American Journal of Clinical Dermatology

, Volume 18, Issue 3, pp 373–381 | Cite as

Tranexamic Acid in the Treatment of Melasma: A Review of the Literature

  • Marina PerperEmail author
  • Ariel Eva Eber
  • Rachel Fayne
  • Sebastian Hugo Verne
  • Robert James Magno
  • Jessica Cervantes
  • Mana ALharbi
  • Ibrahim ALOmair
  • Abdulkarem Alfuraih
  • Keyvan Nouri
Review Article


Melasma is a common acquired pigmentary disorder marked by irregular hyperpigmented macules or patches and most commonly occurs in women of darker skin color. It is a chronic often-relapsing condition that causes negative psychosocial effects in those affected. Current treatments such as hydroquinone, kojic acid, and retinoids, among others, demonstrate variable efficacy and side-effect profiles. We conducted a comprehensive literature review examining the use of tranexamic acid (TA), a well-known anti-fibrinolytic agent, in the treatment of melasma. TA delivered orally, topically, and through physical methods works via the inhibition of ultraviolet (UV)-induced plasmin activity in keratinocytes. Predefined search terms were entered into PubMed. Articles were then independently screened by two authors to include only those written in the English language and relating to human subjects with at least mild melasma. The search identified 28 articles, 15 of which met the criteria for full review. The review revealed that TA treatment for melasma is equally effective or more effective than other standard therapies and may induce fewer side effects. Our comprehensive review suggests that TA may be a promising treatment option for melasma because of its demonstrated effectiveness alone and in combination with other modalities as well as its limited side-effect profile.


Tranexamic Acid Kojic Acid Triple Combination Intense Pulse Light Heavy Menstrual Bleeding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethical Standards

Information contained in this manuscript has never been presented or published in the past.

Conflicts of interest

Marina Perper, Ariel Eva Eber, Rachel Fayne, Sebastian Hugo Verne, Robert James Magno, Jessica Cervantes, Mana ALharbi, Ibrahim ALOmair, Abdulkareem Alfuraih, and Keyvan Nouri have no conflicts of interest.


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Ethics statement

The manuscript does not contain clinical studies or patient data.

Informed consent

The manuscript does not contain clinical studies or patient data.


