Objectives: To study and compare the efficacy of intradermal injection of tranexamic acid versus platelet-rich plasma in the treatment of melasma using modified melasma area and severity index (mMASI) and to evaluate the side effects of both treatments. Methods: A split-face comparative study was conducted on 40 patients with bilateral symmetrical melasma at SMS Medical College, Jaipur. Right side of the face received intradermal tranexamic acid injections while the left side of face received platelet-rich plasma (PRP) injections. Patients were evaluated at baseline, 4, 8 weeks using mMASI scores, subjective assessment, and photographic evaluation. Follow-up was done at 12, 16 and 20 weeks. Findings: Both treatments showed significant improvement in melasma severity. PRP demonstrated superior efficacy with mean mMASI reduction from 5.03 at baseline to 1.93 at 12 weeks (61.6% improvement) compared to tranexamic acid which reduced from 5.08 to 2.73 (46.3% improvement). PRP showed better sustained improvement with lesser recurrence during follow-up period. Both treatments were well-tolerated with minimal adverse effects including transient erythema, pain, and burning sensation. Novelty: This is the split-face comparative study evaluating intradermal tranexamic acid versus PRP in melasma treatment in the Indian population, providing direct comparison of two emerging minimally invasive therapeutic modalities with extended follow-up assessment.
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