
Declarations
Conflict of interest The authors declare no conflict of interest.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article's Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article's Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.
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Table 3 Comparison between the T.X.A and P.R.P according to side
effects and satisfaction
@ Monte-carlo test
¥ Chi-square test
© Fischer’s exact test
*Statistically significant (p < 0.05)
T.X.A P.R.P P value
No %No %
Satisfaction
Poorly satisfied 2 5.0 7 17.5 0.097 @
Slightly satisfied 15 37.5 18 45.0
Satisfied 23 57.5 15 37.5
Side effects
No 10 25.0 25 62.5 0.001* ¥
Pain 25 62.5 3 7.5 < 0.001* ©
Erythema 22 55.0 13 32.5 0.043* ¥
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

1770 Archives of Dermatological Research (2023) 315:1763–1770
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