DOI: 10.4103/cdr.cdr_199_25 ISSN: 2542-551X

A Randomized, Open-label, Comparative Study of Intralesional Tranexamic Acid Microinjection versus Tranexamic Acid Microneedling in the Management of Melasma

Prateek Maharana, Swapnarani Behera, Sonal Jain, Diptiranjani Bisoyi, Sanjib Kumar Juadi
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Abstract

Background:

Melasma is a chronic, relapsing hyperpigmentary disorder with limited response to conventional therapies. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promising results when delivered locally, but comparative data on intradermal and transdermal routes remain limited.

Aims:

The aim of this study was to compare the efficacy and safety of intralesional TXA microinjection and TXA microneedling in the management of melasma.

Materials and Methods:

This was a prospective, randomized, open-label, comparative study conducted in a tertiary care dermatology center in western Odisha over 18 months. One hundred patients with facial melasma were randomized into two groups: Group A received intradermal TXA (4 mg/mL) microinjections, and Group B underwent microneedling-assisted transdermal TXA application. Treatments were administered at 4-week intervals for three sessions. The Modified Melasma Area and Severity Index (mMASI) was used to assess pigmentation at baseline and weeks 4, 8, and 12.

Results:

Both the groups showed significant mMASI reduction ( P < 0.001 within the groups). Microneedling showed a slightly greater mean reduction than microinjection, though not statistically significant. Adverse effects were mild and self-limiting. Pain and transient edema were observed more frequently in the intradermal group compared to the transdermal group.

Conclusions:

Both techniques were effective and safe; microneedling offered marginally better clinical improvement and greater patient comfort. Microneedling-assisted TXA delivery achieves pigmentation reduction comparable to intradermal injections with less discomfort and downtime. This simplified, minimally invasive technique may serve as a practical outpatient alternative for melasma management in routine clinical settings.

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