| ObjectiveThe purpose of this study is to compare the efficacy of Q-switched neodymium doped: yttrium aluminium garnet(Q-s Nd:YAG)laser combined with roller microneedle to introduce 4% tranexamic acid injection and Q-s Nd: YAG laser alone in the treatment of melasma.MethodsFrom October 2021 to October 2022,78 patients with melasma were randomly divided into an experimental group and a control group.The experimental group was cured with 1064 nm Q-s Nd: YAG laser combined with 4% tranexamic acid injection,while the control group was only treated with 1064 nm Q-s Nd: YAG laser.Three patients were lost during the study.The data on melasma area and severity index(MASI)score,satisfaction,and adverse reactions were collected,and the decline rate of MASI score and recurrence rate were calculated according to the changes in MASI score before and after treatment.Results1.The score of MASI in the experimental group was 5.57±2.88 before treatment and 3.19±1.80 after treatment,the difference was statistically significant(P<0.05).The MASI score of the control group was 5.63±3.42 before treatment and 3.57±2.08 after treatment,with statistical significance(P<0.05).2.Calculating the decrease rate of MASI score: the experimental group was 40.93±17.48%,and the control group was 35.23±14.05%,with statistical significance(P<0.05).3.In the experimental group,1 patient was excellent,16 patients were good,14 patients were medium and 6 patients were poor,and the satisfaction rate was 83.7%,while in the control group,6 patients were good,24 patients were medium and 8patients were poor,and the satisfaction rate was 78.9%,with statistical significance(P<0.05).4.The pain score of the experimental group was 4.51±1.17,and that of the control group was 3.71±1.01,with statistical significance(P<0.05).There were 4 patients in the experimental group and 4 patients in the control group,and the difference was not statistically significant(P>0.05).5.Follow-up 3 months after the end of treatment showed that 1 patient(2.7%)recurred in the experimental group and 3 patients(7.89%)recurred in the control group,and the difference was not statistically significant(P>0.05).Conclusion1.Compared with the simple use of laser,the MASI score of the combined therapy method has more decline and higher satisfaction;2.The pain is more intense in combination with micro-acupuncture,but there is no obvious difference in other adverse reactions.The two groups are equally safe and effective.Objective To evaluate the effect of tranexamic acid therapy with microneedles and its treatment duration on melasma.Methods This study follows the guidelines for preferred reporting items of systematic review and meta-analysis.All randomized controlled trials(RCT)on the treatment of melasma by injecting tranexamic acid into microneedles were included.Chinese keywords "huang he ban","wei zhen" and "an jia huan suan" were used to search China biomedical literature(Sinomed),China periodical full text(CNKI),VIP,WANFANG and other databases,and English keywords "melasma","microneedling","Tranex amic acid" and their synonyms were used to search Pub Med.Cochrane 5.1.0 Bias Risk Tool evaluates the bias risk of the 13 RCTs finally included.For the improvement of baseline,it is assumed that there is a common correlation r between the measured values reported before and after treatment,and whether the results of meta-analysis are sensitive to the selection of r,and then the influence of the treatment mode and treatment duration of tranexamic acid by microneedle on the treatment effect of melasma is evaluated by using Revman5.3 software.The main outcome measures were MASI score,m MASI score or their changes before and after treatment.Secondary outcomes were patient satisfaction,quality of life and any reported adverse events.Results A total of 13 studies were included,all of which were RCT,including 456 subjects from 5 countries.The results of bias risk show that most of the studies are evaluated as unclear risk or high risk,with high bias risk and poor quality.The results of statistical analysis show that there is a correlation between the treatment time and curative effect of tranexamic acid by local micro-needle in the treatment of melasma,and the effect is significant at 8 weeks,with statistical significance(SMD=1.12,95%CI[0.8,1.43],P<0.05),and the effect is the best at 12 weeks,with statistical significance(SMD=1.18,95%CI[0.93,1.42],P<0.05).In terms of the effective rate of treatment,the effect of tranexamic acid introduced by microneedle is better than that of other drugs introduced by microneedle(P<0.05),and there is no statistical difference compared with hydroquinone cream,tranexamic acid applied externally after laser surgery and tranexamic acid injected intradermally(P>0.05).In terms of satisfaction,compared with other drugs introduced by microneedles(P<0.05),there was no significant difference between tranexamic acid used externally after laser surgery,tranexamic acid injected intradermally and hydroquinone cream used externally only(P>0.05).In the aspect of adverse reactions,there was no significant difference between tranexamic acid injected by microneedle and tranexamic acid injected intradermally(P<0.05),and other drugs introduced by microneedle,tranexamic acid applied externally after laser and hydroquinone cream applied externally only(P>0.05).Conclusion 1.There is a correlation between the therapeutic effect of tranexamic acid by microneedle and the duration of treatment.The effect is remarkable after 8 weeks,and the effect is the best at 12 weeks.2.The improvement degree,satisfaction and adverse reactions of melasma treated by different methods are different.3.Most of the RCT included in the study suggested that there was no statistical significance.According to the existing literature,it is not possible to accurately evaluate the effect of the treatment of tranexamic acid by microneedle. |
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