Comparison of Effectiveness of Tranexamic Acid Mesotherapy Versus Glutathione Mesotherapy in Post Burn Facial Hyperpigmentation

Burn injuries are one of the leading cause of morbidity and mortality especially in developing countries. skin pigmentation disorders are one of the most frequent sequelae after burn injury while these conditions often improve over time,some are permanent and cause severe psychological disorders(specially on the face). 1 Inflammation of burnt skin triggers the melanocytes during the healing process which results in overproduction of melanin pigment that subsequently either gets dispersed to the epidermal keratinocytes or gets engulfed by the newly recruited macrophages leading to epidermal and dermal melanosis respectively. Unfortunately skin types with darker complexion due to melanosis (Fitzpatrick type III to IV), common in the subcontinent, are more susceptible to post inflammatory hyperpigmentation.1,2 A myriad of treatments including topical bleaching agents, chemical peels, tretinoins, sunscreens and various lasers have been used to prevent and reduce the hyperpigmentation with suboptimal results.

Tranexamic acid (TXA) is a novel agent used in the treatment of post burn hyperpigmentation, available in topical, oral and parentral formulations.3,4 The drug is widely used as anti-fibrinolytic agent and exerts its effects by inhibiting plasminogen-keratinocyte interaction leading to decrease in activity of tyrosinase enzyme thereby resulting in decrease synthesis of melanin from melanocytes.3,4 Human keratinocytes secrete plasminogen activator, which increases the plasmin production and melanogenesis.5 Blockade of this effect is the mechanism behind the therapeutic effect of tranexamic acid.6,7 Tranexamic acid mesotherapy can be a very good option for treating patients of post burn hyperpigmentation.

Glutathione (GSH) is widely used drug available in topical, oral and parenteral formulations with indications encompassing hyperpigmentation, anti-aging and antioxidant effects.8 It improves skin pigmentation by shifting melanogenesis from eumelanin (black brown in color) to pheomelanin (yellow red in color) through inhibiting tyrosinase enzyme, thus regulating the rate limiting step in melanin production.8,9 Glutathione is present intracellularly more abundantly in the reduced form (GSH) and is readily converted into its oxidized form (GSSG) in the process of scavenging free oxygen redicals and other toxins while trying to maintain the redox balance of cellular environment, as described by Sidarth sonthalia in his study. 9 Consequently the levels of glutathione are found to be decreased in the tissues experiencing metabolic stress due to various inflammatory processes like burns and other diseases i.e allergies, melasma and malignancies. 8,9 In our study, we will use mesotherapy, which is an effective way of delivering de-pigmentation drugs like tranexamic acid and glutathione directly into the dermis which is the nidus of ongoing inflammatory process in the burn wounds while avoiding the undesirable consequences of systemic therapy.7,10 There is limited data about the regimen protocol and quantitative comparison of these two types of mesotherapies. This will be the first study on local and international level for measurement of post burn facial hyperpigmentation as to date there are no reliable objective methods for measuring skin hyperpigmentation quantitatively in this population of patients. Our study, with availability of ideal population sample from one of the largest burn centre in the country, will surely add to scarce knowledge currently published in literature regarding the use of tranexamic acid and glutathione to overcome hyperpigmentation. This can lower the psychosocial stigmata of post burn marks and ease the way of burn survivors for re-integration into society.

6.4 OBJECTIVE:

To compare the quantitative effectiveness of tranexamic acid mesotherapy versus glutathione mesotherapy in post burn facial hyperpigmentation.