Oral tranexamic acid lightens refractory melasma.

Area of Science:

• Dermatology
• Hyperpigmentation Disorders
• Pharmacology

Background:

• Melasma is a prevalent acquired hyperpigmentary disorder, particularly affecting Asian and Hispanic populations.
• The precise pathomechanisms underlying melasma remain incompletely understood.
• Oral tranexamic acid demonstrates potential in lightening melasma by modulating melanocyte-keratinocyte interactions via the plasminogen/plasmin system.

Purpose of the Study:

• To assess the therapeutic efficacy of oral tranexamic acid in patients with melasma refractory to conventional topical treatments.
• To evaluate tranexamic acid as an adjunct therapy for persistent melasma.
• To determine the safety and usefulness of low-dose oral tranexamic acid for melasma management.

Main Methods:

• Retrospective analysis of 25 patients with refractory melasma treated at a Singaporean tertiary dermatological center.
• Patients received oral tranexamic acid (250 mg twice daily) in addition to existing topical therapies.
• Objective assessments included physician's global assessment and Melasma Area and Severity Index (MASI) scores, analyzed via paired t-test (P < 0.05 significance).

Main Results:

• A mean treatment duration of 3.7 months with oral tranexamic acid resulted in a significant reduction in MASI scores (2.7 post-treatment vs. 8.8 pre-treatment, P < 0.01).
• The average improvement in melasma severity was 69%.
• Follow-up data up to 6 months indicated sustained positive outcomes.

Conclusions:

• Low-dose oral tranexamic acid is a safe and effective adjunct therapy for managing refractory melasma.
• This treatment modality offers a valuable option for patients unresponsive to topical agents.
• Further research may explore optimal dosing and long-term effects of oral tranexamic acid in melasma.