A comprehensive systematic review of the effectiveness of microneedling combined with topical tranexamic acid versus intradermal tranexamic acid injection in melasma

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.