Comparison of the Efficacy of Intralesional Tranexamic Acid Versus Topical 4% Hydroquinone in Treating Melasma

To compare the efficacy of intralesional tranexamic acid and topical 4% hydroquinone in the treatment of melasma.This comparative prospective study was conducted at the Dermatology Department, Pak Emirates Military Hospital Rawalpindi, Pakistan from October 16, 2018 to April 16, 2019.A total of 290 patients with melasma, 18 to 50 years of age, were included in this study. Patients with a history of discoid lupus erythematosus, pregnancy, lactation, anemia, and oral contraceptives or hormone replacement therapy were excluded from the study. Randomization was 1:1 for groups A and B, i.e., each upcoming patient was included in the next group. This randomization was supervised by another clinician. One hundred forty-five patients were placed in group A (intralesional tranexamic acid), while 145 were enrolled in group B (topical 4% hydroquinone). Follow-up was done at four weekly intervals for 12 weeks. After 12 weeks, the final response was assessed.In group A, the average age was 33.74 ± 6.67 years, while in group B it was 32.08 ± 6.08 years. Among the entire patients, the majority of the patients, 207 (71.38%), were in the age range of 18 to 35 years. Intralesional tranexamic acid was efficacious in 64 (44.14%) patients, while 47 (32.41%) of group B (topical 4% hydroquinone) showed complete improvement (p-value = 0.040).This study concluded that using intralesional tranexamic acid is more effective in treating melasma than topical 4% hydroquinone.