ASCP Skin Deep

JULY | AUGUST 2021

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36 ASCP Skin Deep July/August 2021 TOPICAL TXA WITH LASER A study published in the Journal of Cosmetic Dermatology notes the power of using TXA as a co-therapy with laser, and refers to it as "laser assisted topical tranexamic delivery." 3 In the study, TXA was used as a topical, immediately following laser treatment, and then twice a day for seven days afterward. The participants were then checked at 30, 90, and 180 days post procedure. Researchers found the Melasma Area Severity Index (MASI) scores improved 10–40 percent, with the biggest improvement occurring at 90 days. 4 TOPICAL TXA WITH MICRONEEDLING An article published in the Journal of Dermatological Treatment examines using topical TXA versus vitamin C. 5 Thirty women who suffered from melasma first used a modified Kligman's formula (a combination of hydroquinone, tretinoin, and mometasone) for four weeks, and then were treated with microneedling and TXA on the right side of their face and microneedling and vitamin C on the left side of their face. Their MASI and Dermatology Life Quality Index (DLQI) were evaluated immediately, and then again at four, 12, and 16 weeks. Both sides exhibited significant improvement in several types of pigment, but the side treated with TXA also showed improvement in telangiectasia, where the other side did not. 6 Another study published in the Journal of Cosmetic Dermatology compares microneedling using 4 percent TXA with microneedling using up to 4 percent hydroquinone (HQ). The results showed a significant improvement using either application, making TXA as effective as HQ as an alternative to treat melasma. 7 It is important to note one common discovery from each study mentioned. When researchers followed up with all participants 12–24 months after the conclusion of the study, a common theme was the return of melasma for those who did not continue with treatment. Use this information as a reminder for clients of the importance of daily home care combined with professional guidance. THE FUTURE OF TXA Melasma is just one form of pigment malfunction that TXA is showing promise in alleviating. Trauma pigment from acne lesions or other abrasions—and even UV damage—has potentially met its match with TXA as well. Concise understanding of exactly how TXA works is still being investigated, but theories on its high antioxidant property, as well as its ability to disrupt melanin pathways, are currently being explored. While TXA may sound too good to be true, as with any new ingredient, the concentration, formulation, and indications of use are the most important considerations. Concentrations of 2%–5%, used once to twice daily, show the most progressive promise for pesky pigment. Formulations that pair TXA with other antioxidants and brightening agents (in a serum consistency) seem to be the most effective and are available in both over-the-counter products and professional product lines. With scientific and anecdotal testimonials of efficacy, TXA is definitely deserving of attention in the professional skin care market—both in protocols and in products. TXA has the potential for a very bright future in pigment management— especially in higher Fitzpatrick types. INGREDIENTS Notes 1. Hwee Chyen Lee, Tien Guan Steven Thng, and Chee Leok Goh, "Oral Tranexamic Acid ( TA) in the Treatment of Melasma: A Retrospective Analysis," Journal of the American Academy of Dermatology 75, no. 2 (August 2016): 358–92, https://doi.org/10.1016/j.jaad.2016.03.001. 2. Hwee Chyen Lee, Tien Guan Steven Thng, and Chee Leok Goh, "Oral Tranexamic Acid ( TA) in the Treatment of Melasma: A Retrospective Analysis." 3. Jordan V. Wang et al., "Laser-Assisted Delivery of Tranexamic Acid for Melasma: Pilot Study Using a Novel 1927 Nm Fractional Thulium Fiber Laser," Journal of Cosmetic Dermatology 20, no. 1 (November 2020): 105–09, https://doi.org/10.1111/jocd.13817. 4. Jordan V. Wang et al., "Laser-Assisted Delivery of Tranexamic Acid for Melasma: Pilot Study Using a Novel 1927 Nm Fractional Thulium Fiber Laser." 5. Asmaa Ibrahim Tahoun, Wedad Zoheir Mostafa, and Marwa Ahmed Amer, "Dermoscopic Evaluation of Tranexamic Acid Versus Vitamin C, with Microneedling in the Treatment of Melasma: A Comparative, Split-Face, Single-Blinded Study," Journal of Dermatological Treatment (January 2021): 1–7, https://doi.org/10.1080/09546634.2021.1871582. 6. Asmaa Ibrahim Tahoun, Wedad Zoheir Mostafa, and Marwa Ahmed Amer, "Dermoscopic Evaluation of Tranexamic Acid Versus Vitamin C, with Microneedling in the Treatment of Melasma: A Comparative, Split-Face, Single-Blinded Study." 7. Simin Shamsi Meymandi et al., "Efficacy of Microneedling Plus Topical 4% Tranexamic Acid Solution vs. 4% Hydroquinone in the Treatment of Melasma: A Single Blind Randomized Clinical Trial," Journal of Cosmetic Dermatology 19, no. 11 (May 2020): 2906–11, https://doi.org/10.1111/jocd.13392. Melasma is just one form of pigment malfunction that TXA is showing promise in alleviating. Trauma pigment from acne lesions or other abrasions—and even UV damage—has potentially met its match with TXA as well.

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