Abstract
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 P < 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.