***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Melasma is one of the most common cosmetic disorders with skin darkening . Although several treatment modalities are available , none is satisfactorily used in management of this condition . Tranexamic acid ( TA ) , a plasmin inhibitor , is reported to improve melasma when injected locally or used as oral and topical forms . AIM The aim of this study was to compare therapeutic effects of liposomal tranexamic acid and conventional hydroquinone on melasma . METHODS Thirty women with bilateral melasma were enrolled in a split-face trial lasting 12 weeks . Patients blindly applied 5 % topical liposomal TA and 4 % hydroquinone cream , to the design ated sides of the face twice daily in addition to the assigned sunscreen in the morning . Skin pigmentation was measured using MASI ( Melasma Area and Severity Index ) at each visit separately for each side at the base line and every month until one month after treatment course . Data were obtained from patients file and were analyzed statistically using SPSS software , paired sample s t-test , and repeated measured ANOVA . RESULTS Twenty-three patients completed the study . The mean MASI scores significantly reduced in both treated sides ( P < P = 0.001 ) after 12 week . A greater decrease was observed with 5 % liposomal TA , although this difference was not statistically significant . Irritation occurred in three patients with hydroquinone , while no serious adverse events occurred with TA . CONCLUSION On the basis of these results , topical liposomal TA can be used as a new , effective , safe , and promising therapeutic agent in melasma Abstract Background : Tranexamic acid ( TNA ) is a novel therapeutic agent for hyperpigmented skin disorders . The efficacy and safety of topical TNA in patients with melasma  has not been heretofore studied . The main objective of this study is to evaluate the efficacy and safety of topical TNA combined with intense pulsed light ( IPL ) treatment in Asians with melasma . Methods : A r and omized , split-face ( internally controlled ) study was conducted in 15 women who received four monthly sessions of IPL to both sides of the face .  Topical TNA or vehicle was applied to a r and omly assigned side during and after IPL treatment . Patients were followed up for 12 weeks after completing the IPL treatments . Baseline and follow-up melanin index ( MI ; measured by Mexameter ® , Courage and Khazaka , Cologne , Germany ) and modified melasma area and severity index ( mMASI ) scores were determined . Results : Thirteen subjects completed the study  without serious adverse events . MI and mMASI decreased significantly from baseline to 12 weeks after the last IPL treatment on the topical TNA side but not on the vehicle side . The efficacy of topical TNA in preventing rebound pigmentation after IPL treatment was also statistically significant . Conclusion : Topical TNA can be considered an effective and safe adjuvant to conventional treatment for melasma BACKGROUND Melasma 's high prevalence and profound psychological impact on patients necessitate efficacious , economical , and safe therapeutic interventions . Adjunctive therapies such as tranexamic acid ( TA ) can enhance the therapeutic effect of st and ard treatments like hydroquinone 4 % cream ( HQ ) . OBJECTIVE To conduct an assessor- and analyst-blinded , parallel , superiority , r and omized controlled trial to compare the clinical efficacy and safety of oral TA plus HQ vs. HQ alone in melasma treatment . MATERIAL S AND METHODS A total of 100 eligible patients with symmetric facial melasma were assigned to the intervention ( 250 mg thrice daily oral TA plus HQ 4 % cream nightly ) or the control group ( HQ 4 % cream only ) . Following 3 months of treatment , MASI ( melasma area and severity index ) score reduction was calculated as the primary outcome measure . After a 3-month follow-up , relapse was also assessed . RESULTS A total of 88 patients completed the study . At the end of the 6-month period , the overall mean of the MASI score in the intervention group was 1.8 points lower than in the controls ( 95 % confidence interval , 0.36 - 3.24 , P = 0.015 ) but the relapse rate was not significantly different ( 30 % vs. 26 % in the treatment vs. control group , respectively ) . Side effect occurrence was also similar , but treatment satisfaction was higher in the intervention group than the controls , with 82.2 % vs. 34.95 of patients reporting moderate-to-complete satisfaction , respectively ( P < 0.001 ) . CONCLUSIONS Oral TA can enhance the efficacy of hydroquinone 4 % cream in melasma treatment , but the high incidence of relapse suggests that treatment effects may be temporary , warranting more investigation BACKGROUND Melasma poses a great challenge as its treatment is unsatisfactory and recurrence is high . Treatment of melasma using tranexamic acid ( oral , topical or intralesional ) is a novel concept . OBJECTIVE To compare the efficacy of oral tranexamic acid with routine topical therapies for the treatment of melasma . METHODS It is a prospect i ve , interventional , r and omized controlled trial conducted among 260 melasma patients . Patients were divided into two groups consisting of 130 patients each . First group ( Group A ) was given routine treatment measures and oral Tranexamic Acid while second group ( Group B ) was treated only with routine topical measures . Capsule Tranexamic Acid was prescribed at a dose of 250 mg twice a day for three months and cases were followed for three months . Response was evaluated on the basis of Melasma Assessment Severity Index ( MASI ) . Mean scores between the two groups were then compared . RESULTS Statistically significant decrease in the mean Melasma Assessment Severity Index from baseline to 8 and 12 weeks was observed among group A patients ( 11.08±2.91 vs 8.95±2.08 at week 8 and vs. 7.84±2.44 at week 12 ; p<0.05 for both ) . While among group B patients the decrease in mean score was significant at 8 weeks and insignificant at 12 weeks follow up ( 11.60±3.40 vs 9.9±2.61 at 8 weeks and vs. 9.26±3 at 12 weeks ; p<0.05 for former but p>0.05 for later ) . CONCLUSION Addition of oral tranexamic acid provides rapid and sustained improvement in the treatment of melasma BACKGROUND AND DESIGN Melasma is an acquired , masklike , facial hyperpigmentation . The pathogenesis and treatment of melasma in black ( African-American ) patients is poorly understood . We investigated the efficacy of topical 0.1 % all-trans-retinoic acid ( tretinoin ) in the treatment of  melasma in black patients . Twenty-eight of 30 black patients with melasma completed a 10-month , r and omized , vehicle-controlled clinical trial in which they applied either 0.1 % tretinoin or vehicle cream daily to the entire face . They were evaluated clinical ly ( using our Melasma Area and Severity Index ) , colorimetrically , and histologically . RESULTS After 40 weeks , there was a 32 % improvement in the Melasma Area and Severity Index score in the tretinoin treatment group compared with a 10 % improvement in the vehicle group . Colorimetric measurements showed lightening of melasma after 40 weeks of tretinoin treatment vs vehicle . Lightening of melasma , as determined clinical ly , correlated well with colorimetric measurements . Histologic examination of involved skin revealed a significant decrease in epidermal pigmentation in the tretinoin group compared with the vehicle group . Side effects were limited to a mild " retinoid dermatitis " occurring in 67 % of tretinoin-treated patients . Among the patients in this study in comparison with comparably recruited white patients , melasma was reported to have begun at a later age and was more likely to be in a malar distribution . CONCLUSIONS This controlled study demonstrates that topical 0.1 % tretinoin lightens melasma in black patients , with only mild side effects Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Abstract To evaluate the efficacy of a functional microarray of microneedles ( MNs ) plus topical tranexamic acid ( TA ) for  melasma in middle-aged women in China . Thirty female subjects with melasma were enrolled in this study . The left or right side of the face was chosen r and omly to be pretreated with a functional microarray of MNs , followed by topical 0.5 % TA solution once per week for 12 weeks . The other half-face was the control , treated with a sham device plus topical 0.5 % TA solution . At baseline and at weeks 4 , 8 , and 12 of treatment , clinical ( photographic ) evaluations and parameters determined by Visia were recorded . At baseline and week 12 , patient satisfaction scores and the biophysical parameters measured by Mexameter were also recorded . Side effects were evaluated at baseline and at the end of the 12 weeks . In total , 28 women ( 93.3 % ) completed the study . The brown spots ’ scores measured by Visia were significantly lower on the combined therapy side than on the control side at 12 weeks after starting treatment ; there was no