摘要

Objectives: Assess the effectiveness of intradermal injections of botulinum toxin combined with tranexamic acid in managing melasma, with a focus on the anti-melanogenic role of botulinum toxin and the melanogenesis-inhibiting properties of tranexamic acid (TXA). Introduction: Melasma is one of the most common dermatological conditions, predominantly affecting women with darker skin types. Numerous causes have been associated with its development, the most extensively studied being sun exposure, hormonal changes, and genetic factors. Some studies have identified a direct role of botulinum-toxin in melanogenesis, though further research is required to comprehensively understand its effects. Tranexamic-acid (TXA) is another well-known agent currently used to treat melasma, demonstrating its efficacy. This study explores the synergistic of both agents together. Materials / method: An open case series included 10-female patients (40–50-yo, Fitzpatrick IV) diagnosed with melasma resistant to conventional-treatments. Quantificare-imaging system was used to assess pigment and a MASI score was-applied. Two-out of 10 had severe melasma and the other 8-patients were moderate. A single-session was done. A topical-anesthesia was applied 15 minutes prior. Intradermal-injections were administered to each cheek, 100U-Botox vial diluted in 4cc normal-saline. Fifteen units mixed with 0.7 mL of 100mg/mL tranexamic acid total of 3ml were injected per-site. Post-care instructions given Results: The significant reduction in the MASI score was observed compared to previous treatments used in these patients. The improvement was particularly evident in areas of significant hyperpigmentation treated, suggesting that intradermal injections of botulinum toxin type A combined with TXA effectively reduce visible melanin deposition and improve overall skin tone uniformity. Conclusion: Melasma continue being challenging to treat. Botulinum-toxin effectively modulates melanogenesis by reducing inflammatory mediator and suppressing tyrosinase activity. TXA inhibits the plasminogen/plasmin system, reducing hyperpigmentation and inflammation. TXA has gained traction in dermatology for melasma treatment. This combination therapy appears promising for melasma management, warranting further investigational-studies. Large-scale, randomized, placebo-controlled-trials are needed to validate the effectiveness of this combined therapy in melasma and determine optimal delivery method.