Microneedling beats injection for tranexamic acid in melasma
Study in patients with darker skin shows better results with similar safety (Issue #538, 1,300 words, 7 minutes)
A study investigating the effectiveness and adverse effects of tranexamic acid (TXA), delivered alongside either microneedling or intradermal injections for treating melasma in patients with Fitzpatrick skin types III to V, found that the combination with microneedling resulted in a greater improvement in modified Melasma Area and Severity Index (mMASI) scores.
Published in the Indian Journal of Dermatology (2026 Feb. 27; 71(2):109–114), the study was conducted in the outpatient Department of Dermatology, Venereology and Leprosy at Aarupadai Veedu Medical College, Puducherry, India.
Participants included 70 patients with melasma treated between Nov. 2022 and April 2024. Of those, six (8.6%) were aged 30 or younger, 34 (48.6%) were aged 31 to 40, and 30 (42.8%) were aged 41 or older. Seven (10%) were Fitzpatrick type III, 42 (60%) were type IV, and 21 (30%) were type V.
The patients were divided into two groups. In Group A (n=35), patients received microneedling with TXA (4 mg/mL). Group B (n=35) received intradermal injections of TXA (4 mg/mL). Treatment was administered every four weeks for four sessions, and patients were followed up on once a month for two months. Investigators assessed clinical improvement using photographs taken at baseline and serially through the end of 20 weeks. Patients with no improvement were considered no response, <25% improvement was considered mild response, 25% to <50% improvement was considered moderate response, 50% to <75% improvement was considered good response, and more than 75% improvement was considered very good response.
A total of 71.4% of patients in Group A had more than 50% improvement, compared with 40% in Group B (p<0.05).
This disparity in treatment response reinforces “the superiority of microneedling with TXA in promoting substantial clinical improvement in melasma patients,” the authors write.
They note that microneedling leads to the production of growth factors and collagen induction in the dermis. Microneedling is also believed to promote early keratinocyte proliferation, facilitating transcutaneous elimination of melanin and repairing damaged basal membranes.
“Uniform penetration of TXA with a microneedling device, compared to intradermal injection therapy, is also an added advantage of microneedling. This synergistic effect likely contributes to the accelerated and more pronounced improvement seen in patients undergoing microneedling with TXA.”
Safety was similar between the two approaches, with one patient (2.9%) in Group A and three patients (8.7%) in Group B reporting adverse events, which was not a statistically significant difference (p=0.303).
Bottom line: For patients with melasma and Fitzpatrick skin types III to V, delivery of tranexamic acid via microneedling is more effective with similar safety to subdermal injection.
From the literature on melasma in skin of colour
Dual 1,550 nm erbium glass fibre and 1,927 nm thulium fibre non-ablative fractional laser system treatment in patients with skin of colour: A review of clinical studies and unmet needs
Researchers reviewed 15 clinical studies examining the use of dual 1,550 nm erbium glass fibre and 1,927 nm thulium fibre non-ablative laser treatment to clarify efficacy and safety in patients with Fitzpatrick skin types III to VI.
They found that, despite variability across study designs, consistent improvement was reported with the 1,550 nm wavelength for the treatment of scarring and melasma, and with the 1,927 nm wavelength for the treatment of melasma and photoaging. Post-inflammatory hyperpigmentation (PIH) rates varied across studies. Studies directly comparing different settings reported reduced PIH rates with lower energy and/or density. Histologic studies confirmed dermal remodelling and reduced melanin after treatment.
In their conclusions, the authors say that while the dual-laser system is safe and effective in this patient population, reducing pulse energy and density may result in fewer adverse effects. They also suggest more studies are needed, particularly for patients with Fitzpatrick skin type VI and for the 1,927 nm wavelength.
Exploring the effectiveness, tolerability, and safety of the adjunctive use of microneedling with tranexamic acid in the treatment of melasma
Investigators synthesized and compared clinical evidence assessing the effectiveness, safety, patient satisfaction, and durability of microneedling-based tranexamic acid (TXA) for the treatment of melasma.
They performed a PubMed search for relevant studies published in the last 10 years. Eligible articles included clinical trials, observational studies, and case reports. The authors then conducted a scoping literature review to synthesize relevant findings.