  1. 1.
    Miot LD, Miot HA, Silva MG, Marques ME. Physiopathology of melasma. An Bras Dermatol. 2009;84(6):623–35.CrossRefPubMedGoogle Scholar
  2. 2.
    Chang M. Melasma. In: Bolognia J, editor. Dermatology. 3rd ed. Amsterdam: Elsevier; 2012.Google Scholar
  3. 3.
    Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014;89(5):771–82.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lee A-Y. An updated review of melasma pathogenesis. Dermatol Sin. 2014;32(4):233–9. doi: 10.1016/j.dsi.2014.09.006.CrossRefGoogle Scholar
  5. 5.
    Sheth VM, Pandya AG. Melasma: a comprehensive update: part II. J Am Acad Dermatol. 2011;65(4):699–714. doi: 10.1016/j.jaad.2011.06.001 (quiz 5).CrossRefPubMedGoogle Scholar
  6. 6.
    Shankar K, Godse K, Aurangabadkar S, Lahiri K, Mysore V, Ganjoo A, et al. Evidence-based treatment for melasma: expert opinion and a review. Dermatol Ther (Heidelb). 2014;4(2):165–86. doi: 10.1007/s13555-014-0064-z.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Draelos ZD. Skin lightening preparations and the hydroquinone controversy. Dermatol Ther. 2007;20(5):308–13. doi: 10.1111/j.1529-8019.2007.00144.x.CrossRefPubMedGoogle Scholar
  8. 8.
    Bandyopadhyay D. Topical treatment of melasma. Indian J Dermatol. 2009;54(4):303–9. doi: 10.4103/0019-5154.57602.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Sharma YK, Gupta A. Some other serendipitous discoveries in dermatology. Indian J Dermatol. 2016;61(1):95–6. doi: 10.4103/0019-5154.174045.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Emmett KJ, Lee A, Khiabanian H, Rabadan R. High-resolution genomic surveillance of 2014 ebolavirus using shared subclonal variants. PLoS Curr. 2014;2015:7. doi: 10.1371/currents.outbreaks.c7fd7946ba606c982668a96bcba43c90.Google Scholar
  11. 11.
    Li D, Shi Y, Li M, Liu J, Feng X. Tranexamic acid can treat ultraviolet radiation-induced pigmentation in guinea pigs. Eur J Dermatol. 2010;20(3):289–92. doi: 10.1684/ejd.2010.0912.PubMedGoogle Scholar
  12. 12.
    Kim EH, Kim YC, Lee E-S, Kang HY. The vascular characteristics of melasma. J Dermatol Sci. 2007;46(2):111–6. doi: 10.1016/j.jdermsci.2007.01.009.CrossRefPubMedGoogle Scholar
  13. 13.
    Lee HC, Thng TG, Goh CL. Oral tranexamic acid (TA) in the treatment of melasma: a retrospective analysis. J Am Acad Dermatol. 2016;75(2):385–92. doi: 10.1016/j.jaad.2016.03.001.CrossRefPubMedGoogle Scholar
  14. 14.
    Wu S, Shi H, Wu H, Yan S, Guo J, Sun Y, et al. Treatment of melasma with oral administration of tranexamic acid. Aesthet Plast Surg. 2012;36(4):964–70. doi: 10.1007/s00266-012-9899-9.CrossRefGoogle Scholar
  15. 15.
    Li Y, Sun Q, He Z, Fu L, He C, Yan Y. Treatment of melasma with oral administration of compound tranexamic acid: a preliminary clinical trial. J Eur Acad Dermatol Venereol. 2014;28(3):393–4. doi: 10.1111/jdv.12209.CrossRefPubMedGoogle Scholar
  16. 16.
    Tan AW, Sen P, Chua SH, Goh BK. Oral tranexamic acid lightens refractory melasma. Australas J Dermatol. [Epub 13 May 2016]. doi: 10.1111/ajd.12474.
  17. 17.
    Na JI, Choi SY, Yang SH, Choi HR, Kang HY, Park KC. Effect of tranexamic acid on melasma: a clinical trial with histological evaluation. J Eur Acad Dermatol Venereol. 2013;27(8):1035–9. doi: 10.1111/j.1468-3083.2012.04464.x.CrossRefPubMedGoogle Scholar
  18. 18.
    Cho HH, Choi M, Cho S, Lee JH. Role of oral tranexamic acid in melasma patients treated with IPL and low fluence QS Nd:YAG laser. J Dermatol Treat. 2013;24(4):292–6. doi: 10.3109/09546634.2011.643220.CrossRefGoogle Scholar
  19. 19.
    Shin JU, Park J, Oh SH, Lee JH. Oral tranexamic acid enhances the efficacy of low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet laser treatment for melasma in Koreans: a randomized, prospective trial. Dermatol Surg. 2013;39(3 Pt 1):435–42. doi: 10.1111/dsu.12060.CrossRefPubMedGoogle Scholar
  20. 20.
    Padhi T, Pradhan S. Oral tranexamic acid with fluocinolone-based triple combination cream versus fluocinolone-based triple combination cream alone in melasma: an open labeled randomized comparative trial. Indian J Dermatol. 2015;60(5):520. doi: 10.4103/0019-5154.164416.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Karn D, Kc S, Amatya A, Razouria EA, Timalsina M. Oral tranexamic acid for the treatment of melasma. Kathmandu Univ Med J (KUMJ). 2012;10(40):40–3.Google Scholar
  22. 22.
