Faculty Opinions recommendation of Combination of Oral Tranexamic Acid with Topical 3% Tranexamic Acid versus Oral Tranexamic Acid with Topical 20% Azelaic Acid in the Treatment of Melasma.

Objective: To compare the effect of combination therapies of topical 3% tranexamic acid versus topical 20% azelaic acid each combined with oral tranexamic acid in the treatment of melasma. Study Design: Interventional comparative study.Place and Duration of Study: Department of Dermatology, Sheikh Zayed Hospital, Rahim Yar Khan, from July 2017 to June 2018.Methodology: Cases of melasma diagnosed clinically (based upon history and the clinical findings of symmetrically distributed hyperpigmented macules and patches on the face), aged 12 to 50 years, were selected.The cases were divided into two groups by simple random sampling method.The cases in group A were treated by oral tranexamic acid (250 mg twice daily) with topical 3% tranexamic acid (twice daily).In group B, cases had oral tranexamic acid (250 mg twice daily) with topical 20% azelaic acid (daily) for six months.They were followed every second month upto 6 months and the efficacy was assessed on the basis of scores on MASI scale.Results: In 100 patient, there was no significant difference in terms of mean MASI score at 2 and 4 months with p-value of 0.20 and 0.89, respectively.However, mean MASI score was significantly less in group A (6.06 ±5.06 vs. 10.62 ±7.43) in group B (p=0.001).In group A, 14 (28%) had excellent response, whereas in group B, 11 (22%) had excellent results.Conclusion: Combination of oral and topical 3% tranexamic acid is significantly better than oral tranexamic acid with 20% azelaic acid for treatment of melasma.