The International Journal of Medical Science and Health Research
A comprehensive systematic review of the effectiveness of microneedling combined with topical tranexamic acid versus intradermal tranexamic acid injection in melasma
By Lisa Anggraini.
Abstract
Introduction
Melasma is a chronic facial hyperpigmentation disorder with substantial psychosocial burden, predominantly affecting reproductive-aged women with Fitzpatrick skin phototypes III-V. Tranexamic acid (TXA) has emerged as a depigmenting agent through competitive inhibition of the plasminogen-plasmin system. Two dominant minimally invasive locoregional delivery strategies are microneedling-assisted topical TXA (MN+TXA) and intradermal TXA microinjection (ID-TXA). No systematic review has restricted primary analysis to head-to-head comparisons of these routes.
Methods
The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines to ensure methodological rigor and accuracy. Eligible studies included randomized controlled trials, split-face trials, and prospective comparative studies enrolling adults with clinically diagnosed melasma receiving locoregional TXA. Primary outcome was post-treatment melasma severity (MASI/mMASI/hemi-MASI). Effect measures were Hedges' g standardized mean differences, mean differences, and risk ratios pooled using DerSimonian-Laird random-effects models. Heterogeneity was quantified with τ², Cochran's Q, and I². Risk of bias was appraised with RoB 2 and ROBINS-I, and certainty of evidence with GRADE.