Evaluation the Efficacy of Microneedling with Topical Metformin Solution Compared with Microneedling with Topical Tranexemic Acid Solution in Treatment of Melasma

Background: Melasma, a commonly inherited pigmentary disease that primarily affects women of reproductive age, is characterized by symmetric hyperpigmented macules and patches on the face. Aim: This study sought to compare the effectiveness and safety of microneedling combined with topical metformin solution versus microneedling combined with topical tranexemic acid in the treatment of melasma. Methods: This randomized comparative study was conducted on 45 female patients aged from 20 to 50 years old with any type of melasma, Fitzpatrick skin type 3-4, and didn't receive any treatment for melasma for at least 3 months. Three equal groups of patients have been further divided: Group A: metformin is administered after microneedling. Group B: tranexamic acid was administered after microneedling. Group C: received Kligman's formula once a day at night for a period of two months. Results: Group B exhibited a considerably lower modified Melasma Area and Severity Index (mMASI) score in comparison to groups A and C. Group B's mMASI reduction percentage was noticeably higher than those of groups A and C. In terms of mMASI according to skin type, there was no discernible difference between the groups under study. There was a statistically significant difference between the studied groups in terms of patient satisfaction (p=0.001). Conclusions: Melasma can be successfully treated with topical metformin, topical tranexamic acid, and a modified Kligman's recipe. It has been demonstrated that combining microneedling with trichloroacetic acid can resolve hyperpigmentation much more quickly and effectively.