Fractional RF lifting and tranexamic acid in the treatment of hypermelanosis

This review addresses the topic of hypermelanosis, which is characterized by disturbances in melanin metabolism and the development of cosmetic defects that adversely impact patients' quality of life. The article highlights the challenges associated with the treatment of melanogenesis disorders, which require thorough analysis and precise diagnostic assessment before the therapy initiation. Particular attention is given to the potential risks associated with technologies aimed at melanin destruction, such as laser and light-based methods, which may result in iatrogenic complications and aggravation of pigmentation. Pathogenetic therapy encompasses inhibition of melanin synthesis and its degradation, acceleration of epidermal turnover, and photoprotection. Topical agents such as hydroquinone, thiamidol, and retinoids are employed as first-line therapy, whereas chemical peels, hardware-based, and injectable technologies constitute second-line options. Tranexamic acid has emerged as an important component of combination treatment protocols for hypermelanosis, enhancing therapeutic efficacy and reducing the risk of relapse. Contemporary fractional radiofrequency devices (so-called ‘microneedle RF') provide controlled thermal effects on the skin, thereby minimizing the risk of post-inflammatory hyperpigmentation, destructing melanosomes and reducing manifestations of pigmentation, while also facilitating restoration of the basement membrane. Following microneedle RF application, microchannel formation allows for intradermal delivery of agents that regulate melanogenesis, representing a critical element of comprehensive treatment for melanodermia. The combination of microneedle RF lifting and tranexamic acid represents a promising approach for the treatment of hypermelanosis, providing effective correction of hyperpigmented areas, regulation of melanogenesis, and reduction in relapse rates. The effectiveness of this combined modality is illustrated by a clinical case involving a patient with mixed-type melasma of unclear etiology. © 2025 Elsevier B.V., All rights reserved.