Melasma treatment: Comparative study between triple combination vs topical and triple combination vs trasexamic intradermal acid

Melasma is an acquired disorder of hyperpigmentation, multifactorial, affecting the quality of life. There are several lines of treatment with variable response, constituting a therapeutic challenge. Objective: To compare the effectiveness and adverse effects of the triple combination vs. topical niacinamide, and effectiveness and adverse effects of the triple combination vs. intradermal tranexamic acid. Materials and methods: a prospective, comparative, randomized and intraindividual study was carried out, with a double blind arm, which included patients diagnosed with melasma of the external consultation of the dermatology service of the University Hospital of Caracas during 8 weeks, divided into 2 groups, group A: triple combination Vs niacinamide topical, and group B: triple combination Vs intradermal tranexamic acid. Results: total of 20 patients were included (10 per arm), the female sex predominated (90%), in ages between 30-66 years, as well as phototypes II and IV. 60% had malar, epidermal or mixed involvement. The initial mMASI score ranged from 4 to 15, moderate melasma prevailing in 55%, at the end of the study most of the patients were classified as mild, with a good response, given the decrease in the index between 25-50%. The therapeutic response in all three treatments was good. Few adverse effects were reported. Conclusion: the triple combination, topical niacinamide and tranexamic acid have similar responses. The redness and pain were the adverse effects identified in this study for the triple combination and the tranexamic acid respectively, no adverse effect was reported for topical niacinamide. This work recommends including intradermal tranexamic acid and topical niacinamide as a treatment for melasma.