Tawfic Shereen O, Abdel Hay Rania M, Abouelazm Dina I, Said Eman R
All authors are affiliated with the Faculty of Medicine, Cairo University, Cairo Egypt.
Dermatol Surg. 2022 May 1;48(5):556-561. doi: 10.1097/DSS.0000000000003423. Epub 2022 Mar 24.
Melasma is a challenging pigmentation disorder.
To assess and compare the efficacy of tranexamic acid (TXA) intradermal microinjection alone versus its combination with low-power, low-density fractional CO2 laser in a sequential pattern in melasma.
This study included 29 patients with melasma. Half of the face was randomly assigned to fractional CO2 laser; the other half to TXA. This split-face session was repeated every 6 weeks for 3 sessions. In between, TXA was applied to the full face every 2 weeks. Treatment duration was 4 months. Dermoscopy, melanin index (M.I), and erythema index (E.I) were evaluated at baseline and 4 weeks after the last session.
Melanin index, E.I, total dermoscopic score and different dermoscopic patterns of pigmentation, and vascular features showed significant reduction posttreatment on both sides of the face. No statistically significant difference was found regarding the degree and percentage of improvement in M.I, E.I, and total dermoscopic score between both sides.
Tranexamic acid microinjection alone or combined with low-power, low-density fractional CO2 laser in a sequential pattern are comparatively effective and safe for melasma treatment; however, combined treatment is recommended. Dermoscopy is an essential noninvasive tool in the assessment of melasma and monitoring patients' response to treatment.
黄褐斑是一种具有挑战性的色素沉着障碍。
评估并比较单独使用氨甲环酸（TXA）皮内微注射与低能量、低密度分次二氧化碳激光按序联合治疗黄褐斑的疗效。
本研究纳入29例黄褐斑患者。将面部的一半随机分配至分次二氧化碳激光治疗组；另一半分配至TXA治疗组。这种分脸治疗每6周重复一次，共进行3次。在此期间，每2周对面部进行一次TXA治疗。治疗持续时间为4个月。在基线期和最后一次治疗后4周评估皮肤镜检查、黑色素指数（M.I）和红斑指数（E.I）。
治疗后，面部两侧的黑色素指数、E.I、皮肤镜检查总评分以及色素沉着和血管特征的不同皮肤镜模式均有显著降低。两侧在M.I、E.I和皮肤镜检查总评分的改善程度和改善百分比方面未发现统计学上的显著差异。
单独使用氨甲环酸微注射或与低能量、低密度分次二氧化碳激光按序联合治疗黄褐斑相对有效且安全；然而，推荐联合治疗。皮肤镜检查是评估黄褐斑和监测患者治疗反应的重要无创工具。
