الفهرس | Only 14 pages are availabe for public view |
Abstract Melasma is an acquired hyperpigmentation disorder and is characterized by light-to-dark brown-colored irregular macules or patches on sun-exposed areas of skin, usually the face individuals. In addition, it can occur in other visible body parts such as the neck and upper limbs. Melasma can affect men and women of all ethnicities and skin types but is especially prevalent in women with Fitzpatrick skin types III to V who are exposed to ultraviolet (UV) light and commonly observed in the 2nd–5th decade. It often brings negative psychosocial implications to patients and lowers their quality of life. Pathogenesis of melasma has not been fully identified, but it may be an interplay of multiple internal and environmental factors, which are responsible for triggering, aggravating, or relapsing of the melasma lesions. These factors could be hormonal, genetic, sun exposure, and cosmetics; also drugs, thyroid, and hepatic diseases may play a role. Various treatment modalities are used for melasma. These include the use of sunscreens, hypopigmenting agents, superficial peeling agents such as glycolic and lactic acid and laser therapy. Newer studies have found that tranexamic acid (TXA), a hemostatic agent, has hypopigmentary effect on melasma lesions and also prevents ultraviolet-induced pigmentation. Tranexamic acid (TXA) is an antifibrinolytic drug, which is being used as a depigmenting agent. It can be given either orally, topically, intradermally, or intravenously. It inhibits UV-induced plasmin activity in keratinocytes by preventing the binding of plasminogen to the keratinocytes. This results in less free arachidonic acid and a diminished ability to produce prostaglandins, and this decreases melanocyte tyrosinase activity. Microneedling is a minimally invasive procedure that creates microperforations within the skin and has shown efficacy in improving the transcutaneous delivery of topical agents. Microneedling as an adjuvant to topical medications has shown promising but variable results in treating melasma, and the literature lacks an evaluation of its tolerability and efficacy. The aim of this work is to evaluate the efficacy of tranexamic acid for treatment of melasma by its various formulations (oral, solution after microneedling by dermapen and topical cream). This study was performed on 60 patients suffering from facial melasma, were recruited from the Dermatology outpatient clinic at Menoufia University Hospital. A written consent form approved by Local Ethical Research Committee in Menoufia Faculty of Medicine was obtained from every participant prior to study initiation after explanation of the study nature and procedure. All patients were subjected to full history taking including onset, course, and duration of melasma, family history, occupational history, previous treatment methods used, history of other diseases, general, dermatological examination including Assessment the skin type, site, type and extent of lesions. Digital photos were taken for the lesions with covering of eyes before and after the end of treatment. Wood’s lamp examination was done to all patients before the treatment to determine the type of melasma (epidermal, dermal and mixed). Patients were subjected to the application of tranexamic acid by its various formulations as following: A) group 1: included 20 patients: received oral tranexamic acid 250 mg tablets twice daily for 2 months. |