Comparison of efficacy and safety of topical hydroquinone 2% and oral tranexamic acid 500 mg in patients of melasma

Objective To compare the efficacy of topical hydroquinone 2% and oral tranexamic acid 500mg daily in patients of melasma. Methods A total of 140 patients (70 patients in each group) were enrolled, who were randomly divided into 2 groups. Group A was treated with topical hydroquinone 2% and group B was given oral tranexamic acid 500mg daily. Follow-up was carried out at the end of 2nd, 4th and 8th week to compare reduction in MASI score at last follow-up. Results The mean age of patients was 29.67 ± 6.38 years with an age range of 15 to 45 years. There were 28 (20%) male and 112 (80%) female patients. Majority i.e. 120 (85.7%) cases were married and 20 (14.3%) were unmarried. The age of onset was 15-25 years in 67 (47.9%) patients, 26-35 years in 52 (37.14%) and 36-45 years in 21(15%) patients. Both groups showed a decline in MASI score; however, the results were significantly greater in group B (oral tranexamic acid). At final follow-up, the mean percentage reduction was higher in group B (77.97±8.37) as compared to group A (67.02±8.42), p < 0.001. Adverse effects like erythema, burning, allergic contact dermatitis and pigmentation were noticed in the first group. One (1.4%) patient developed nausea and vomiting and diarrhea with oral tranexamic acid. Conclusion Oral tranexamic acid 500 mg had a better response when compared with topical hydroquinone 2% cream and better safety profile. It might be considered as a future treatment option.