Efficacy and Safety Evaluation of Microneedling Combined with Tranexamic Acid-Arbutin Liquid Excipients in the Treatment of Melasma: A Retrospective Study

Abstract

Background: The condition of melasma presents a complex pigmented skin disorder, characterized by increased production of melanin in the dermis. The main pathological change of melasma is photodamage to the dermis. The treatment of melasma is relatively complex, and tranexamic acid is a well-known drug, both topical and oral. While arbutin demonstrates notable skin brightening effects, it has not yet gained widespread clinical adoption. Microneedle therapy, however, not only enhances drug penetration and absorption but also stimulates tissue regeneration. Nevertheless, research on the combined application of tranexamic acid, arbutin, and microneedle therapy for melasma treatment remains limited. Methods: A single-center retrospective dermatology study (Jan 2022–Jun 2023, n=27) evaluated microneedling plus tranexamic acid-arbutin solution for melasma. Medical records of 27 patients (3–6 months of treatment) were analyzed; efficacy was assessed via mMASI and PGA scores by two dermatologists, with side effect analysis. Results: Before treatment, the average mMASI score of 27 patients with melasma was 5.426±2.128. After treatment with microneedling combined with tranexamic acid and arbutin liquid adjuncts, the mMASI score was 3.387±1.224, showing a mean decrease of 2.039±1.472 (37.58%). In terms of the PGA score, 20 patients achieved a score of 3 or higher (overall rate: 74.07%). The observed adverse reactions mainly include temporary erythema, burning sensation, petechiae (or/and ecchymosis), and skin dryness. The first two are more common but are mild in severity, with most cases resolving within hours; petechiae (or/and ecchymosis) and skin dryness are less common, and no cases of skin infection have been found. Conclusion: Microneedling combined with tranexamic acid-arbutin liquid adjuvant treatment for melasma is feasible and well-tolerated. Its side effects are relatively few, but it is still recommended to appropriately adjust the treatment intervals, intensity, and density, or combine it with other methods to enhance efficacy.