Evaluation of Therapeutic Outcomes of Microneedling assisted Tranexamic Acid + Vtamin C versus Platelet Rich Plasma in the Management of Melasma: A Prospective Comparative study

Background: Melasma is a chronic acquired hyperpigmentary disorder that predominantly affects women and has a significant psychosocial impact. Conventional therapies often yield incomplete responses and are associated with frequent recurrences. Microneedling enhances transdermal drug delivery and may improve the efficacy of topical therapeutic agents such as tranexamic acid and vitamin C. Platelet-rich plasma (PRP), through its regenerative and anti-inflammatory properties, has also emerged as a promising treatment modality. The objective is to compare the efficacy and safety of microneedling-assisted tranexamic acid plus vitamin C with microneedling-assisted platelet-rich plasma in the treatment of melasma. Material and Methods: This prospective randomized comparative study included 60 patients with clinically diagnosed melasma who were allocated into two groups of 30 patients each using computer-generated randomization. Group A received microneedling-assisted tranexamic acid and vitamin C, while Group B received microneedling-assisted PRP. Treatment sessions were performed at 21-day intervals for 3–4 sessions. Clinical response was assessed using the Melasma Area and Severity Index (MASI), Physician Global Assessment (PGA), patient satisfaction scores, and standardized photographic documentation at baseline, 4, 8, and 12 weeks. Results: Both treatment modalities resulted in clinical improvement. Group A demonstrated a greater reduction in MASI scores from 12.8 ± 3.2 at baseline to 6.2 ± 1.8 at week 12, whereas Group B improved from 13.1 ± 3.5 to 8.3 ± 2.3 (p=0.001). Marked improvement (>50% reduction in MASI) was observed in 66.7% of patients in Group A compared with 36.7% in Group B. Patient satisfaction scores were significantly higher in Group A (8.1 ± 1.2) than in Group B (7.2 ± 1.4; p=0.02). Both treatments were well tolerated, with only mild and transient adverse effects. Conclusion: Microneedling-assistedtranexamic acid plus vitamin C was more effective than microneedling-assisted PRP in reducing melasma severity and achieving higher patient satisfaction. Both modalities were safe and well tolerated; however, tranexamic acid plus vitamin C demonstrated superior overall clinical outcomes.

Keywords: Melasma; Microneedling; Tranexamic acid; Platelet-rich plasma; Vitamin C; MASI.