IOSR Journal Of Pharmacy And Biological Sciences (IOSR-JPBS) e-ISSN:2278-3008, p-ISSN:2319-7676. Volume 16, Issue 1 Ser. V (Jan. – Feb. 2021), PP 51-56 www.Iosrjournals.Org DOI: 10.9790/3008-1601055156 www.iosrjournals.org 51 | Page Effectiveness of Combination TranexamicAcid 3% and Nicotinamide 3% with Microneedling in the Treatment of Melasma Rahma Tri Irfanti, Prasetyadi Mawardi, Nurrachmat Mulianto Department of Dermatology and Venereology, Faculty of Medicine, Sebelas MaretUniversity/Dr. Moewardi General Hospital Surakarta-Indonesia Abstract: Introduction:Melasma is a facial hyperpigmentation that is common in women and areas frequently exposed sunlight that chronic and recurrent. Kligman formula therapy is still the effectivetreatment but has several side effects especially for long-term use. The combination of tranexamic acid therapy, nicotinamide and microneedling is an alternative therapy for melasma that safe and effective for the long term. Objective:This study aimed to evaluate the efficacy of the combination 3% tranexamic acid, 3% nicotinamide, and microneedling versus Kligman’s formula in reducing melanin index. Materials and Methods:This experimental pre and post control group design was conducted in 28 melasma patients, group A received a topical cream combination of 3% tranexamic acid and 3% nicotinamide with microneedling compared with group B received a modified Kligman’s formula (4% hydroquinone, 0.05% tretinoin, and 0.01% fluocinolone acetonide). The efficacy of the treatments was determined through the Mexameter® at baseline, week fourth, eighth and twelfth. The statistical analysis used the chi-square test. The p-value of <0,05 statistically significant. Results:The melanin index showed a decrease in both groups without statistically significant difference between them (p> 0.05). The decrease in melanin index difference in group A has shown its effectiveness significantly in week 8 to week 12, whereas in group B started to be significant at week 12.. Conclusion:The combination therapy of tranexamic acid cream 3%, nicotinamide 3%, and microneedling was as effective as the modified Kligman formula (hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01%) in decreasing the melanin indeks Keywords : microneedling, melasma, nicotinamide, tranexamic Acid --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 18-02-2021 Date of Acceptance: 03-03-2021 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Melasma is a hypermelanosis of the skin characterized by the appearance of irregular brown macules, varying in size, symmetrically distributed in areas that are often exposed to sunlight. 1 Melasma is a hyperpigmentation disorder that is often encountered that acquired, chronic and recurrence. 2 Melasma usually occurs in women although men can also be affected, but the incidence is rarely less than 10%. 3 Melasma occurs in women of reproductive age (20-45 y.o) although this condition can occur in men and often occurs in tropical countries. 1,4 The causes of melasma are multifactorial such as genetics, sunlight, age, sex, hormones, pregnancy, thyroid dysfunction, cosmetics and drugs that cause an increase in melanogenesis in melanocytes. 5,6 One of the important factors influencing melasma is ultraviolet (UV). The diagnosis of melasma based on clinical features and supporting examination. 1,3 Therapy of melasma patients is protect causative factors, use of sunscreen, use of depigmentation agents and laser therapy but have different effectiveness and side effects. 7 Study by Chan et al. (2008) reportedthat there was an improvement in melasma patients with Kligman’s formula based on the investigator's assessment of the Global Severity Score and Melasma Area Severity Index (MASI) score but this study also reported side effects. 8 Some therapeutic modalities such as topical depigmentation agents, chemical peels, dermabrasion and laser therapy have been used in different studies with unsatisfactory results. Therapeutic options for melasma to be developed, one of which is the use of tranexamic acid. 1,9 Another therapeutic agent for melasma is nicotinamide, which has an effect on reducing pigmentation through reducing melanosome transfer, photoprotection, anti-inflammatory and anti-aging effects by reducing the presence of solar elastosis. 10 There has not been scientific evidence yet about the combination of topical nicotinamide and. Microneedling for melasma