الفهرس 
MelasmaOnly 14 pages are availabe for public view
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Abstract
Melasma is an acquired hyperpigmentation disorder and is characterized by
light-to-dark brown-colored irregular macules or patches on sun-exposed
areas of skin, usually the face individuals. In addition, it can occur in other
visible body parts such as the neck and upper limbs.
Melasma can affect men and women of all ethnicities and skin types
but is especially prevalent in women with Fitzpatrick skin types III to V
who are exposed to ultraviolet (UV) light and commonly observed in the
2nd–5th decade. It often brings negative psychosocial implications to
patients and lowers their quality of life.
Pathogenesis of melasma has not been fully identified, but it may be
an interplay of multiple internal and environmental factors, which are
responsible for triggering, aggravating, or relapsing of the melasma lesions.
These factors could be hormonal, genetic, sun exposure, and cosmetics;
also drugs, thyroid, and hepatic diseases may play a role.
Various treatment modalities are used for melasma. These include
the use of sunscreens, hypopigmenting agents, superficial peeling agents
such as glycolic and lactic acid and laser therapy. Newer studies have
found that tranexamic acid (TXA), a hemostatic agent, has hypopigmentary
effect on melasma lesions and also prevents ultraviolet-induced
pigmentation.
Tranexamic acid (TXA) is an antifibrinolytic drug, which is being
used as a depigmenting agent. It can be given either orally, topically,
intradermally, or intravenously. It inhibits UV-induced plasmin activity in
keratinocytes by preventing the binding of plasminogen to the
keratinocytes. This results in less free arachidonic acid and a diminished
ability to produce prostaglandins, and this decreases melanocyte tyrosinase
activity.
Microneedling is a minimally invasive procedure that creates
microperforations within the skin and has shown efficacy in improving the
transcutaneous delivery of topical agents. Microneedling as an adjuvant to
topical medications has shown promising but variable results in treating
melasma, and the literature lacks an evaluation of its tolerability and
efficacy.
The aim of this work is to evaluate the efficacy of tranexamic acid for
treatment of melasma by its various formulations (oral, solution after
microneedling by dermapen and topical cream).
This study was performed on 60 patients suffering from facial
melasma, were recruited from the Dermatology outpatient clinic at
Menoufia University Hospital.
A written consent form approved by Local Ethical Research
Committee in Menoufia Faculty of Medicine was obtained from every
participant prior to study initiation after explanation of the study nature and
procedure.
All patients were subjected to full history taking including onset,
course, and duration of melasma, family history, occupational history,
previous treatment methods used, history of other diseases, general,
dermatological examination including Assessment the skin type, site, type
and extent of lesions. Digital photos were taken for the lesions with
covering of eyes before and after the end of treatment. Wood’s lamp
examination was done to all patients before the treatment to determine the
type of melasma (epidermal, dermal and mixed).
Patients were subjected to the application of tranexamic acid by its
various formulations as following:
A) group 1: included 20 patients: received oral tranexamic acid 250
mg tablets twice daily for 2 months.