Behrangi Elham, Shemshadi Mahsa, Ghassemi Mohammadreza, Goodarzi Azadeh, Dilmaghani Sara
Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
J Cosmet Dermatol. 2022 Jan;21(1):279-289. doi: 10.1111/jocd.14496. Epub 2021 Nov 1.
Melasma is a common hyperpigmentation disorder. This study aimed to compare the efficacy of Nd-Yag fractional 1064 plus microinjection of tranexamic acid versus Nd-Yag fractional 1064 plus oral tranexamic acid in patients with melasma.
This is a prospective, randomized study with a sample size of 40 patients, 20 in each treatment arm, which was done six times with 2-week intervals. Twenty patients were administered localized microinjections (4 mg/ml) of tranexamic acid and Q-switched 1064 laser every 2 weeks in one arm, while in the other arm, 20 were given oral tranexamic acid 250 mg three times a day and Q-switched 1064 laser every 2 weeks per visit.
Twenty-one patients with mean SD 40.52+-4.95 y/o were treated with oral tranexamic acid, and 20 patients with 43.3+-5.87 y/o treated with microinjection of tranexamic acid were analyzed. There was no statistically significant difference between the two groups in terms of demographic and clinical characteristics at the baseline (p > 0.05). The patients MASI score and ∆E decrease over the study period in both treatments significantly (p < 0.001). However, patient's MASI score (p = 0.99) and ∆E (p = 0.53) did not differ significant between the two group over the time. Satisfaction (p = 0.41) and complication during the study period (p = 0.09) were not significantly different between the two group.
The combination treatment method can be a viable option for Middle Eastern patients having melasma disorder, and tranexamic acid appears to be an effective and safe treatment for melasma, irrespective of its route of administration. Tranexamic acid can increase the permeability locally by non-invasive methods such as microneedling which is less painful than microinjection and can also increase patient satisfaction. Although the oral method is more tolerable for the patient, it may have systemic side effects, and its combination with Q-switch laser increases its effect regardless of the type of prescription. Therefore, it is recommended to use of this drug topically (cream or lotion) by non-invasive methods like microneedling to reduce pain and laser treatment in future studies.
黄褐斑是一种常见的色素沉着紊乱疾病。本研究旨在比较Nd-Yag 1064波长分数激光联合注射氨甲环酸与Nd-Yag 1064波长分数激光联合口服氨甲环酸治疗黄褐斑患者的疗效。
这是一项前瞻性随机研究，样本量为40例患者，每个治疗组20例，共进行6次，间隔2周。一组20例患者每2周接受一次局部注射（4mg/ml）氨甲环酸和调Q 1064激光治疗，另一组20例患者每次就诊时每天口服3次250mg氨甲环酸并每2周接受一次调Q 1064激光治疗。
分析了21例平均年龄为40.52±4.95岁接受口服氨甲环酸治疗的患者以及20例平均年龄为43.3±5.87岁接受氨甲环酸注射治疗的患者。两组在基线时的人口统计学和临床特征方面无统计学显著差异（p>0.05）。在研究期间，两种治疗方法中患者的MASI评分和∆E均显著下降（p<0.001）。然而，随着时间推移，两组患者的MASI评分（p=0.99）和∆E（p=0.53）无显著差异。两组在研究期间的满意度（p=0.41）和并发症（p=0.09）也无显著差异。
联合治疗方法对于患有黄褐斑的中东患者可能是一种可行的选择，氨甲环酸似乎是一种治疗黄褐斑的有效且安全的药物，无论其给药途径如何。氨甲环酸可通过微针等非侵入性方法局部增加渗透性，微针比注射疼痛轻，还能提高患者满意度。虽然口服方法对患者更易耐受，但可能有全身副作用，其与调Q激光联合使用无论处方类型如何均可增强效果。因此，建议在未来研究中通过微针等非侵入性方法局部使用该药物（乳膏或洗剂）以减轻疼痛并联合激光治疗。
