MICROINJECTION-BASED THERAPIES FOR MELASMA: CURRENT EVIDENCE AND PRACTICAL CLINICAL APPROACHES

Melasma is a chronic hyperpigmentation disorder with multifactorial pathogenesis, involving melanocyte hyperactivity, low-grade inflammation, oxidative stress, and vascular alterations. Current treatment modalities remain limited by suboptimal long-term efficacy and high recurrence rates. Intradermal microinjection has emerged as a promising approach to deliver active agents directly into the dermis and target multiple pathogenic pathways. Materials and methods: A narrative review was conducted by systematically searching biomedical databases for studies investigating the mechanisms, efficacy, and clinical applications of microinjection therapy in melasma. Results: Available evidence suggests that microinjection, particularly with tranexamic acid, significantly improves pigmentation by inhibiting melanogenesis, reducing inflammation, and modulating vascular factors. Compared to topical therapies, it provides faster clinical improvement, and compared to energy-based devices, it demonstrates a more favorable safety profile in darker skin types. However, sustained outcomes depend on combination strategies and strict control of triggering factors. Conclusion: Intradermal microinjection is a biologically plausible and clinically effective modality in melasma management. Optimization of technique and integration into multimodal treatment strategies are essential for achieving durable outcomes.