April 8, 2020 Is Tranexamic Acid Effective For Treating Melasma?
Tranexamic acid is a synthetic derivative of the amino acid lysine that has been used as a topical application, intradermal microinjection, and as an oral agent to treat melasma. Let’s find out how effective is tranexamic acid when dealing with melasma.
Is Tranexamic Acid Effective For Treating Melasma?
There have been many successful treatments with TA in patients with melasma since the 1980s with a significant overall reduction in MASI (Melasma Area and Severity Index) score.
Tranexamic acid inhibits the synthesis of melanin (skin pigment) and the transfer of pigment to the topmost layer of the skin. Since melasma happens when skin cells produce too much melanin, this makes tranexamic acid an ideal way to counteract dark patches on the skin.
Although many scientific studies have shown significant improvement in patients with melasma treated with tranexamic acid, studies have found oral treatments to be more effective at treating melasma than topical or intradermal methods (Wang). In a retrospective review in Singapore, 91.7% of 561 patients who took oral tranexamic acid at a dose of 250 mg twice a day had improvement (Zhang).
Tranexamic acid has not been approved by the FDA for use in the US, and there is still no consensus as to its use (Wang). As a result, tranexamic acid is considered a second-line treatment for melasma that does not respond to first-line treatments such as hydroquinone.
It’s important to remember that both UV and visible light can trigger melasma, so any type of treatment must also include UV protection in order to be effective.
Related:
The Skin Quiz
Our Dermatologist worked closely with experts to create a melasma skin quiz that guides you to the best treatments on the market 
The Skin Quiz
Our Dermatologist worked closely with experts to create a melasma skin quiz that guides you to the best treatments on the market
What Are The Side Effects Of Tranexamic Acid?
In general, tranexamic acid is well tolerated by most patients, meaning that it causes few side effects. However, some side effects are possible.
- Oral TA: Abdominal pain, nausea, headaches, and depression
- Topical TA: Skin irritation
- Injection TA: Pain or swelling at the injection site
Although tranexamic acid is a promising therapeutic agent and causes no significant side effects, hydroquinone remains the gold standard in treatment due to its effectiveness and well-studied effects.
Related:
Is Tranexamic Acid Safe?
According to the results of many meta-analyses, TA is an effective and safe therapy for melasma patients (Palmer). However, more studies are needed to confirm the effectiveness and safety of this type of treatment.
It’s important to consult with your doctor prior to starting a tranexamic acid treatment as this treatment is unsuitable for individuals with certain conditions, including:
- Deep vein thrombosis
- Increased risk of blood clotting
- Heart valve disease
- Use of anticoagulants
- Moderate to severe kidney impairment
Effectively Treat Melasma
Everyone’s melasma is unique, and finding the most effective treatment to manage this condition depends on a variety of factors, including skin type, genetics, sun exposure, and more. A dermatologist can takes the guesswork out of your quest for clear skin.
References
- Palmer WJ. Tranexamic acid for melasma. Dermatology Times. November 2018. https://www.dermatologytimes.com/melasma-and-hyperpigmentation-treatments/tranexamic-acid-melasma. Accessed April 6, 2020.
- Handel AC, Miot LDB, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014;89(5):771-782. doi:10.1590/abd1806-4841.20143063 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155956/
- Pandya A.G, University of Texas Southwestern Medical Center, Dallas. 2017 American Academy of Dermatology Summer Meeting https://www.practiceupdate.com/content/most-patients-with-melasma-need-long-term-treatment-with-close-follow-up/56393
- Pazyar N, Yaghoobi R, Zeynalie M, Vala S. Comparison of the efficacy of intradermal injected tranexamic acid vs hydroquinone cream in the treatment of melasma. Clin Cosmet Investig Dermatol. 2019; 12: 115–122. doi:10.2147/CCID.S191964 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386353/
- Tehranchinia Z, Saghi B, Rahimi H. Evaluation of Therapeutic Efficacy and Safety of Tranexamic Acid Local Infiltration in Combination with Topical 4% Hydroquinone Cream Compared to Topical 4% Hydroquinone Cream Alone in Patients with Melasma: A Split-Face Study.Dermatol Res Pract. 2018; 2018: 8350317. doi:10.1155/2018/8350317 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051262/
- Wang JV, Jhawar N, Saedi N. Tranexamic Acid for Melasma: Evaluating the Various Formulations. J Clin Aesthet Dermatol. 2019;12(8):E73–E74. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6715124/
- Zhang L, Tan W-Q, Fang Q-Q, Zhao W-Y, Zhao Q-M, Gao J, Wang X-W, Tranexamic Acid for Adults with Melasma: A Systematic Review and Meta-Analysis. Biomed Res Int. 2018; 1683414. doi: 10.1155/2018/1683414 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247725/
About the author
Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the ...
