In recent years, off-label Tranexamic acid (TA) has emerged as a potential treatment for melasma. Although the mechanism of action remains unclear, it is thought that TA may inhibit melanin synthesis by blocking the interaction between melanocytes and keratinocytes. TA may also reverse the abnormal dermal changes associated with melasma, such as the aforementioned increased vasculature. While different forms of TA (i.e. oral, topical, and localized microinjections) have shown promising results.

However, till date, there is no consensus on the optimum route, dose, and timing of the treatment with TA in melasma. It has been tried both orally and topically. When used along with micro-needling, the frequency of the treatment depends on the size of the derma-roller used that is, the needle size. Hence the present study is needed to comparatively evaluate the effect of topical versus mesotherapy using Tranexamic acid. Moreover, the novel mesotherapy device used in the study which uses cryo electroporation technology without using needles could provide a new approach to conventional microneedling.