Background and Introduction: A common pigmentary condition, melasma, is best defined as localized, chronic – acquired hyper melanosis of the skin characterized by light to dark brown macules and patches symmetrically involving the sun-exposed areas of the face, neck and occasionally the forearms. It is commonly observed in reproductive age group women, rarely in postmenopausal females and males (10% of cases). Causative factors implicated in the melisma pathogenesis include genetic susceptibility, ultraviolet (UV) light exposure, pregnancy, sex hormones, contraceptive pills, thyroid disease, cosmetics, phototoxic drugs (e.g., antiseizure medications).(Grimes PE,1995)(Park et al,2017)
There are three clinical patterns of melasma, malar (most common), centro facial and mandibular. On the basis of visible light, wood’s light and lesional histology, melasma has been classified as epidermal, which has increased melanin predominantly in basal and suprabasal layers of the epidermis with pigment accentuation on Wood’s lamp. The dermal type has perivascular melanin-laden macrophages in the superficial and deep dermis and does not accentuate with Wood’s lamp. The mixed variety has elements of both and appears as deep brown colors with Wood’s lamp accentuation of only the epidermal component.(Sanchez NP et al,1981)
Melasma is found to be refractory to treatment, with a tendency to recur after treatment (Del Rosario E., et al, 2018).
In melasma treatment, the introduction of tranexamic acid ( oral, topical or intralesional) is relatively a novel concept. The skin?whitening effects of TXA were incidentally found when it was used in the treatment of aneurysmal subarachnoid hemorrhage. Nijor from Japan,1979 first reported TXA to be effective in melasma treatment.
Objective: This dissertation proposal seeks to offer therapeutic benefits of the use of Tranexamic acid (TXA) as an innovative agent, either as an oral, topical or intralesional method for melasma treatment.
Importance of this Proposal: Tranexamic acid being originally a hemostatic agent. Its use in treating and gaining clinical benefits in Melasma treatment is not highly documented and there is scope for establishing and validating TXA with accurate, medically focused perspectives.
HI: Alternative hypothesis: There have been medically documented and validated evidence that smaller doses use of TXA (250 mg BD) has a beneficial role in Melasma Treatment(Poojary & Minni, 2015).
HO: Null Hypothesis: There is no medical evidence to even remotely suggest that smaller doses use of TXA (250 mg BD) has a beneficial role in Melasma Treatment.