Efficacy of tranexamic acid solution versus vitamin C solution after micro-needling in treatment of persistent post acne erythema: a split face clinical and 3DAntera camera comparative study

Post acne erythema (PAE) is a common sequela of acne inflammation, and it refers to telangiectasia and erythematous lesions remaining after the acne treatment. Although some PAE may improve over time, persisting PAE might be esthetically undesirable for patients. The efficacy of various treatment options for PAE has been investigated in many studies but there exists no gold standard treatment modality. This current split face comparative study aimed to assess and compare the therapeutic efficacy of vitamin c solution 10% with microneedling versus Tranexamic acid solution (TXA) (50 mg/ml) with microneedling in treating patients with PAE. Four sessions were held, two weeks apart. The assessment was done 2 weeks after the last session via change in Clinical Erythema Assessment (CEA) score, Antera 3D camera parameter changes (average hemoglobin level and hemoglobin variation), and patient satisfaction scale. Also, side effects were documented. Our study showed that both topical vitamin C and TXA solutions after microneedling showed significant decrease in hemi-CEA score and Antera camera measures of both Hb variations and average Hb levels. However, TXA treated side showed superior improvement than the side treated with vitamin c. Also, there was great patient satisfaction on both treated sides. The side effects reported were transient and minimal. Microneedling with TXA solution is a safe, effective and readily available modality of PAE treatment and showed superior results over vitamin C solution. Antera 3D camera is an excellent objective tool for assessing even minimal changes in Hb level and variation.