The Effect of Platelet Rich Plasma (PRP) Plus Microneedling Versus Tranexamic Acid Plus Microneedling in the Biometric Characteristics of Melasma: A Before-After, Assessor Analysis, Blinded, Clinical Trial
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Keywords
Platelet Rich Plasma, PRP, Microneedling, Transexamic Acid, Melasma
Abstract
Background: Melasma is a chronic, acquired, focal pigment disorder showing symmetrical hyperpigmentation or hypermelanosis of photo-exposed areas on the face. Tranexamic acid (TXA) is a treatment for melasma. The regression of melasma after platelet-rich plasma (PRP) treatment is an interesting finding.
Objectives: To evaluate the effect of PRP plus microneedling vs. tranexamic acid plus microneedling on the quality of melasma.
Methods: This is a left-right split-face comparison study with 18 patients with melasma. The patients underwent four sessions of PRP plus microneedling and tranexamic acid (5%) plus microneedling on right and left sides of the face, respectively, at monthly intervals. Evaluations were performed before the start of treatment and one month after the last treatment session.
Results: Totally, 20 female patients with melasma were included with a mean age of 41 years (range: 34-49 years). Five participants had Fitzpatrick phototype II, eleven had phototype III, and others had phototype IV skin. Both TXA + microneedling and PRP + micro-needling caused a significant reduction in the Tewameter measurement (mean difference PRP =-3.33, P=0.003, and mean difference TXA =-2.15, P=0.003). In addition, the median delta E in the patients who received both treatments was significantly decreased after the treatment (mean difference =6.66, P<0.001 in TXA + microneedling group; mean difference =1.90, P<0.001 in PRP + microneedling group). The patients who received TXA + microneedling showed a significant reduction in melanin mexameter measurement. The patients were satisfied with both treatments.
Conclusion: This study showed that PRP and tranexamic acid with microneedling have a significant effect in reducing the MASI score and are considered an effective treatment. Although none of these two methods was superior over the other one, they can be a good combination or alternative for the treatment of melasma because they have good efficacy, safety, tolerability, and satisfaction among patients.
References
2. Behrangi E, Shemshadi M, Ghassemi M, Goodarzi A, Dilmaghani SJJoCD. Comparison of efficacy and safety of tranexamic acid mesotherapy versus oral tranexamic acid in patients with melasma undergoing Q‐switched fractional 1064‐nm Nd: YAG laser: A blinded RCT and follow‐up. 2022;21(1):279-89.
3. Sarkar R, Gupta MJDS. Platelet-Rich Plasma in Melasma—A Systematic Review. 2022;48(1):131-4.
4. Hiramoto K, Yamate Y, Sugiyama D, Takahashi Y, Mafune EJP, Photoimmunology, Photomedicine. The gender differences in the inhibitory action of UVB‐induced melanocyte activation by the administration of tranexamic acid. 2016;32(3):136-45.
5. Chatterjee M, Vasudevan BJPI. Recent advances in melasma. 2014;1(2):70.
6. Pavlovic V, Ciric M, Jovanovic V, Stojanovic PJOM. Platelet rich plasma: a short overview of certain bioactive components. 2016;11(1):242-7.
7. Sheth VM, Pandya AGJJotAAoD. Melasma: a comprehensive update: part II. 2011;65(4):699-714.
8. Mosher DBJDigm. Hypomelanoses and hypermelonoses. 1999.
9. Achar A, Rathi SKJIjod. Melasma: a clinico-epidemiological study of 312 cases. 2011;56(4):380.
10. Guinot C, Cheffai S, Latreille J, Dhaoui M, Youssef S, Jaber K, et al. Aggravating factors for melasma: a prospective study in 197 Tunisian patients. 2010;24(9):1060-9.
11. Dominguez AR, Balkrishnan R, Ellzey AR, Pandya AGJJotAAoD. Melasma in Latina patients: cross-cultural adaptation and validation of a quality-of-life questionnaire in Spanish language. 2006;55(1):59-66.
