Nerve Block-Assisted Intradermal Injection of Tranexamic Acid, Vitamin C, and Glutathione for Melasma: A Split-Face Comparative Study.

BACKGROUND

Melasma is a common acquired pigmentary disorder characterized by symmetrical hyperpigmented macules. However, combination therapy using tranexamic acid (TXA), vitamin C, and glutathione under nerve block remains inadequate.

OBJECTIVE

To evaluate the efficacy and safety of intradermal injection of TXA, vitamin C, and glutathione under nerve block for melasma treatment.

METHODS

A prospective, split-face trial was conducted on 20 patients with melasma during November 2023-July 2024. Lidocaine cream was applied to one side of the face, while infraorbital and zygomaticofacial nerve blocks were applied to the other. Intradermal injections of TXA, vitamin C, and glutathione were administered at weeks 2, 4, 6, and 8. Efficacy was assessed before treatment and three months post-treatment.

RESULTS

VISIA analysis showed significant increases in UV spots and brown spots (P < 0.001), indicating improved skin condition. Modified Melasma Area and Severity Index (mMASI) scores decreased significantly from 6.99 ± 1.62 to 4.50 ± 1.27 (P < 0.001). Visual analog scale (VAS) pain scores were higher on to topical anesthesia side (4.35 ± 1.22) compared to the nerve block side (2.50 ± 0.83) (P < 0.001). No severe adverse events were reported.

CONCLUSION

Intradermal injection of TXA, vitamin C, and glutathione under nerve block is an effective, safe, and low-pain treatment for melasma.

LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .