A comparative study between two topical treatments (tranexamic acid and flutamide) in the treatment of patients with melasma

Background Melasma is a common cause of cosmetic disfigurement in the face. This facial hyperpigmentation leads to many psychological problems. It is difficult to be treated and has a high rate of recurrence. Objective The aim of this study was to evaluate and compare the efficacy of topical tranexamic acid 5% versus topical flutamide 1% in the treatment of patients with melasma. Patients and methods This comparative study included 30 female patients with different types and patterns of melasma. Patients were treated with 1% flutamide topical gel on the right side (side A) of the face and 5% tranexamic acid topical gel on the left side of the face (side B) every night for 12 weeks. Clinical assessment was performed for all patients according to the modified melasma area and severity index (mMASI) before and after treatment. Results Both sides showed highly significant decrease in mMASI score after treatment. Better results were found in side B with a statistically significant decrease in mMASI score than in side A. There was a significant difference, with regard to patient satisfaction, with the better results in side B. No side effects were reported in all patients. Conclusion Topical tranexamic acid and topical flutamide were both effective and safe therapeutic modalities for treatment of melasma with no side effects, but topical flutamide was less effective than topical tranexamic acid.