Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Dermatology and Venerology

Background: Melasma continues to be a difficult to treat disease with no fully staisfactory results. Role of fractional CO₂ laser in its treatment is controversial. Addition of tranexamic acid might be helpful in the treatment. Objective: To assess the efficacy of low power fractional CO₂ laser alone versus its combination with tranexamic acid used either topically or intradermally for melasma treatment.. Methods: A randomized comparative split face study included a total of thirty female patients with bilateral, symmetrical melasma. The whole face was subjected to low power fractional CO₂ laser. One side was randomly assigned to topical application of Tranexamic acid solution after the session immediately or intradermal microinjection of tranexamic acid prior to the laser session. Sessions were received every 4-6 weeks for 5 consecutive sessions. Assessment was done using the MASI score, melanin index (MI), and erythema index (EI) before sessions and two weeks after the last session. Results: After treatment, significant reduction in the MASI score was noted on both sides of the face; the side receiving fractional CO₂ laser alone and the side receiving fractional CO₂ laser combined with TXA (topically or intradermal injection) (p value 0.007, {u02C2} 0.001,0.016 respectively). MI was significantly reduced in the side receiving fractional co2 laser alone and the side receiving fractional CO₂ laser combined with intradermal injection of TXA (pvalue <0.001, 0.003 respectively), while the EI showed significant improvement only on the the side receiving fractional CO₂ laser alone - p value 0.023

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