Efficacy of mesotherapy with tranexamic acid and ascorbic acid with and without glutathione in treatment of melasma: A split face comparative trial

Introduction: Melasma is a prevalent annoying skin hyperpigmentation disorder that commonly involves reproductive-aged females. Variety of treatments with controversial results has been recommended. The aim of the current study was to evaluate combination therapy of tranexamic acid (TA) and vitamin C with and without glutathione with mesotherapy technique for treatment of melasma. Methods and Materials: This is a randomized clinical trial study conducted on 30 patients referred to Dermatology Clinics. Patients were examined under wood lamp in order of melasma type (epidermal, dermal, or mixed) determination. Then, patients underwent melasma therapy using Cocktail A (TA 4 mg/mL; vitamin C 3% and glutathione 2%) on their right half of the face and Cocktail B (TA 4 mg/mL and vitamin C 3%) on their left half of the face, with mesotherapy technique. This procedure was done for six times with 2-week intervals. Patients' modified Melasma Area and Severity Scoring (mMASI) was assessed at initiation and end of the study. Results: According to mMASI score changes 12 weeks after intervention, both cocktails had significant efficacy in reduction of mMASI score in each side. Mean of mMASI in left side had decrease of 1.82 +/- 0.88 (P-value < 0.001) and in right side had decrease of 3.046 +/- 1.25 (P-value < 0.001) from base line. Comparison between two groups 12 weeks after treatment showed significantly more reduction (1.28 +/- 0.64) of mMASI score with cocktail A than B (P-value < 0.001). Erythema, edema, and ecchymosis was not significantly different among two cocktails (P-value > 0.05). Conclusion: Use of combination mesotherapy in treatment of melasma was accompanied with appropriate outcomes regardless of type of agents but treatment with glutathione containing cocktail A presented superior results compared with cocktail of TA and vitamin C but not glutathione.