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Updated: Sep 11, 2025
Author Spotlight: Non-Surgical Treatment of Melasma– Microneedling with Tranexamic Acid
Published on: January 19, 2024
Microneedling-assisted delivery of metformin versus tranexamic acid in treating melasma: a randomized controlled
Abdelshakour Al Mohammady1, Ahmed S Kadah2, Mohamed A Mahran1
1Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Background:
Melasma is a common, relapsing hyperpigmentation disorder with limited long-term treatment success. Recent advances suggest that microneedling may enhance the transdermal delivery and efficacy of topical agents. This study compares the clinical outcomes of microneedling-assisted delivery of topical metformin and tranexamic acid (TXA) in the treatment of facial melasma, with modified Kligman's formula as a control.
Objectives:
To evaluate and compare the efficacy, safety, and patient satisfaction of microneedling with topical metformin versus TXA in melasma patients.
Methods:
Forty-five female patients with facial melasma were randomized into three equal groups. Group A received microneedling with topical metformin; Group B received microneedling with topical TXA; Group C applied modified Kligman's formula nightly. Treatments were conducted over 8 weeks. Outcomes included changes in modified Melasma Area and Severity Index (mMASI), patient satisfaction scores, pain levels, and adverse events.
Results:
All groups showed significant mMASI reductions. Group B achieved the greatest reduction (mean 45.3%) followed by Group C (38.2%) and Group A (22.1%) (p < 0.001). Satisfaction scores were highest in Group B, with 33.3% reporting marked improvement. Minimal adverse events were reported across all groups, with no serious side effects. Pain scores were comparable between microneedling groups.
Conclusion:
Microneedling with topical TXA demonstrated superior efficacy and patient satisfaction compared to metformin and Kligman's formula. While topical metformin showed some potential, its formulation and clinical utility require further study. Microneedling offers a promising approach to improve treatment outcomes in melisma.
