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Melasma is a complex pigmentary disorder with challenging management. Evaluation of efficacy of topical tranexamic acid (TXA) versus Vitamin C (Vit C) with microneedling (MN) in melasma therapy. In 30 females with melasma, after 4 weeks of using Modified Kligman’s formula, the right side of the face was treated with MN + TXA and the left with MN + Vit C for five biweekly sessions. Wood’s light, dermoscopy, Melasma Area and Severity Index (MASI), MASI malar right and malar left (MASI MR  and MASI ML ), Visual Analogue Score (VAS), and Dermatology Life Quality Index (DLQI) were evaluated at weeks 0, 4, 12, and 16. Both MASI MR  and MASI ML  decreased significantly ( p  &lt; .001). Both sides exhibited significant diminution in dark fine granules ( p -value &lt; .001), homogeneous pigmentation ( p -value = .005) and pseudoreticular brown network ( p -value = .028). However, telangiectasia significantly improved only on the TXA treated side ( p  = .002). DLQI improved significantly on both sides ( p  &lt; .001). In some patients transformation of mixed to dermal melasma was depicted. MN followed by Vit C or TXA is successful in melasma management, the latter being advantageous vis-a-vis dermal vascularity and epidermal pigmentation. Dermoscopic evaluation appears crucial in choosing optimum treatment in each patient.

journal of dermatological treatment

Dermoscopic evaluation of tranexamic acid versus Vitamin C, with microneedling in the treatment of melasma: a comparative, split-face, single-blinded study