Effectiveness of application of serum and cream containing combination of tranexamic acid, galactomyces ferment filtrate, niacinamide, and alpha arbutin using layering technique in melasma

Objective: This research aimed to determine the effect of tranexamic acid 3% in combination with several brightening agents including Galactomyces ferment filtrate 2%, niacinamide 4% and alpha arbutin 2%, in melasma treatment. Methods: This was a multi-centre trial which was held Hasanuddin University hospital in Makassar, South Sulawesi, Indonesia and Gatot Soebroto Central Army hospital in Jakarta, Indonesia. A total of 66 patients with epidermal and/or mixed-type melasma were instructed to apply tranexamic acid in combination serum containing 3% tranexamic acid, 2% Galactomyces ferment filtrate, 4% niacinamide, and 2% alpha-arbutin, followed by cream with the same content (layering technique) for four weeks. The clinical appearance was assessed using melasma severity score (MSS) while skin analyser Janus Facial Analyses System^® was used to assess the spot ultraviolet (UV) (parameter for dermal hyperpigmentation) and spot polarised (PL) (hyperpigmentation in the epidermis). The MSS score, spot UV and spot PL were measured at baseline and at follow up every two weeks and four weeks. Results: MSS score showed significant reduction in week 2 (1.33%) and week 4 (1.47%) compared to baseline (1.65%). There was a significant decrease of spot UV value from baseline (22.6%) compared to week 2 (20.1%) and week 4 (19.8%). However, no significant differences in spot PL value from baseline to week 2 and week 4. Conclusion: Application of combination of tranexamic acid 3% with Galactomyces ferment filtrate 2%, niacinamide 4% and alfa arbutin 2% in serum and cream preparation using layering technique was effective in treating melasma.