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The intradermal injection of platelet-rich plasma is more effective in treating melasma than tranexamic acid injection, with no significant difference in the occurrence of side effects.

Melasma is a skin disorder characterized by hyperpigmented patches and macules in the centrofacial, mandibular, and malar regions. This split-face comparative study assessed the therapeutic efficacy and safety of platelet-rich plasma (PRP) versus tranexamic acid (TXA) in the treatment of different melasma types. Intradermal PRP injection yielded greater treatment efficacy in melasma patients compared to the administration of TXA injections, without any significant differences between the two treatments regarding side effects. These study findings are published in the journal Archives of Dermatological Research.

PRP Treatment Resulted in Greater Reduction in the Mean mMASI Score 

The mean modified melasma area severity index (mMASI) scores were not significantly different between the PRP and TXA treatments (2.17 ± 1.41 and 2.49 ± 1.58, respectively); however, the percentage of mMASI score reduction was significantly higher in the PRP treatment compared to TXA treatment (53.66 ± 11.27 and 45.67 ± 8.10, respectively; p = 0.014  ).

TXA and PRP Treatments Significantly Decreased mMASI Scores

The study also demonstrated that the mean mMASI scores significantly decreased from 4.59 ± 2.87 to 2.49 ± 1.8 before and after TXA treatment. Moreover, the mean mMASI scores significantly decreased from 4.72 ± 2.72 to 2.17 ± 1.41 before and after PRP treatment. The two scores had a statistically significant difference (p < 0.001).

Side Effects of TXA and PRP Treatments: Is One Safer than the Other?

The side effects in the TXA treatment group included erythema and pain in 55% and 62.5% of the patients, respectively. Pain and erythema reported in the PRP treatment group constituted 7.5% and 32.5% of the cases, respectively. Nonetheless, there was no statistical significance found in these variations.

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Melasma Risk Factors and Site of Lesions

The risk factors for melasma identified in this study included positive family history, sun exposure, and hormonal causes in 35%, 37.5%, and 25% of the cases, respectively. Regarding the site of lesions, the malar region, mustache, and frontal area of the face were affected in 97.5%, 60%, and 55% of the cases.

Degree of Patient Satisfaction in PRP and TXA Treatment Groups

In the TXA treatment group, 5% of the cases reported poor satisfaction, 35.7% reported slight satisfaction, and 57.5% reported satisfaction with the treatment. In the PRP treatment group, 17.5% reported poor satisfaction, 45% reported slight satisfaction, and 37.5% reported satisfaction. Nevertheless, these variations did not have any notable statistical importance.

In conclusion, this study found that PRP administration has greater therapeutic efficacy in treating melasma than TXA; however, there was no statistically significant difference between the two treatment groups regarding adverse reactions.  


Abd Elraouf, I. G., Obaid, Z. M., & Fouda, I. (2023). Intradermal injection of tranexamic acid versus platelet-rich plasma in the treatment of melasma: a split-face comparative study. Archives for Dermatological Research. Archiv für Dermatologische Forschung. https://doi.org/10.1007/s00403-023-02580-y