Comparison Between Efficacy of Topical Tranexamic Acid Vs Topical Ethyl Ascorbic Acid In Treatment Of Melasma

Comparison Between the Efficacy of Topical Tranexamic Acid VS Topical Ethyl Ascorbic Acid in the Treatment of Melasma Introduction Melasma is a prevalent acquired condition marked by brownish to grayish patches of discoloration on sun-exposed areas of the face, predominantly affecting women. While the precise cause of melasma remains unclear, it is thought to be multifactorial, involving the interplay of genetic, hormonal, and environmental factors, along with other risk elements.1 According to reports the prevalence of melasma in Pakistan is 46%, which is quite high. 2 The etiology of melasma is complex, involving multiple factors such as genetics, UV exposure, pregnancy, and the use of hormonal contraceptives.3 Melasma treatment is challenging due to its unclear etiology, refractory nature, and frequent relapse. Current therapies are divided into non energy-dependent (e.g., hydroquinone, alpha arbutin, azelic Acid, retinoids, Vit C , chemical peels( glycolic acid, lactic acid, salicylic acid)and energy-dependent (e.g., lasers, intense pulsed light) categories.3,4 Topical tranexamic acid (TXA) and ascorbic acid are both effective in treating melasma, with outcomes varying by skin type and treatment combination. TXA demonstrates versatility, particularly when combined with lasers or hydroquinone, yielding significant pigmentation improvements. Ascorbic acid, especially with microneedling, shows notable efficacy in skin type III and outperforms TXA in specific cases. Both agents are valuable, with tailored approaches enhancing their effectiveness. (4-7) Muhammad Fahim et al. compared the effectiveness of intradermal tranexamic acid (TXA) and topical magnesium ascorbyl phosphate (MAP) in treating melasma. The study included 128 patients, divided into two groups of 64 each. Group A received intradermal TXA injections, while Group B used topical MAP cream. After 12 weeks, the study found that the efficacy of TXA was 54.7%, while MAP showed a higher efficacy of 78.1%. The study concluded that topical MAP is more effective than intradermal TXA for treating melasma .2 The rationale of this study is to compare the efficacy with topical TXA versus topical Ethyl Ascorbic Acid (EAA ) for Melasma in terms of reduction in MASI scores. Melasma treatment often involves trial and error due to variability in patient response and recurrence rates. While both TXA and EAA are widely used, comparative data on their efficacy and safety profiles in similar clinical scenarios is scarce. This study seeks to address this gap, providing insights to guide clinicians in choosing the most effective and patient-friendly option.

Objective:

To compare the efficacy of topical TXA versus topical EAA for Melasma in terms of reduction in mean MASI scores.

Operational Definition:

Melasma: It is defined as a skin condition characterised by brownish to greyish discoloration on skin.