Ultimately, eight prospective, controlled clinical trials were included. The most common study duration was 12 weeks, with follow‐up ranging from six to 24 weeks. Sample sizes ranged from 20 to 100 adults, most commonly aged 18 to 55 years, and were predominantly women with Fitzpatrick skin types II–V, most commonly type IV.
Most of the studies demonstrated improvement in melasma scores when TXA was delivered through microneedling. Outcomes were comparable to other TXA delivery methods and adjunctive therapies, with microneedling providing potential advantages in satisfaction, tolerability, and durability.
The authors say their findings support consideration of microneedling-based TXA for patients unable to tolerate systemic TXA or those seeking minimally invasive alternatives to laser-based treatments.
Clinical and dermoscopic characteristics of facial hyperpigmentation disorders in skin of colour
This narrative review details the clinical and dermoscopic characteristics of facial hyperpigmentation disorders (FHD) in patients with skin of colour (SOC), along with diagnostic clues for early diagnosis.
Disorders discussed include pigmentary demarcation lines, melasma, post-inflammatory and drug-induced hyperpigmentation, acanthosis nigricans, frictional melanosis, seborrheic melanosis, nevus of Ota, lichen planus pigmentosus, Riehl’s melanosis, exogenous ochronosis, maturational hyperpigmentation, and ashy dermatosis.
“Given globalization and migratory flows, improving dermatologic training in diseases that more frequently affect individuals with skin of colour is necessary,” the authors write. “FHD are very common in this population, and certain conditions such as seborrheic melanosis or maturational hyperpigmentation are almost exclusive to SOC. Although studies on dermoscopy in SOC have increased over the last decade, few specifically evaluate FHD, and we did not find systematic reviews or meta-analyses addressing this topic.”
At the intersection of skin and society
Many banks are working to expand their ability to support Indigenous equity in large-scale construction and other projects. On April 30, 2026, RBC announced it is launching an advisory service to help Indigenous groups buy into major projects, reports APTN News.
The practice adds to efforts such as BMO’s launch of the first labelled Indigenous bond last October and Scotiabank’s backing of investment dealer Cedar Leaf Capital Inc. to open more doors to financial services for Indigenous groups.
“The banks recognize that this is a growth area,” Mark Podlasly, chief executive of the First Nations Major Projects Coalition, said at a conference in Toronto.
Podlasly said Indigenous people in Canada have approximately $120 billion in assets under management or control. Those assets could enable these communities to invest in projects and take an active role.
“Indigenous people can start to leverage the assets that they do have,” he said.
Podlasly said that if Indigenous people have an ownership stake in a project, that can signal their consent, reducing perceived risk to investors. Additionally, an ownership stake can provide Indigenous communities with longer-term returns on their investment.
Securing an ownership stake can help de-risk a project by signalling consent, while also providing longer-term returns for the communities buying in, said Podlasly.
RBC’s Indigenous advisory service is intended to help communities navigate opportunities such as the federal loan guarantee program, which helps create lower borrowing costs.
Combined federal and provincial loan guarantee programs have grown to $17 billion in capacity. Still, so far only about $1.8 billion has been allocated across 26 deals, said David McKay, President and CEO of RBC.
Māori Queen Nga wai hono i te po said in an address at the First Nations Major Projects Coalition conference on April 30 that Indigenous finance networks and initiatives are growing, including the $100 million Kotahitanga Fund launched last year to pool and invest Māori funds.
“New capital frameworks are emerging,” she said. “First Nations are asserting ownership in major projects, not as beneficiaries, but as partners and leaders.”
This week
May 12 is International Nurses Day
May 15 is International Day of Families
May 16 is International Day of Living Together in Peace
Something to think about in the week ahead . . .
—Nick Rahall, (1949-present), U.S. politician
Next issue
Skin Spectrum Weekly is taking a break for next week’s Victoria Day long weekend. We will return on May 25, 2026.
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Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dermatologist Dr. Andrew F. Alexis (New York) summarizes recent advances in managing pigmentary disorders.
Drs. Nicole Hawkins (Tampa, Fla.), Mark Lupin (Victoria, B.C.), and Sophia Colantonio (Ottawa) review the current options for managing AKs and BCCs.
Dr. Harvey Lui (Vancouver) provides clinical pearls for the diagnosis of photosensitivity.
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