Indraswari Anindia, Indramaya Diah Mira, Sari Maylita, Utomo Budi, Ervianti Evy, Setyaningrum Trisniartami, Astindari Astindari, Umborowati Menul Ayu
From the Department of Dermatology and Venerology, Faculty of Medicine, Airlangga University/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Department of Public Health Science and Preventive Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.
Indian J Dermatol. 2025 Mar-Apr;70(2):89-96. doi: 10.4103/ijd.ijd_1002_23. Epub 2025 Feb 27.
Melasma is a symmetrical chronic hypermelanosis that affects the skin of the face, characterised by brownish patches with uneven margins, particularly in areas regularly exposed to sunlight. Although topical triple combination modifications are good first-line therapy for melasma, they have a wide range of negative effects. Consequently, new effective treatments with fewer side effects are required. It has been observed that intradermal tranexamic acid (TA) has low adverse effects and a good therapeutic response in treating melasma. This study aimed to assess the degree of the melasma area and severity index in patients treated with topical triple combination modifications and intradermal tranexamic acid therapy. Electronic databases were searched for relevant articles based on predetermined eligibility requirements. The statistical analysis was conducted using the Review Manager (RevMan) v5.4 software. Randomized controlled trials were used in designing three investigations with a total of 184 patients. After intervention, there was a significant difference in the MASI score between the intradermal tranexamic acid group and the modified topical triple combination group, with a mean difference (MD) of -0.81 (95% CI [-1.05, -0.57]), a combined result of 6.54 with < 0.00001 and low heterogeneity (I2 = 0%). The intradermal tranexamic acid group also demonstrated a lower MASI score, and the funnel plot revealed no publication bias. This study found that intradermal tranexamic acid is more effective than topical triple combination modifications and has fewer side effects. Therefore, it can serve as an alternative primary therapy option for melasma.
黄褐斑是一种对称性慢性色素沉着过度疾病，累及面部皮肤，其特征为边缘不规则的褐色斑片，尤其在经常暴露于阳光下的部位。尽管局部三联组合疗法是黄褐斑的良好一线治疗方法，但它们有广泛的负面影响。因此，需要副作用更少的新的有效治疗方法。据观察，皮内注射氨甲环酸（TA）治疗黄褐斑不良反应少且治疗反应良好。本研究旨在评估接受局部三联组合疗法和皮内注射氨甲环酸治疗的患者的黄褐斑面积和严重程度指数。根据预定的纳入标准在电子数据库中检索相关文章。使用Review Manager（RevMan）v5.4软件进行统计分析。采用随机对照试验设计三项研究，共纳入184例患者。干预后，皮内注射氨甲环酸组和改良局部三联组合组的MASI评分存在显著差异，平均差值（MD）为-0.81（95%CI[-1.05，-0.57]），合并结果为6.54，P<0.00001，异质性低（I2=0%）。皮内注射氨甲环酸组的MASI评分也较低，漏斗图显示无发表偏倚。本研究发现，皮内注射氨甲环酸比局部三联组合疗法更有效且副作用更少。因此，它可作为黄褐斑的替代一线治疗选择。
