Skip to main content
SpringerLink
Log in

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

American Journal of Clinical Dermatology volume 18, pages 373–381 (2017)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Miot LD, Miot HA, Silva MG, Marques ME. Physiopathology of melasma. An Bras Dermatol. 2009;84(6):623–35.

    Article  PubMed  Google Scholar 

  2. Chang M. Melasma. In: Bolognia J, editor. Dermatology. 3rd ed. Amsterdam: Elsevier; 2012.

    Google Scholar 

  3. Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014;89(5):771–82.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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).

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  8. Bandyopadhyay D. Topical treatment of melasma. Indian J Dermatol. 2009;54(4):303–9. doi:10.4103/0019-5154.57602.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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. 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.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  25. Ebrahimi B, Naeini FF. Topical tranexamic acid as a promising treatment for melasma. J Res Med Sci. 2014;19(8):753–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rodrigues M, Pandya AG. Melasma: clinical diagnosis and management options. Australas J Dermatol. 2015;56(3):151–63. doi:10.1111/ajd.12290.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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).

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  35. Cicardi M, Bergamaschini L, Zingale LC, Gioffre D, Agostoni A. Idiopathic nonhistaminergic angioedema. Am J Med. 1999;106(6):650–4.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology and Cutaneous Surgery, University of Miami Hospital, 1475 NW 12th Ave. Suite 2175, Miami, FL, 33136, USA

    Marina Perper, Ariel Eva Eber, Rachel Fayne, Sebastian Hugo Verne, Robert James Magno, Jessica Cervantes & Keyvan Nouri

  2. Imam Muhammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia

    Mana ALharbi, Ibrahim ALOmair & Abdulkarem Alfuraih

Authors
  1. Marina Perper
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ariel Eva Eber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rachel Fayne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sebastian Hugo Verne
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert James Magno
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jessica Cervantes
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mana ALharbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ibrahim ALOmair
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Abdulkarem Alfuraih
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Keyvan Nouri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marina Perper.

Ethics declarations

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.

Funding

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.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Perper, M., Eber, A.E., Fayne, R. et al. Tranexamic Acid in the Treatment of Melasma: A Review of the Literature. Am J Clin Dermatol 18, 373–381 (2017). https://doi.org/10.1007/s40257-017-0263-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-017-0263-3

Keywords

search

Navigation