# Exploring the Effectiveness, Tolerability, and Safety of the Adjunctive Use of Microneedling With Tranexamic Acid in the Treatment of Melasma

## TL;DR

This review explores combining microneedling with tranexamic acid to treat melasma, finding it effective, well-tolerated, and potentially better than other methods.

## Contribution

The study compares microneedling-based tranexamic acid delivery to other treatments, emphasizing patient-centered advantages.

## Key findings

- Most studies showed improvement in melasma scores with microneedling-based TXA.
- Microneedling offers better tolerability and durability compared to other TXA delivery methods.
- The approach is a viable alternative for patients who cannot tolerate systemic TXA.

## Abstract

Melasma is a chronic pigment disorder associated with significant psychosocial burden. The gold standard triple combination cream is effective but limited by relapse and adverse effects. Tranexamic acid (TXA) and microneedling have independently shown promise in the treatment of melasma, and their combined use may provide enhanced efficacy, durability, and tolerability.

This review aims to synthesize and compare clinical evidence assessing the effectiveness, safety, patient satisfaction, and durability of microneedling‐based TXA for the treatment of melasma.

A PubMed search was performed for relevant studies published in the last 10 years. Eligible articles included clinical trials, observational studies, and case reports. A scoping literature review was then conducted to synthesize relevant findings.

Most identified studies demonstrated improvement in melasma scores when TXA was delivered through microneedling. Outcomes are comparable to other TXA delivery methods and adjunctive therapies, with microneedling providing potential advantages in satisfaction, tolerability, and durability. These findings support its consideration for patients unable to tolerate systemic TXA or those seeking minimally invasive alternatives to laser‐based treatments.

This review compares microneedling‐based TXA delivery with other treatment approaches, highlighting patient‐centered advantages in tolerability and durability that may inform individualized treatment selection. Future studies should address limitations in protocol heterogeneity, reliance on semi‐objective outcome measures, and limited long‐term follow‐up. Particular focus is needed on evaluating patients with skin of color, who may be more susceptible to post‐inflammatory hyperpigmentation.