Comparison of the clinical outcomes of oral tranexamic acid and platelet-riched plasma treatment in patients with melasm

Aim: Melasma is one of the most commonly diagnosed dermatological diseases worldwide. Although there are many options in the treatment of melasma, which is a cosmetic problem for the majority of patients; it is a disease that is resistant to treatment and has a high probability of recurrence. The pathogenesis is not fully understood yet, which often causes difficulties in treatment. Oral TA, which has been used in the treatment of bleeding diathesis and menorrhagia from the past, is now successfully used for the treatment of melasma. PRP is defined as a small amount of plasma in which a large number of platelets are suspended by centrifugation of autologous blood, and its potential effect in hyperpigmentation treatment has been reported in recent studies. In our study, we aimed to compare the clinical results of oral TA and PRP therapy in patients with melasma. Material and Method: The clinical results of 30 melasma patients over the age of 18 who applied to the İnönü University Turgut Ozal Medical Center Dermatology and Venereal Diseases Outpatient Clinic between September 2017 and June 2019, who were treated with oral TA and 30 patients with melasma who were treated with PRP were retrospectively evaluated. Prior to the treatment; age, gender, skin type, smoking, alcohol use, melasma duration, previous treatments used for melasma, presence of additional disease, family history, sunscreen use were recorded by questioning; and patients whose right and left side photographs were found on both sides were examined. Melasma patients in the 1st group who were started on 2x500 mg oral TA treatment; MASI score at 0, 1, 2 and 3 months was evaluated together with the photographs taken under standard conditions. In addition, complete blood count, liver and kidney function tests and bleeding profile at 0 and 3 months were evaluated. In the second group, patients with melasma who had PRP injection intradermally on their faces at the 1st, 2nd and 3rd months were evaluated together with their MASI score and photographs taken under standard conditions. Results: In our study, it was determined that both oral TA and PRP provide statistically significant improvement in melasma patients. It was found that the 75% improvement in the MASI score was statistically significantly higher in the patient group treated with oral TA compared to the patients treated with PRP. There was no statistically significant difference in MASI score improvement rates in both groups according to skin type, gender and melasma duration. Conclusion: Although oral TA and PRP are both successful in the treatment of melasma, it has been shown in our study that oral TA gives better results. More studies are needed to support our study, which is the first in this field in the literature. Keywords: Melasma, platelet rich plasma, tranexamic acid