Tranexamic Acid vs. Combination With Fractional Carbon Dioxide Laser in Melasma

Study Overview
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Brief Summary
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The objective of this study is to assess and compare the efficacy of tranexamic acid intradermal microinjection alone versus its combination with low power fractional CO2 laser in a sequential pattern. In all participants one half of the face will be randomly assigned to low power fractional CO2 laser while other side to Tranexamic acid intradermal microinjections on the 1st session. This split face session will be repeated every six weeks for 3 sessions. In addition, Tranexamic acid intradermal microinjections will be applied for full face at the 2nd and 4th week of each split face session. The response will be evaluated by the Melanin and erythema Indices which will be measured using reflectance spectrophotometer, Dermoscopy and photography before starting the study, two and four weeks after the last session. The sessions will take 4 months for each patient and another one month free of sessions for follow up.

Official Title
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Comparing Tranexamic Acid Microinjection Alone Versus Its Combination With Fractional Carbon Dioxide Laser in Melasma Treatment

Conditions
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Melasma

Intervention / Treatment
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* Device: Fractional CO2 laser
* Drug: Tranexamic acid intradermal microinjections


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with bilateral symmetrical facial melasma Exclusion Criteria: Pregnancy and lactation. Patients taking oral contraceptive pills or hormonal replacement therapy at the time of the study or during the past 12 months. Concomitant use of anticoagulants. Bleeding disorders. Personal or family history of deep venous thrombosis or thromboembolic events. Scarring and keloid tendency. Active skin infection, active Herpes simplex virus. History of Post-inflammatory hyperpigmentation. History of photosensitivity or photosensitizing medication as sulfonamides tetracycline,retinoids, bleaching creams, peeling and laser two months before the study. Occupational sun exposure.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Each participate will be assigned to both arms (split face manner). One half of the face will be assigned to Tranexamic acid alone and the other side of the face will be assigned to combined Tranexamic acid and Fractional CO2 laser. Both sides of the face will take the same time of treatment and will be assessed at the same time.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Fractional CO2 laser combined with Tranexamic acid<br>one side of the face of all participants will be subjected to low power fractional CO2 laser with a power of 12 watts, spacing 800 micrometer (7.3% density), and dwell time 300 microsecond for 3 sessions every 6 weeks. In addition to Tranexamic acid intradermal microinjections using tranexamic acid 500mg/5ml ampoules, the dose of 1ml syringe with 100mg/ml with maximum of 4ml per session, on the 2nd and the 4th week of each laser session. With total treatment time for each patient of 4 months and another month free of sessions for followup. | Device: Fractional CO2 laser<br>* Low power fractional CO2 laser with a power of 12 watts, spacing 800 micrometer (7.3% density), and dwell time 300 microsecond<br>Drug: Tranexamic acid intradermal microinjections<br>* Tranexamic acid 500mg/5ml ampules<br>|
| Active Comparator: Tranexamic acid alone<br>the other side of the face of all participants will be subjected Tranexamic acid intradermal microinjections using tranexamic acid 500mg/5ml ampoules, the dose of 1ml syringe with 100mg/ml with maximum of 4ml per session, every 2 weeks for 4 months then another month free of sessions for followup. | Drug: Tranexamic acid intradermal microinjections<br>* Tranexamic acid 500mg/5ml ampules<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Melanin and Erythema indices change from baseline | Comparing the effect of Tranexamic acid intradermal microinjection alone versus its combination with low power fractional CO2 laser in a sequential pattern on melasma improvement by measuring the Melanin and erythema Indices (MI and EI) using reflectance spectrophotometer before starting the study, two and four weeks after the last session. | baseline, 18 weeks and 20 weeks | 
| Dermoscopic features change from baseline | Comparing the effect of Tranexamic acid intradermal microinjection alone versus its combination with low power fractional CO2 laser in a sequential pattern on melasma improvement by Dermoscopy before starting the study, two and four weeks after the last session. | baseline, 18 weeks and 20 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Melasma, Tranexamic acid, Fractional CO2 laser