Abstract
This study was aimed at evaluating the efficacy of Tranexamic Acid (TA) mesotherapy versus cysteamine 5% cream in the treatment of melasma. This single-blind, randomized clinical trial was conducted among 54 subjects between 2018 and 2019. Cysteamine 5% cream group was instructed to apply the cream on the melasma lesions 30 min before bed for 4 consecutive months. Conversely, 0.05 mL (4 mg/mL) TA mesotherapy was performed by a physician every 4 weeks until 2 months. The severity of melasma was evaluated using both Dermacatch® device and the modified Melasma Area Severity Index (mMASI). The most remarkable improvement rate was observed in the TA group at the third visit based on mMASI and Dermacatch® values at 47% and 15% in turn. The mMASI scores were substantially improved in both groups at the second visit (cysteamine vs TA 8.48 ± 2.34 and 7.03 ± 3.19; P = 0.359) and third visit (cysteamine vs TA 6.32 ± 2.11 and 5.52 ± 2.55; P = 0.952) as compared to baseline (cysteamine vs TA: 11.68 ± 2.70 and 10.43 ± 2.69). Dermacatch® values were significantly declined at the second and third visits (cysteamine vs TA 42.54 ± 12.84 and 38.75 ± 9.80, P = 0.365; 40.74 ± 12.61 and 36.17 ± 10.3, P = 0.123, respectively) compared with baseline (cysteamine vs TA 45.76 ± 13.41 and 42.41 ± 10.48), although the improvement rates between two groups were not significantly different. Findings suggest that none of the cysteamine and TA mesotherapy treatments measured by both mMASI and Dermacatch® methods have substantial advantages over the other; however, complications are less in the cysteamine than the TA mesotherapy group.
Similar content being viewed by others
References
Sanchez NP et al (1981) Melasma: a clinical, light microscopic, ultrastructural, and immunofluorescence study. J Am Acad Dermatol 4:698–710
Werlinger KD et al (2007) Prevalence of self-diagnosed melasma among premenopausal Latino women in Dallas and Fort Worth. Tex Arch Dermatol 143:423–431
Sheth VM, Pandya AG (2011) Melasma: a comprehensive update: part II. J Am Acad Dermatol 65:699–714
Lee A-Y (2014) An updated review of melasma pathogenesis. Dermatologica Sinica 32:233–239
Passeron T (2013) Melasma pathogenesis and influencing factors–an overview of the latest research. J Eur Acad Dermatol Venereol 27:5–6
Ortonne J et al (2009) Abstract. J Eur Acad Dermatol Venereol 23:1254–1262
Achar A, Rathi SK (2011) Melasma: a clinico-epidemiological study of 312 cases. Indian journal of dermatology 56:380
Harumi O, Goh CL (2016) The effect of melasma on the quality of life in a sample of women living in Singapore. J Clin Aesthet Dermatol 9:21
Ogbechie-Godec OA, Elbuluk N (2017) Melasma: an up-to-date comprehensive review. Dermatol Ther 7:305–318
Bala HR et al (2018) Oral tranexamic acid for the treatment of melasma: a review. Dermatol Surg 44:814–825
Budamakuntla L et al (2013) A randomised, open-label, comparative study of tranexamic acid microinjections and tranexamic acid with microneedling in patients with melasma. Journal of cutaneous and aesthetic surgery 6:139
Tse TW, Hui E (2013) Tranexamic acid: an important adjuvant in the treatment of melasma. J Cosmet Dermatol 12:57–66
Iraji F et al (2019) Efficacy of mesotherapy with tranexamic acid and ascorbic acid with and without glutathione in treatment of melasma: a split face comparative trial. J Cosmet Dermatol 2:1–6
Hsu, C., et al. (2013) Cysteamine cream as a new skin depigmenting product. Journal of the J Am Acad Dermatol 68
Qiu L et al (2000) Inhibition of melanin synthesis by cystamine in human melanoma cells. J Invest Dermatol 114:21–27
Farshi S, Mansouri P, Kasraee B (2018) Efficacy of cysteamine cream in the treatment of epidermal melasma, evaluating by Dermacatch as a new measurement method: a randomized double blind placebo controlled study. J Dermatolog Treat 29:182–189
Mansouri P et al (2015) Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial. Br J Dermatol 173:209–217
Sun R et al (2017) Wood's lamp image of porokeratosis. Photodermatol Photoimmunol Photomed 33:114–116
Shakeeb N et al (2018) Efficacy of intense pulse light therapy and tripple combination cream versus intense pulse light therapy and tripple combination cream alone in epidermal melasma treatment. J Coll Physicians Surg Pak 28:13–16
Handa S et al (2018) The clinicoaetiological, hormonal and histopathological characteristics of melasma in men. Clin Exp Dermatol 43:36–41
Baquié M, Kasraee B (2014) Discrimination between cutaneous pigmentation and erythema: comparison of the skin colorimeters dermacatch and mexameter. Skin Res Technol 20:218–227
Kimbrough-Green CK et al (1994) Topical retinoic acid (tretinoin) for melasma in black patients: a vehicle-controlled clinical trial. Arch Dermatol 130:727–733
Mansournia, M.A. and D.G. Altman (2018), Invited commentary: methodological issues in the design and analysis of randomised trials. Br J Sports Med 52:553–555
Hollis S, Campbell F (1999) What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ 319:670–674
Shankar K et al (2014) Evidence-based treatment for melasma: expert opinion and a review. Dermatol Ther 4:165–186
Hwang J et al (2004) Pigment-lightening effect of N, N′-dilinoleylcystamine on human melanoma cells. Br J Dermatol 150:39–46
Li D et al (2010) Tranexamic acid can treat ultraviolet radiation-induced pigmentation in guinea pigs. Eur J Dermatol 20:289–292
Lee JH et al (2006) Localized intradermal microinjection of tranexamic acid for treatment of melasma in Asian patients: a preliminary clinical trial. Dermatol Surg 32:626–631
Kim S et al (2016) Efficacy and possible mechanisms of topical tranexamic acid in melasma. Clin Exp Dermatol 41:480–485
Wu S et al (2012) Treatment of melasma with oral administration of tranexamic acid. Aesthetic Plast Surg 36:964–970
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Karrabi, M., Mansournia, M.A., Sharestanaki, E. et al. Clinical evaluation of efficacy and tolerability of cysteamine 5% cream in comparison with tranexamic acid mesotherapy in subjects with melasma: a single-blind, randomized clinical trial study. Arch Dermatol Res 313, 539–547 (2021). https://doi.org/10.1007/s00403-020-02133-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00403-020-02133-7