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

The effect of topical tranexamic acid with micro-needling and micro-needling alone in treatment of macular amyloidosis

BACKGROUND

Macular amyloidosis is a form of primary localized cutaneous amyloidosis presented by pruritic pigmented macules in rippled or reticulate pattern. The aim of this study was to assess the efficacy of using topical tranexamic acid with micro-needling comparing to micro-needling alone in patients with macular amyloidosis.

MATERIALS AND METHODS

Patients with bilaterally located macular amyloidosis on trunk or upper extremities were recruited in this trial. The skin lesions in all patients were divided into two parts which were randomly assigned to the group of treatment with micro-needling plus tranexamic acid and the group of micro-needling alone. There were four sessions of treatment with 2 weeks interval. The percentage of improvement in pigmentation (based on photographs and dermoscopy) and rippling of each group was determined by three blinded dermatologists. The level of patient satisfaction and reduction of pruritus was measured by a questionnaire and defined as a percentage.

RESULTS

Twenty females were enrolled in this study. The mean (SD) patients' age was 39.7 (±10.13) years. Both groups showed improvement in pigmentation based on images, dermoscopy, and rippling pattern. Patients' satisfaction was 46.5% in tranexamic acid group and 47.5% in micro-needling alone. Nevertheless, there was no significant difference between both groups (p value >0.05). Interestingly, the pruritus improved 61.66% after four sessions of treatment in both groups.

CONCLUSION

Micro-needling is a suitable modality for decreasing pruritus and pigmentation in macular amyloidosis. However, topical application of tranexamic acid does not lead to additional improvement.

Tranexamic Acid for the Treatment of Hyperpigmentation and Telangiectatic Disorders Other Than Melasma: An Update

Tranexamic acid (TXA), a synthetic lysine analog, is a commonly used antifibrinolytic and procoagulant agent. Based on its good hemostatic efficacy, it is mainly used clinically for bleeding in trauma, various types of surgical and dental procedures and prevention of bleeding in patients with hemophilia. In recent years, studies have shown that TXA has the effects of anti-melanogenesis, anti-inflammation, anti-angiogenesis and promotes the recovery of the skin barrier, so it has been tried to be used as a treatment for hyperpigmentation and telangiectatic diseases. Oral, topical, intradermal injections and microneedling are all commonly used modes of administration. TXA for melasma is the most studied and has achieved indications in some countries, whereas it is still an off-label drug for many other dyschromia. We review the clinical use of TXA in hyperpigmentation and telangiectatic disorders other than melasma, such as post-inflammatory hyperpigmentation, Riehl's melanosis, rosacea, and post-acne erythema, to provide more evidence for the use of TXA in these disorders, and to provide safer and more cost-effective alternatives for the treatment of these diseases.

Laser-mediated Solutions: Breaking Barriers in Transdermal Drug Delivery

Skin diseases pose challenges in treatment due to the skin's complex structure and protective functions. Topical drug delivery has emerged as a preferred method for treating these conditions, offering localized therapy with minimal systemic side effects. However, the skin's barrier properties frequently limit topical treatments' efficacy by preventing drug penetration into deeper skin layers. In recent years, laser-assisted drug delivery (LADD) has gained attention as a promising strategy to overcome these limitations. LADD involves using lasers to create microchannels in the skin, facilitating the deposition of drugs and enhancing their penetration into the target tissue. Several lasers, such as fractional CO2, have been tested to see how well they work at delivering drugs. Despite the promising outcomes demonstrated in preclinical and clinical studies, several challenges persist in implementing LADD, including limited penetration depth, potential tissue damage, and the cost of LADD systems. Furthermore, selecting appropriate laser parameters and drug formulations is crucial to ensuring optimal therapeutic outcomes. Nevertheless, LADD holds significant potential for improving treatment efficacy for various skin conditions, including skin cancers, scars, and dermatological disorders. Future research efforts should focus on optimizing LADD techniques, addressing safety concerns, and exploring novel drug formulations to maximize the therapeutic benefits of this innovative approach. With continued advancements in laser technology and pharmaceutical science, LADD has the potential to revolutionize the field of dermatology and enhance patient care.

Evaluation of effectiveness of tranexamic acid as mesotherapy in improvement of periorbital wrinkling in a trial study

BACKGROUND

Tranexamic acid is used to treat pigmented disorder in dermatology for a long time however there are limited data for effectiveness of tranexamic acid for rejuvenation and improvement of wrinkle. Here we want to find the effectiveness of tranexamic acid as mesotherapy in improvement of periorbital wrinkle in a clinical trial study.

