COMPARISION OF MICRONEEDLING AND MESONEEDLING FOR THE EVALUATION OF MELASMA IN ADULTS

Abstract

Background: Melasma is a common acquired hyperpigmentation disorder characterized by symmetrical brown to gray-brown patches, predominantly affecting sun-exposed areas of the face in adults. It is more prevalent among women and individuals with darker skin types and is influenced by factors such as ultraviolet exposure, hormonal changes, and genetic predisposition. Although benign, melasma has a chronic and recurrent course and can significantly impact psychological well-being and quality of life, making effective and safe management a persistent clinical challenge.       

Objective: The objective of this study was to evaluate microneedling and mesoneedling for the management of melasma in adults.

Methods: This randomized control trial was conducted in Lahore at the Chaudhry Muhammad Akram Teaching and Research Hospital over a duration of four months after approval of the synopsis. A total sample size of 46 participants (23 in each group after adding 20% dropout) were recruited using purposive sampling technique. Adults aged 18–50 years of both genders with Fitzpatrick skin types III–V and clinically diagnosed epidermal melasma confirmed by Wood’s lamp examination were included, while pregnant or lactating females, patients on hormonal therapy, those with active infection, systemic illness, recent depigmenting treatment, or known allergies will be excluded. After screening and written informed consent, participants were randomly allocated into Group A (microneedling) and Group B (mesoneedling) using lottery technique. Each group received one session per month for four months. Prior to each session, topical anesthesia (2.5% lidocaine and 2.5% prilocaine) was applied, and a 1.5 mm automated microneedling device was used. Group A received microneedling alone, while Group B received mesoneedling with a depigmenting solution containing tranexamic acid, N-acetyl glucosamine, vitamin C, and idebenone. All participants were advised to use broad-spectrum sunscreen (SPF ≥ 50). Outcome measures including modified Melasma Area and Severity Index (mMASI) and Investigator’s Global Assessment (IGA) were assessed at baseline and after four months. Data analysis was performed using IBM SPSS version 26, with appropriate parametric or non-parametric tests applied, and p value < 0.05 considered statistically significant.

Results: Shapiro-wilk test showed that most variables were non-normally distributed except mMASI. A total of 38 participants (mean age 30.12 ± 3.36 years; 68.4% females) were included with comparable demographics. Baseline mMASI was slightly higher in Group B (p = 0.027), while IGA was similar (p = 0.334). Post-intervention, both groups improved, but Group B showed significantly greater reduction in mMASI and better IGA outcomes (p = 0.001), with 100% participants almost clear. Within-group analysis also showed significant improvements in both mMASI and IGA (p = 0.001), indicating superior effectiveness in Group B.

Conclusion: Microneedling and mesoneedling are both effective, safe, and minimally invasive treatments for melasma, showing significant clinical improvement. However, mesoneedling demonstrated superior outcomes, likely due to enhanced transdermal delivery of depigmenting agents along with dermal remodeling. Both methods are cost-effective and clinically practical, with mesoneedling offering greater overall benefit.