12. Handel AC, Miot LDB, Miot HAJAbdd. Melasma: a clinical and epidemiological review. 2014;89:771-82.
13. Gururangan S, Cavazos CM, Ashley D, Herndon JE, Bruggers CS, Moghrabi A, et al. Phase II study of carboplatin in children with progressive low-grade gliomas. 2002;20(13):2951-8.
14. Ponzio HA, Favaretto AL, Rivitti EAJCD-CK-. Proposal of a quantitative method to describe melasma distribution in women. 2007;20(2):103-11.
15. T Jadotte Y, A Schwartz RJADC. Melasma: insights and perspectives. 2010;18(2):0-.
16. Sarkar R, Puri P, Jain R, Singh A, Desai AJJotEAoD, Venereology. Melasma in men: a clinical, aetiological and histological study. 2010;24(7):768-72.
17. Roohaninasab M, Sadeghzadeh-Bazargan A, Goodarzi AJLiMS. Effects of laser therapy on periorbital hyperpigmentation: a systematic review on current studies. 2021;36(9):1781-9.
18. Nouri K. The treatment of melasma: A review of clinical trials. 2006.
19. Rigopoulos D, Gregoriou S, Katsambas AJJocd. Hyperpigmentation and melasma. 2007;6(3):195-202.
20. Tehranchinia Z, Saghi B, Rahimi HJDr, practice. Evaluation of therapeutic efficacy and safety of tranexamic acid local infiltration in combination with topical 4% hydroquinone cream compared to topical 4% hydroquinone cream alone in patients with melasma: a split-face study. 2018;2018.
21. Abdelrazik H, editor Combination of skin micro-needling and topical application of tranexamic acid and vitamin C: new clinical application: a pilot study for treatment of persistent post acne erythema. JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY; 2016: MOSBY-ELSEVIER 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA.
22. Saleh FY, Abdel-Azim ES, Ragaie MH, Guendy MGJJotEWsDS. Topical tranexamic acid with microneedling versus microneedling alone in treatment of melasma: clinical, histopathologic, and immunohistochemical study. 2019;16(2):89.
23. Abdelshafy ASJJD, Cosmet. Intralesional Tranexamic Acid Versus Platelet Rich Plasma in Melasma Treatment. A Split Face Comparative Study. 2019.
24. Al-Shami SHJAJDV. Treatment of periorbital hyperpigmentation using platelet-rich plasma injections. 2014;3(5):87-94.
25. Alves R, Grimalt RJSad. A review of platelet-rich plasma: history, biology, mechanism of action, and classification. 2018;4(1):18-24.
26. Sirithanabadeekul P, Dannarongchai A, Suwanchinda AJJoCD. Platelet‐rich plasma treatment for melasma: a pilot study. 2020;19(6):1321-7.
27. Çayırlı M, Çalışkan E, Açıkgöz G, Erbil AH, Ertürk GJAod. Regression of melasma with platelet-rich plasma treatment. 2014;26(3):401-2.
28. Hofny ER, Abdel-Motaleb AA, Ghazally A, Ahmed AM, Hussein MRAJJoDT. Platelet-rich plasma is a useful therapeutic option in melasma. 2019;30(4):396-401.
29. Sadeghzadeh‐Bazargan A, Behrangi E, Najar Nobari N, Ghassemi M, Roohaninasab M, Goodarzi AJJoCD. Systematic review of clinical studies assessing the needling for treatment of melasma: focusing on efficacy, safety, and recurrence rate. 2022.
30. Kalluri H, Banga AJJoDDS, Technology. Microneedles and transdermal drug delivery. 2009;19(5):303-10.
31. Ziaeifar E, Ziaeifar F, Mozafarpoor S, Goodarzi AJDT. Applications of microneedling for various dermatologic indications with a special focus on pigmentary disorders: A comprehensive review study. 2021;34(6):e15159.
32. Ghassemi M, Roohaninasab M, Kamani SA, Sadeghzadeh‐Bazargan A, Goodarzi AJDT. Comparison of the efficacy and safety of intralesional injection of tranexamic acid and the topical application of Kligman combination drug in the treatment of macular amyloidosis. 2022;35(1):e15213.
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