Objective: To evaluate the efficacy of intradermal tranexamic acid (TA) verses fluocinolone-based triple combination (hydroquinone 4%, tretinoin 0.05%, fluocinolone acetonide 0.01%)therapy in the treatment of melasma.

Study Design: Randomized comparative trial

Place and Duration: Study was conducted at outpatient dermatology department of Sheikh Zayed hospital Rahim Yar Khan for period of six months i.e from September 2020 to February 2021.

Methods: Total 110 patients (age 18-40 year) of both genders having melasma on face were enrolled. Patients details demographics, age, sex and body mass index were recorded after taking written consent. Patients were divided into 2-groups. Group I had 55 patients and received intradermal tranexamic acid and group II had 55 patients andwere given topical fluocinolone-based triple combination (hydroquinone 4%, tretinoin 0.05%, fluocinolone acetonide 0.01%) cream. Follow up was taken for 2-months to determine efficacy and safety. Complete data was analyzed usingSPSS 22.0 version.

Results: Out of 110 patients 60 (54.54%) were females and 50 (45.46%) were males. Mean age of the patients in group I was 29.15±5.14 years with mean BMI 24.16±7.22 kg/m2 and in group II mean age was 28.17±5.18 years with mean BMI 23.61±2.48 kg/m2. Most of the patients (85 or 77.27%) had mixed melasma followed by dermal (16 patients /14.54%) and epidermal melasma(9 patients/8.18%). We found that malar-type pattern of melasma was most common, found in 66 (60%) of cases. A decrease in MASI score from baseline (15.4) was found 2.4 in group-Iand 5.6 in group-II. In group II erythema, hypertrichosis, hypopigmentation and acneiform lesions were the side effects found but there was no clinically significant side effect found in group I patients.

Conclusion: We found in this study that use of intradermal tranexamic acid (TA) in the treatment of melasma was effective and safe because there were no clinically significant side effects found after this treatment and reduction of MASI score was also significant.

Keywords: Triple combination, Melasma, MASI, Intradermal tranexamic acid