Fractional carbon dioxide laser with topical tranexamic acid versus fractional carbon dioxide laser with topical vitamin C in the treatment of melasma

Background Both Tranexamic acid (TXA) and vitamin C have been proved to decrease skin melanin formation and have been prescribed as a treatment for melasma. The work aimed to assess and compare the clinical efficacy of fractional carbon dioxide (CO 2 ) laser with topical TXA versus fractional CO 2 laser with topical vitamin C in the treatment of melasma. Patients and methods A total of 40 female patients with melasma were involved in the study. For each patient, a fractional CO 2 laser with TXA solution was applied to the right side of the face, and a fractional CO 2 laser with topical Pure L-Ascorbic acid 20% was applied to the left side. Total of four sessions with intervals of 3 weeks in between. Wood’s lamp examination, dermoscopy and modified melasma area and severity index (mMASI) before treatment, every session and 3 months after treatment had been done. Results The median values of hemi-mMASI decreased over time for both treatments, in TXA from 3.78±1.81 to 1.58±1.19, and in topical vitamin c from 3.71±1.58 to 1.65±1.25 indicating an improvement in melasma. There was a statistically insignificant difference between TXA and topical vitamin C at any visit. Still, at the 3-month follow-up after the last session, the median mMASI for TXA remained the same (1.58±1.32), while it increased for topical vitamin c (1.98±1.15) with a P value of 0.024. Conclusion TXA plus fractional CO 2 laser treatment resulted in a higher percentage of individuals achieving better improvement grades after 3 months of follow-up, indicating a better long-term outcome for TXA.