Hypothesis: its treatment can be often unsatisfactory

Hypothesis:

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). 

We Will Write a Custom Essay Specifically
For You For Only $13.90/page!


order now

 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.

 

Methodology:

 This Proposal uses the qualitative method of research, to achieve the quantum of literature, findings, and studies to ascertain research question, as the first step.  The literature used is secondary sources such as trial proceedings of peers and data from published papers on the effect of TXA treatment on Melasma. All of the referenced publications will be no older than 10 years and will not have a low rating. In the next step, the author will infeG1 r from the research and use the new-found knowledge to address the use of TXA. G2 

 Methods: The first phase of the research will investigate literature on the chosen topic to establish the effects of administering TXA on Melasma treatment. 

 At the outset, it is important to understand Melasma as a disorder and explore the reasons for its occurrence. Melasma is a pigmentation disorder and is common among women of Hispanic and Asian groups. The etiology of melasma has yet to be established, and the course of treatment continues to be a challenge.

Treatment modalities include use of hypo pigmenting agents such as hydroquinone, tretinoin, topical corticosteroids, superficial peeling (lactic acid, glycolic acid, trichloroacetic acid and kojic acid), LASERS (including Q-switched ruby laser, Q-switched Alexandrite laser, erbium: yttrium-aluminum-garnet (Er: YAG) laser, Fraxel laser, and intense pulsed light.(Gupta AK et al,2006)

Despite the availability of these therapies, melasma is often recalcitrant to treatment, melasma poses a great challenge as its treatment can be often unsatisfactory with high recurrence rates.(Prignano F et al,2007)

Additionally, the success rates of all these procedures are considered paradoxical darkening and low, apart from their recognizable side-effect.

  Journal paper by Budamakuntla L., et al., titled “A Randomized, Open-label, Comparative Study of Tranexamic Acid Microinjections’ and Tranexamic Acid with Microneedling in Patients with Melasma”,

Cho, Choi, Cho, and Lee titled “Role of oral tranexamic acid in melasma patients treated with IPL and low fluence QS ND: Yag laser.G3 

Karn et al, 2012 concluded addition of oral TXA to routine treatment measures provide a rapid and better lightning in patients with melasma. Low dose oral TXA is thus recommended for melasma treatment.G4 G5 G6 G7 

Aamir S.et al, 2014G8  concluded a rapid and sustained improvement can be provided with the introduction of tranexamic acid in melasma treatment which none of the existing treatment modalities for melasma has provided till date. G9 G10 G11 

Na Ji, et al., titled” Effect of tranexamic acid on melasma- a clinical trial with Histological evaluation”

Ebrahim Naeini study called “Topical tranexamic acid as a promising treatment for melasma”.

 Anju George (2015) review article in Journal Pigment International, established that TXA is an effective depigmenting agent as it is a synthetic derivative of lysine amino acid and useful in arresting the conversion of plasminogen into plasmin (inhibiting plasminogen activator). The result is a lower production of arachidonic acid and thereby lowering prostaglandin levels. Thus, TXA becomes responsible for lowered melanocyte tyrosinase activity and therefore, useful in treating melasma or UV-induced hyperpigmentation.

AWM Tan et al, 2016 concluded low-dose oral TA can serve as a safe and useful adjunct in the treatment of refractory melasma. How TA works in lightening melasma is unknown, but it is possibly by modulating keratinocyte-melanocyte interactions and by reducing vascularity in melasma lesions and through its effects on mast cells.

 

Padhi T et al,2015 concluded oral tranexamic acid can be used as an adjunct with fluocinolone based triple combination cream for the faster and sustained improvement in melasma treatment.G12 G13 

 

Del Rosario E, Florez- Pollack S, Zapata Jr. L, Hernandez K, Tovar-Garza A, Rodrigues M, Hynan LS, Pandya AG’s (2017), “Randomized, placebo-controlled, double-blind study of oral tranexamic acid in the treatment of moderate to severe melasma” treated 250mg of TA/placebo capsules (2 times a day, for three months) to 44 patients. 39 completed the study and the primary outcomes were the Modified Melasma Area and the Severity Index (mMASI) score showing 49% lower mMASI in TA group and 18% in the control group. Severe melasma showed higher rates of improvement over moderate melasma. Further, after treatment stopped for three months, there was 26% reduction in mMASI in the TA Group, over the baseline results. Additionally, they witnessed 19% reduction in the placebo arm and reported no adverse events in both the groups. Hence, this study established that oral TXA was effective and superior to placebo in patients who had moderate to severe melasma, and thus ideal alternative to standard therapies. The limitations of this group were:  the study was conducted at a single center where patient demography was predominantly Hispanic women.

 Other studies which tested the efficacy of oral TXA vs Triple combination for melasma treatment ( Neerja Puri, 2015) and concluded that recurring melasma is satisfactorily treated with oral TXA in comparison to the combination of other modalities. 

Expected Outcomes

The therapeutic benefits of the use of Tranexamic acid (TXA), as an innovative agent, either as an oral, topical or intralesional method for the treatment of melasma

x

Hi!
I'm Ethel!

Would you like to get a custom essay? How about receiving a customized one?

Check it out