Abstract
BACKGROUND: Melasma, characterized by irregular skin hyperpigmentation, presents a therapeutic challenge with limited universal solutions. Platelet-rich plasma (PRP) and Tranexamic Acid (TXA), coupled with microneedling, offer promising avenues for treatment. This clinical trial sought to compare the efficacy and adverse effects of microneedling with PRP versus TXA in managing melasma. METHODS: The study was a single-blind, randomized controlled trial from May 2022 to Apr 2023 and enrolled 23 female melasma patients. Using the coin toss method, patients were randomly assigned to receive microneedling with PRP on one side and microneedling with TXA on the other. Evaluation parameters included Melasma Area and Severity Index (MASI) scores, melasma improvement grading, patient satisfaction, and treatment-related side effects, monitored over three sessions at 3-week intervals. RESULTS: Both microneedling approaches demonstrated effectiveness, with the PRP group exhibiting significantly lower MASI scores at the 6th and 9th wk. However, no significant distinctions were observed in improvement grading or patient satisfaction between the PRP and TXA groups. Side effects were minimal, limited to transient burning and mild pain during the procedure. CONCLUSION: Microneedling with PRP and TXA emerged as a safe and effective treatment for melasma. While the PRP group showed potential superiority in MASI scores, comprehensive considerations, including patient preferences and long-term outcomes, are crucial. Larger, multi-center studies with extended follow-up periods are warranted for a more nuanced understanding of these treatments in melasma management.