Micro‐needling versus fractional carbon dioxide laser for delivery of tranexamic acid in the treatment of melasma: A split‐face study

Abstract

Abstract Background Tranexamic acid (TXA) in oral, topical, and intra‐dermal injection routes showed efficacy in melasma treatment. Micro‐needling and fractional carbon dioxide (CO 2 ) laser were reported to enhance the drug delivery of TXA. Aims This study aimed at comparing the use of micro‐needling and fractional CO 2 laser for drug delivery of TXA in the treatment of facial melasma. Patients/Methods Thirty female patients with bilateral symmetrical facial melasma were subjected to micro‐needling, for one side of the face, and fractional CO 2 laser, for the other, followed by an immediate topical application of TXA solution 4 mg/mL. Patients received six biweekly sessions. Results Two weeks after the last session, a significant reduction in baseline modified melasma area and severity index (mMASI) score was observed on both sides. The mean ± SD baseline mMASI dropped from 3.43 ± 1.84 to 1.59 ± 1.51 (mean reduction 57.73%, P < .001) and from 3.51 ± 1.84 to 1.78 ± 1.51 (mean reduction 55.82%, P < .001) in the micro‐needling–treated side and in the fractional CO 2 laser–treated side, respectively. However, no statistically significant differences were found between the two sides ( P = .81). Conclusions Micro‐needling and fractional CO 2 laser are equally safe and effective for the delivery of TXA in the treatment of facial melasma.