    Kim SJ, Park JY, Shibata T, Fujiwara R, Kang HY. Efficacy and possible mechanisms of topical tranexamic acid in melasma. Clin Exp Dermatol. 2016;41(5):480–5. doi: 10.1111/ced.12835.CrossRefPubMedGoogle Scholar
  23. 23.
    Kanechorn Na Ayuthaya P, Niumphradit N, Manosroi A, Nakakes A. Topical 5 % tranexamic acid for the treatment of melasma in Asians: a double-blind randomized controlled clinical trial. J Cosmet Laser Ther. 2012;14(3):150–4. doi: 10.3109/14764172.2012.685478.CrossRefPubMedGoogle Scholar
  24. 24.
    Banihashemi M, Zabolinejad N, Jaafari MR, Salehi M, Jabari A. Comparison of therapeutic effects of liposomal tranexamic acid and conventional hydroquinone on melasma. J Cosmet Dermatol. 2015;14(3):174–7. doi: 10.1111/jocd.12152.CrossRefPubMedGoogle Scholar
  25. 25.
    Ebrahimi B, Naeini FF. Topical tranexamic acid as a promising treatment for melasma. J Res Med Sci. 2014;19(8):753–7.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Lee JH, Park JG, Lim SH, Kim JY, Ahn KY, Kim MY, et al. Localized intradermal microinjection of tranexamic acid for treatment of melasma in Asian patients: a preliminary clinical trial. Dermatol Surg. 2006;32(5):626–31. doi: 10.1111/j.1524-4725.2006.32133.x.PubMedGoogle Scholar
  27. 27.
    Budamakuntla L, Loganathan E, Suresh DH, Shanmugam S, Suryanarayan S, Dongare A, et al. A randomised, open-label, comparative study of tranexamic acid microinjections and tranexamic acid with microneedling in patients with melasma. J Cutan Aesthet Surg. 2013;6(3):139–43. doi: 10.4103/0974-2077.118403.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Rodrigues M, Pandya AG. Melasma: clinical diagnosis and management options. Australas J Dermatol. 2015;56(3):151–63. doi: 10.1111/ajd.12290.CrossRefPubMedGoogle Scholar
  29. 29.
    Chai Q, Fei Y, Cao H, Wang C, Tian J, Liu J. Acupuncture for melasma in women: a systematic review of randomised controlled trials. Acupunct Med. 2015;33(4):254–61. doi: 10.1136/acupmed-2014-010633.CrossRefPubMedGoogle Scholar
  30. 30.
    Ikino JK, Nunes DH, Silva VP, Frode TS, Sens MM. Melasma and assessment of the quality of life in Brazilian women. An Bras Dermatol. 2015;90(2):196–200. doi: 10.1590/abd1806-4841.20152771.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Pandya AG, Hynan LS, Bhore R, Riley FC, Guevara IL, Grimes P, et al. Reliability assessment and validation of the Melasma Area and Severity Index (MASI) and a new modified MASI scoring method. J Am Acad Dermatol. 2011;64(1):78–83. doi: 10.1016/j.jaad.2009.10.051 (e1–2).CrossRefPubMedGoogle Scholar
  32. 32.
    Kim MS, Bang SH, Kim JH, Shin HJ, Choi JH, Chang SE. Tranexamic acid diminishes laser-induced melanogenesis. Ann Dermatol. 2015;27(3):250–6. doi: 10.5021/ad.2015.27.3.250.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Lee DH, Oh IY, Koo KT, Suk JM, Jung SW, Park JO, et al. Reduction in facial hyperpigmentation after treatment with a combination of topical niacinamide and tranexamic acid: a randomized, double-blind, vehicle-controlled trial. Skin Res Technol. 2014;20(2):208–12. doi: 10.1111/srt.12107.CrossRefPubMedGoogle Scholar
  34. 34.
    Zhong S, Sun N, Liu H, Niu Y, Chen C, Wu Y. Topical tranexamic acid improves the permeability barrier in rosacea. Dermatol Sin. 2015;33(2):112–7. doi: 10.1016/j.dsi.2015.04.012.CrossRefGoogle Scholar
  35. 35.
    Cicardi M, Bergamaschini L, Zingale LC, Gioffre D, Agostoni A. Idiopathic nonhistaminergic angioedema. Am J Med. 1999;106(6):650–4.CrossRefPubMedGoogle Scholar
  36. 36.
    Byun SY, Chae JB, Na JI, Park KC. Significant improvement in crow’s feet after treatment with Jet-M and a mixed solution of copper–GHK, oligo-hyaluronic acid, rhodiolar extract, tranexamic acid, and beta-glucan (GHR formulation). J Cosmet Laser Ther. 2016;18(5):293–5. doi: 10.3109/14764172.2016.1157367.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Marina Perper
    • 1
    Email author
  • Ariel Eva Eber
    • 1
  • Rachel Fayne
    • 1
  • Sebastian Hugo Verne
    • 1
  • Robert James Magno
    • 1
  • Jessica Cervantes
    • 1
  • Mana ALharbi
    • 2
  • Ibrahim ALOmair
    • 2
  • Abdulkarem Alfuraih
    • 2
  • Keyvan Nouri
    • 1
  1. 1.Department of Dermatology and Cutaneous SurgeryUniversity of Miami HospitalMiamiUSA
  2. 2.Imam Muhammad Ibn Saud Islamic University (IMSIU)RiyadhSaudi Arabia

Personalised recommendations