METHODS

Patients with melasma who were treated with 4 session of tranexamic acid mesotherapy at intervals on 1 week were evaluated with Visioface device before starting and 1 month after last course of treatment. The outcomes including volume, area, area percent, and depth were measured by Visioface device.

RESULTS

Mean of periorbital wrinkles volume before and after procedure were 89 271 and 74 639 pixel3 (px3 ), respectively. Very significant difference with p-value of <0.001 was detected at volume of patient wrinkles before and after treatment. Moreover, the mean of area (and area percent) of their periorbital wrinkles before and after therapeutic method were 8481 Px3 (1.131%) and 7184 Px3 (0.646%), respectively, with significant differences (both have p-value of <0.001).Mean of periorbital wrinkles depth at before and after treatment were 9.8 and 9.6, respectively, without remarkable difference (p-value was 0.257).

CONCLUSION

Tranexamic acid mesotherapy significantly leads to reduced volume and area of wrinkles. Injection of tranexamic acid as mesotherapy seems to be effective in improvement of periorbital wrinkling.

Systematic review of clinical studies assessing the needling for treatment of melasma: Focusing on efficacy, safety, and recurrence rate

BACKGROUND AND OBJECTIVE

Melasma is common, chronic and treatment-challenging cosmetic concern and the aim of this study was to systematically evaluate clinical studies assessing the treatment of melasma through needling while focusing on efficiency, safety, and recurrence.

METHOD

After e-search a total of 54 articles were reviewed and 12 published articles (February 2011-September 2020) in terms of content, topic, and purpose, were finalized. Articles were open pilot trials, case reports, case series, retrospective studies, quasi-experimental trials, randomized clinical trials, and split face comparative studies.

RESULTS

The highest decrease in MASI score was 85.71% and allocated to microneedling method following only 3 sessions with an interval of 30 days. On the other hand, the lowest decrease in this score was 3.7% and allocated to microneedling treatment and its use for vitamin C delivery at the end of the fourth week of treatment. No side effects were reported in included studies, and the various needling methods used were safe. Recurrence after treatment was reported in none of these articles, and only one of them reported a 4% recurrence in the second phase of treatment, but no recurrence was reported in the last phase of that study.

CONCLUSION

Non-aggressive microneedling with topical depigmenting agents was more effective than topical depigmenting agents alone, so that the mean MASI score was significantly higher than those who used lightening serum alone. So needling can be suggested as an effective and safe method with low recurrence rate for the treatment of melasma.

Association between the Expression Levels of MicroRNA-101, -103, and -29a with Autotaxin and Lysophosphatidic Acid Receptor 2 Expression in Gastric Cancer Patients

Background

Gastric cancer (GC) is regarded as the most prevalent malignancy with the high mortality rate, worldwide. However, gastroscopy, a biopsy of suspected sample, and detecting CEA, CA19-9, and CA72-4 are presently used, but these diagnostic approaches have several limitations. Recently, microRNAs as the most important member of noncoding RNAs (ncRNAs) have received attention; recent evidence demonstrates that they can be used as the promising candidate biomarkers for GC diagnosis. We aimed to investigate the association between the microRNA-29a, -101, and -103 expression and autotaxin (ATX) and lysophosphatidic acid receptor 2 (LPA2) expression in GC patients. Material and Methods. The present study was conducted on 40 paired samples of primary GC tissue and adjacent noncancerous tissue. The gene expression levels of miR-101, -103, -29, ATX, and LPA2 were analyzed by quantitative reverse-transcription PCR (qRT-PCR). Besides, the protein levels of ATX and LPA2 were evaluated using western blot.

Results

The expression levels of miR-29 and miR-101 were significantly lower (p value < 0.0001), but the miR-103 and LPA2 were significantly higher in gastric tumor samples compared to the corresponding nontumor tissues (p value < 0.0001). Moreover, the diagnostic accuracy of miRs to discrimine the GC patients from noncancerous controls was reliable (miR-101, sensitivity: 82.5% and specificity: 85%; miR-103, sensitivity: 72.5% and specificity: 90%; miR-29, sensitivity: 77.5% and specificity: 70%).

Conclusion

It seems that determining the expression level of miR-101, -103, and -29, as the novel diagnostic biomarkers, has diagnostic value to distinguish GC patients from healthy individuals.