Muhammad Fahim, Hina Khoso, Jahangir Khan, Huma Gul, Rabeeka Bakhtiar.
Efficacy of Intradermal Tranexamic acid versus topical 5% Magnesium ascorbyl phosphate in the treatment of melasma: a head-to-head comparison.
J Pak Assoc Derma Jan ;33(4):1412-20.

Background Melasma is a chronic skin hyperpigmentation disorder involving 50–70% of people worldwide, mostly women of childbearing age. Various treatment modalities are available, but no previous study has undergone a head-to-head comparison of intradermal tranexamic acid (TXA) and topical magnesium ascorbyl phosphate (MAP) to treat melasma. This study aimed to fill this research gap.   Objective: To compare effectiveness of intradermal (TXA) and topical (MAP) in the treatment of melasma.   Methods: A total of 128 patients were enrolled, 64 in each group. Patients were divided into groups A and B using randomization technique, and their melasma severity index score (MASI) was calculated. Patients in group A were treated with four cycles of intradermal TXA at weeks 0, 4, 8, and 12. Group B was treated with topical MAP cream once a day for 12 weeks. At the end of 12 weeks, efficacy was assessed by calculating the MASI score.   Results: The mean age in the injected TXA group (A) was 39.4±7.9 years and 37.5±8.3 years in the MAP group (B). In the group-wise distribution of gender, 20.3% of males and 79.7% of females were enrolled in group A, while 17.1% of males and 82.9% of females were included in group B. Baseline MASI scores for groups A and B were 16.7±5.4 and 16.06±6.15, respectively. At the end of 12 weeks, the efficacy of injected TXA was noted as being 54.7%, while 78.1% effectiveness was noted in the MAP group (P- value=0.005).   Conclusion: It has been concluded that topical MAP is better than intradermal TXA for the treatment of melisma.  

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