Tranexamic Acid Microneedling Outperforms Intradermal Injections for Melasma Treatment: Randomized Trial

Melasma remains a complex hypermelanotic condition involving multiple etiopathogenic components often resistant to conventional therapies like chemical peels or lasers, and while previous research confirms the pigment-inhibiting properties of tranexamic acid, a clinical gap remains regarding the most effective delivery route; therefore, Dr. Damayandhi Kaliyaperumal and colleagues from the Department of Dermatology, Venereology, and Leprosy, Aarupadai Veedu Medical College, Puducherry, conducted this investigation to compare the efficacy and side effects of this agent when administered via microneedling versus traditional intradermal injections.

Therefore, the hospital-based randomized controlled study involved 70 participants aged 18 to 60 years and was conducted over four treatment sessions at four-week intervals between November 2022 and April 2024 to compare 4 mg/mL of tranexamic acid delivered via a 1.5 mm derma-roller versus intradermal injections with an insulin syringe. Utilizing analytical tools such as independent t-tests and repeated-measures ANOVA, the researchers excluded individuals receiving hormonal therapy or with keloidal tendencies, while designating mMASI score improvement as the primary endpoint and secondary outcomes as clinical response via photographic assessment and patient satisfaction using the Patient Global Assessment (PGA) scale.

Key Clinical Findings of the Study Include:

• Superior Symptom Reduction: The study confirmed that the microneedling cohort achieved significantly lower mMASI scores starting from the 12th week of treatment compared to the injection group, with reductions continuing through the 20-week follow-up.

• Enhanced Clearance Rates: Approximately 82.9% of patients in the microneedling group reported nearly cleared melasma on the PGA scale, whereas only 37.1% reached this significant milestone in the intradermal group.

• Greater Clinical Response: Photographic evidence showed that over 71% of microneedling participants experienced more than 50% clinical improvement, which was significantly higher than the 40% observed in the injection cohort.

• Favorable Safety Profile: While minor adverse events like persistent erythema or bruising occurred, the study observed no statistically significant difference in safety between the two delivery methods, with events reported in only 2.9% of the microneedling group.

The results suggest that both delivery methods for tranexamic acid are effective in reducing pigmentation, with the microneedling group showing a superior mMASI reduction from a baseline of 7.1 down to 4.6 compared to the injection group's baseline of 7.0 reducing to 5.3.

Thus, the study concludes that clinicians might consider microneedling with tranexamic acid as a more efficient and satisfying treatment strategy for patients managing various patterns of melasma.

While the current results are quite favorable, future research involving larger groups and longer observation periods could help further refine treatment parameters such as needle depth and drug concentrations.

Reference

Srijha M, Kaliyaperumal D, Dileep JE, Kuruvila S. Efficacy of tranexamic acid microneedling versus intradermal injection of tranexamic acid in the treatment of melasma – A randomised controlled trial. Indian J Dermatol 2026;71:109-14.