Abstract

Objectives: • Present a case series of successful treatment of melasma with the use of tranexamic acid mesotherapy in Latin-American women. • Literature review regarding tranexamic acid mesotherapy in the treatment of melasma and other hyperpigmentation disorders. Introduction: Melasma is a type of hyperpigmentation that most frequently affects the face and rarely extends to the chest and forearms. It is disproportionally prevalent in women of Latin-American descent making it a common concern in the dermatological practice, also representing a big therapeutic hurdle in many cases. The following case series aims to highlight the use of tranexamic acid mesotherapy as an alternate strategy for melasma treatment, as well as evaluating its use in other formulations and the evidence that supports newer therapeutic strategies. Materials / method: Patients recruited in private practice after being evaluated by the dermatologist who oversaw the procedure and calculated the MASI score. A liposomal solution with tranexamic acid, along with IL-10 and human growth hormone was used along with a standard anti-pigment regimen without hydroquinone. Sessions are done monthly with 2.0cc in each session and following a 0,5cm grid for each injection site with 0,05cc per point. Photos were taken before each mesotherapy appointment. Short literature review was done in PubMed database to evaluate evidence behind tranexamic mesotherapy use in melasma. Results: 8 female patients recruited for mesotherapy sessions with varying degrees of melasma, mean age of 42 years, different number of monthly sessions (one to three). All achieved improvement based on photographic follow-up and MASI score. Data base evaluation with “tranexamic acid” and “mesotherapy” had 9 studies that evaluated hyperpigmentation disorders, mostly melasma. Pharmacological evidence behind its use indicates that by inhibiting plasmin activation it indirectly inhibits melanogenesis. Treatment regimens vary regarding frequency and concentration but coincide in volume and point interval. Conclusion: Patients submitted to monthly tranexamic acid mesotherapy show important improvement both in photographic follow-up and MASI score without significant adverse events. These results, along with evidence found through database review highlight the importance of this local spot-on therapy that may avoid limitations associated with systemic tranexamic treatment. However, more evidence is needed to standardize treatment regimens.