Efficacy of intradermal tranexamic acid injection following IPL for the treatment of persistent post acne erythema: a split-face, controlled trial

Abstract

Post-acne erythema (PAE) is a common consequence of acne vulgaris, often leading to significant psychological distress and social impairment. While Intense Pulsed Light (IPL) has been proven as a non-invasive option for reducing erythema, the addition of adjunctive therapies may enhance treatment outcomes. To evaluate the effects of intradermal tranexamic acid (TXA) injections on the reduction of persistent PAE following IPL therapy in a split-face controlled trial. 33 patients aged 16 to 45 with persistent PAE were randomly assigned to receive either IPL with intradermal injection of TXA or IPL with placebo (normal saline) on opposite sides of their faces. A total of three treatment sessions were performed three weeks apart. Improvement in PAE was assessed at the follow-up session one month after the third session compared to before treatment. The response to treatment was assessed using the total physician’s score of improvement based on the clinician erythema assessment scale and the patient’s self-assessment based on a rating of 1 to 4. According to physicians’ scores of improvement and patients’ self-assessment of TXA injection, improvement in erythema was observed in most of the patients. Nevertheless, these results were not statistically significant. In addition, IPL treatment (on the control side) effectively improved PAE based on physicians’ scores of improvement and patients’ self-assessments, still, these results were statistically significant only in the physicians’ scores of improvements. Furthermore, 53% of patients did not report adverse reactions on the intervention side. The most commonly mentioned side effect was erythema on the injection side in 27.3% of patients, which was resolved within 24 h in all cases. This study highlights the complexities of treating persistent PAE. While most patients reported mild to moderate improvement with intradermal TXA, the combination of intradermal TXA and IPL did not show significant improvement over IPL treatment. Adverse effects were minimal, with injection site erythema being the most common. These findings warrant further investigation into optimizing treatment protocols for PAE management.