Intradermal Tranexamic Acid Injection for the Treatment of Melasma: A Pilot Study with 48-week Follow-up

BACKGROUND: Despite being an effective treatment for melasma, there have been limited reports on the long-term efficacy of intradermal tranexamic acid (TA) injection. OBJECTIVE: This study sought to evaluate the 48-week efficacy of a 4mg/mL intradermal TA injection for the treatment of melasma. METHODS: Five female patients with melasma participated in the 48-week follow-up after receiving 4-mg/mL intradermal TA injections on the face every two weeks for seven sessions and a sunscreen prescription. Assessments were performed at baseline and Weeks 4, 8, 12, 16, and 48 using the modified Melasma Area Severity Index (mMASI) score, melanin index, and patient satisfaction score. Safety and adverse effects were also evaluated. RESULTS: The mean (standard deviation) age of patients was 53.6 (8.14) years and Fitzpatrick Skin Type IV (60%) and Fitzpatrick Skin Type V (40%) were observed. The mean (standard deviation) duration of melasma was 7.6 (2.51) years and 60 percent of participants reported a family history of melasma. There was a significant decrease in mMASI score and melanin index at 16 weeks, without a statistically significant improvement of mMASI score at 48 weeks. Melasma recurrence was observed in 60 percent of the participants, with higher mMASI scores recorded, but the severity remained less than at baseline. The patient satisfaction score was lower from Week 16 to Week 48. Interestingly, a statistically significant decrease in the melanin index was observed up to Week 48, with no serious adverse effects. CONCLUSION: The 4-mg/mL intradermal TA injection yields significant efficacy at Week 16; however, melasma recurrence occurred during the 48-week follow-up. In addition to tranexamic acid injections, maintenance therapy and sun protection should be considered for patients with melasma.

Transient Treatment Response of Platelet-rich Plasma Injection for Temporal Triangular Alopecia: A Case Report with Dermoscopic Examination Follow-up

Temporal triangular alopecia (TTA) is congenital anomalies that usually develops in childhood, with rarely acquired cases in adults. TTA shares common clinical, dermoscopic, and histologic features of characterized vellus hair formation change, similar to androgenetic alopecia (AGA). Whereas, platelet-rich plasma (PRP) with multiple growth factors can provide treatment efficacy in AGA. Due to limited treatment for TTA, such as topical minoxidil, complete surgical excision, and hair transplantation, the multiple growth factors in PRP is thus postulated to be also effective for TTA treatment, just as in AGA. We present a case of TTA with unsatisfactory treatment outcome of only increased number and thickness of vellus hair by dermoscopic examination follow-up after the 5-session PRP injection and only transient response for 6 months. Unlike, AGA, the PRP injection might not consequently be a suitable treatment option for TTA. Nonetheless, further studies should be performed to investigate the potential treatment modality for TTA.