Therapeutic Effects of Tranexamic Acid Cream in Comparison to Hydroquinone 4% Cream in Treatment of Melasma: A Split Face Comparative Study

Abstract Background Melasma is a chronic, acquired pigmentary disorder characterized by gray-brown macules and patches affecting photodistributed part of the face such as the bridge of the nose, cheek, upper lip, forehead, and mandible. It is seen mostly in women of reproductive age group and has an onset usually after pregnancy. However, in around 10% of the cases, males are also affected. Objectives The aim of our study was to assess and compare the therapeutic effects of tranexamic acid cream versus hydroquinone 4% cream in treating patients with melasma. Patients and Methods This prospective split face comparative study included thirty three patients with their age ranging from 18 to 40 years, participated for treatment of different types of melasma, recruited from outpatient clinic of Dermatology department Ain Shams University Hospitals during the period from January to June 2019. The study was approved by the Research Ethical Committee, Faculty of Medicine, Ain Shams University and fulfilled all the ethical aspects required in human research. All patients received full information about description of the procedure of treatment, possible side effects, photo documentation and they all provided informed consent. Results Both topical TA and HQ 4% cream were efficient in treatment of different types of melasma as shown by significant decrease in Hemi MASI score, patient satisfaction score, significant decrease in average level of melanin measured by Antera 3D camera and significant decrease in area % of melanin by histopathological evaluation after 3 months of treatment, although slight recurrence of melasma was observed one month after stopping both treatments. Meanwhile, no significant difference was observed in treatment response of TA and HQ regarding Hemi MASI score, patient satisfaction score, average level of melanin (Antera 3D camera). This could be attributed to the small number of included patients. Conclusion We concluded that the TA appears to be a promising therapeutic option in the treatment of melasma. TA has fewer adverse effects, same or even better results in comparison with other melasma targeting therapies as hydroquinone cream.