significant difference between sides at 4 or 8 weeks . After 12 weeks , melanin index ( MI ) decreased significantly in both 2 groups , and the MI was significantly less on the combined side at week 12 . Transepidermal water loss , roughness , skin hydration , skin elasticity , and erythema index showed no significant differences between 2 sides at baseline , 4 , 8 , and 12 weeks after treatment . Physicians ’ evaluations of photographs showed better results at week 12 with combined therapy : > 25 % improvement was observed in the MNs plus TA side in 25 patients , and in the TA side in only 10 patients . Subjective satisfaction scores on both sides increased significantly . The participants were more satisfied with the results of the combined therapy side than the control side . No obvious adverse reactions were observed throughout the study . Combined therapy with a functional microarray of MNs and topical TA solution is a promising treatment for melasma BACKGROUND Melasma is a common cosmetic problem among Asians . While various treatments are currently being used , there is no entirely satisfactory treatment . It was recently reported that the topical plasmin inhibitor is an effective treatment for ultraviolet-induced hyperpigmentation . OBJECTIVE Because there are no studies assessing the efficacy and safety of localized microinjection of tranexamic acid ( TA ) for the treatment of melasma , we conducted a pilot study to evaluate the efficacy and side effects of this potentially new method for the treatment of melasma in Korean women . METHODS A total of 100 women with melasma , after written consent , were enrolled for a prospect i ve open pilot study of 12 weeks . After applying topical anesthesia , 0.05 mL TA ( 4 mg/mL ) was injected intradermally into the melasma lesion at 1 cm intervals by using a 0.5 mL insulin syringe with a 30-gauge needle . This was repeated weekly for 12 weeks . A clinical investigator evaluated the results by using the Melasma Area and Severity Index ( MASI ) at baseline and at 4 , 8 , and 12 weeks . The patient satisfaction question naire was documented at 12 weeks . Safety evaluations were performed at each follow-up visit . RESULTS Eighty-five patients completed the trial . A significant decrease in the MASI from baseline to 8 and 12 weeks was observed ( 13.22±3.02 vs 9.02±2.62 at week 8 and vs. 7.57±2.54 at week 12 ; p<.05 for both ) . The patients ' self- assessment of melasma improvement was as follows : 8 of 85 patients ( 9.4 % ) rated as good ( 51–75 % lightening ) , 65 patients ( 76.5 % ) as fair ( 26–50 % lightening ) , and 12 patients ( 14.1 % ) as poor ( 0–25 % lightening ) . Side effects were minimal and all the patients tolerated the treatment well . CONCLUSION Based on these results , we suggest that the intralesional localized microinjection of TA acid can be used as a potentially new , effective , and safe therapeutic modality for the treatment of melasma BACKGROUND Melasma is associated with epidermal hyperpigmentation , weak basement membrane , vascular proliferation and increased numbers of mast cell . Tranexamic acid ( TXA ) , a plasmin inhibitor , is reported to improve melasma when injected locally . However , the effects of oral and topical TXA on melasma have not been well studied and the underlying mechanism remains unclear . OBJECTIVES To eluci date the effects of oral and topical TXA on melasma . METHODS A clinical study was conducted with 25 women for 8 weeks from March to July 2010 . Volunteers were instructed to take two TXA tablets three times a day and apply a TXA topical agent twice a day for 8 weeks .  Skin pigmentation and erythema was measured using a Mexameter ( ® ) during each visit and skin biopsies were collected from eight subjects before and 8 weeks after treatment . Fontana-Masson , anti-CD31 , antitryptase and antitype IV collagen staining was performed . RESULTS Twenty-two subjects completed the study and no serious adverse events occurred during the study period 
    Output:
    
Results The combined results showed that the use of TA was associated with reduced Melasma Area and Severity Index ( MASI ) and Melanin Index ( MI ) .
No significant difference in Erythema Index ( EI ) was observed with TA treatment .
Side effects were minor , with a few cases reporting mild gastrointestinal reaction , oligomenorrhoea , hypopigmentation , urticarial rash , and skin irritation xerosis .
Conclusion The meta- analysis suggested that TA treatment appeared to be a promising therapeutic approach for melasma