Comparison of the Efficacy of Intralesional Ascorbic Acid Mesotherapy and Intralesional Tranexamic Acid in Treating Melasma in the Skin of Colour Population.

BACKGROUND: Melasma remains an important dermatological ailment affecting diverse types of skin across the world. Various treatment modalities are currently employed to control melasma; however, the ideal treatment remains elusive. Comparative data regarding the efficacy of intralesional tranexamic acid (TA) and ascorbic acid (AA) mesotherapy (MT) in the treatment of melasma in South Asian skin is sparse. The objective of this study was to compare the clinical efficacy and safety of intralesional tranexamic acid versus ascorbic acid mesotherapy for treating melasma in patients with skin of colour (SOC).

METHODOLOGY: This quasi-experimental study was conducted at the Dermatology Department of Combined Military Hospital Kohat, a tertiary healthcare setup in Pakistan, between April 16, 2024, and October 16, 2024. A total of 110 volunteer patients with melasma, aged 18 to 55 years, were included. Individuals with a history of other dermatological conditions such as cutaneous infections, discoid lupus erythematosus, positive pregnancy tests, lactation, oral contraceptive use, or anaemia were excluded from the research. The patients were randomly assigned to two groups. In Group A, 55 patients were included and administered fortnightly sessions of intralesional TA MT, while in Group B, 55 patients received fortnightly sessions of intralesional AA MT. Both groups were also prescribed a daily Kligman regimen-based cream at night, along with sun protection measures in the form of broad-spectrum SPF 60 creams. Final evaluation was done at the end of 12 weeks, during which the Melasma Area Severity Index (MASI) was calculated and compared. The side effect profiles in both groups were also recorded.

RESULTS: Of the total 110 patients, around two-thirds (n = 77, 70%) were found to have mixed-type melasma, while the rest (n = 33, 30%) presented with dermal melasma. The average age of patients in Group A was 34.4 ± 5.1 years, while in Group B, it was 32.8 ± 4.5 years. Around two-thirds (n = 79, 71.8%) of the cohort were in the age bracket of 18-35 years. The efficacy of intralesional TA MT (Group A) was found to be higher than that of intralesional AA MT (Group B) when modified MASI scores were compared. For TA, the baseline MASI ranged from 6.4 to 8.1 (mean 7.2), and end-treatment MASI ranged from 3.3 to 5.6 (mean 4.45), showing a clear reduction of 2.75 in the mean MASI score. For AA, the baseline MASI ranged from 6.3 to 7.9 (mean 7.1), and end-treatment MASI ranged from 5.8 to 6.7 (mean 6.25), showing a clear reduction of 0.85 in the mean MASI score. The difference was statistically significant, with a p-value of 0.001. Intralesional TA MT was also associated with a lower incidence of irritation compared to intralesional AA MT, although this difference was not statistically significant.

CONCLUSION: The use of intralesional TA MT in melasma in South Asian skin appears more effective in clearing melasma than intralesional AA MT. It also remains a cheaper and safer treatment option for the control of melasma. Further large-scale randomised controlled studies are warranted to ascertain these findings.