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Treatment of melasma using tranexamic acid: what's known and what's next
1Department of Dermatology, Stanford University Medical Center, California, USA.
Abstract:
Tranexamic acid is a procoagulant agent that is approved by the US Food and Drug Administration for treatment of menorrhagia and to prevent hemorrhage in patients with hemophilia undergoing tooth extractions. Through its inhibitory effects on the plasminogen activation pathway, tranexamic acid also mitigates the UV radiation-induced pigmentation response. Systemic tranexamic acid has consistently been reported as an effective treatment of melasma, though its broad use may be limited by the risk for thromboembolism. Limited studies have investigated the efficacy of topical tranexamic acid, with or without the use of adjunctive therapies to increase uptake. This review summarizes the effects of tranexamic acid on the pathophysiology of melasma and the available evidence on the off-label treatment of melasma using systemic and topical tranexamic acid.
Insights
Tranexamic acid effectively treats melasma by inhibiting UV-induced pigmentation. While systemic use is effective, topical applications are being explored to mitigate risks associated with oral administration.
Area of Science:
- Dermatology and Pharmacology
- Investigating the efficacy of tranexamic acid for dermatological conditions.
Background:
- Tranexamic acid is FDA-approved for menorrhagia and hemophilia-related bleeding.
- It inhibits plasminogen activation, reducing UV-induced pigmentation.
- Systemic tranexamic acid shows efficacy for melasma but carries thromboembolism risks.
Purpose of the Study:
- To review the effects of tranexamic acid on melasma pathophysiology.
- To summarize evidence for off-label use of tranexamic acid in melasma treatment.
- To explore both systemic and topical administration routes.
Main Methods:
- Literature review of studies on tranexamic acid and melasma.
- Analysis of evidence regarding systemic and topical tranexamic acid efficacy.
- Examination of tranexamic acid's role in the plasminogen activation pathway.
Main Results:
- Systemic tranexamic acid is a consistent melasma treatment.
- Limited studies exist on topical tranexamic acid efficacy and uptake enhancement.
- Thromboembolism risk is a consideration for systemic use.
Conclusions:
- Tranexamic acid impacts melasma pathophysiology.
- Both systemic and topical formulations are investigated for melasma.
- Further research into topical tranexamic acid is warranted.