Tranexamic Acid for Melasma: A Dermatologist’s Secret Weapon

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Melasma, a common skin concern characterized by brown to gray-brown patches on the face, often proves challenging to treat due to its multifaceted nature. Triggered by factors like hormonal fluctuations, sun exposure, and genetics, melasma can diminish one’s self-esteem and confidence. However, dermatologists have been turning to tranexamic acid to lighten the most stubborn dark spots and patches that don’t seem to go away. 

  • Dr. Matthew Elias is a dermatologist based in Fort Lauderdale, FL
  • Dr. Kenneth Beer is a dermatologist based in West Palm Beach, FL
  • Dr. Tina Alster is a dermatologist based in Washington, DC
  • Dr. Brenda Dintiman is a board-certified dermatologist based in Vienna, VA 
  • Dr. Lana Kashlan is a board-certified dermatologist based in Chicago
  • Dr. Marie Jhin Lassila is a board-certified dermatologist based in San Francisco
  • Dr. Peter Chien is a board-certified dermatologist based in New York
  • Dr. Sarah Geeis a board-certified dermatologist based in Smithville, TX

What Is Melasma?

Melasma, also referred to as chloasma, manifests as brown or grayish patches on the face, stemming from hyperpigmentation, either as patches or freckle-like spots. This condition arises due to the hyperactivity of melanocytes, the cells accountable for skin pigmentation, leading to excessive melanin production, the pigment responsible for skin coloration. Although the precise cause of melanocyte hyperactivity in melasma necessitates further research, it is believed to be influenced and exacerbated by various factors inducing melanocyte overactivity. These triggers include exposure to ultraviolet (UV) light, pregnancy, hormonal fluctuations, stress, thyroid disorders, and certain medications such as contraceptive pills and phototoxic anti-seizure drugs.

While no permanent solution exists currently, there are several treatments aimed at lightening hyperpigmentation and preventing melasma recurrence. This skin condition predominantly affects women, with approximately 90 percent of cases occurring in females, particularly among those aged 20 to 40. Often dubbed “the mask of pregnancy,” melasma afflicts 15-50 percent of pregnant women. Individuals with darker skin tones, particularly those classified as type IV or darker, are more prone to developing melasma.

What Is Tranexamic Acid?

Washington D.C. dermatologist Tina Alster, MD explains, “Tranexamic acid blocks the interaction between melanocytes and keratinocytes, thereby reducing skin pigmentation.” This mechanism proves invaluable in treating melasma, as it curtails the excessive production of melanin responsible for the pigmented patches. “It enhances the effectiveness of chemical peels and lasers by reducing the risk of post-inflammatory hyperpigmentation, a common side effect of these treatments.”

What Is Oral Tranexamic Acid?

Oral tranexamic acid, as highlighted by Fort Lauderdale, FL dermatologist Dr. Matthew Elias, is a game-changer. “Administered at 650mg ½ tab twice daily, it blocks the pigment pathway in melasma patients,” he says. However, caution is advised. “Patients on oral contraceptives, if pregnant or at increased risk of blood clots, like smokers, should not take it.

On the other hand, topical tranexamic acid offers a safer alternative for certain patients. Vienna, VA dermatologist Brenda Dintiman, MD advocates for using a topical formula, especially for active individuals. This topical solution, like its oral counterpart, aids in skin rejuvenation and combating the notorious pigmentation. “I use the topical tranxenemic acid with a daily tinted sunscreen since my Type 3 skin is prove to brown spots and melasma especially when I play tennis,” she explains. “I love it for my golfers, tennis players and walkers to encourage them to work on rejuvenating their skin all year long!”

What Are the Potential Side Effects of Oral Tranexamic Acid? 

Tranexamic acid may elicit minor side effects, typically resolving spontaneously without medical intervention as the body adjusts to the medication. Common side effects encompass: nausea and/or vomiting, stomach pain or discomfort, diarrhea, chills, fever, headache, muscle pain or stiffness. Rare yet severe side effects include anaphylaxis, alterations in vision, confusion, anxiety, pale skin, unusual bleeding, bruising or fatigue. Immediate medical attention is crucial for these adverse reactions, and consulting a dermatologist for follow-up care is strongly recommended.

How to Use Tranexamic Acid for Melasma

Chicago dermatologist Lana Kashlan, MD emphasizes the superiority of oral tranexamic acid’s effectiveness over topicals. Within just eight weeks, many patients notice significant improvements. However, Dr. Kashlan says this treatment is best suited for those with melasma with an underlying vascular component. 

San Francisco dermatologist Marie Jhin Lassila, MD notes there is a prolonged journey to results, requiring patience from patients. “It takes about 8-12 weeks to display visible improvements.” 

Additionally, Ft. Lauderdale, FL dermatologist Kenneth Beer, MD underscores the collaborative approach. Tranexamic acid’s synergy with other modalities such as chemical peels enhance its potency and effectiveness. “There really are no cons aside from minor irritation that is associated with its use. It really depends on the person’s degree of patience. Tranexmic acid takes a while to see results. I think that it is not really strong enough to use by itself, so it is something we use with other products. For patients that do not want to use hydroquinone, this is a nice alternative.”

How Does Tranexamic Acid for Melasma Work?

While the effectiveness of tranexamic acid is undeniable, its use comes with considerations. New York dermatologist Peter Chien, MD highlights the potency of the oral form, emphasizing its superiority over topical versions. “The oral form is more potent than commercially available ones,” he says.

Smithville, TX dermatologist Sarah Gee, MD, adds an intriguing insight. ” What’s interesting about melasma and why we think the treatment is so challenging is that not only is there increased pigment, but biopsies show a prominent increase in blood vessels. This isn’t something that we can see, but can partially explain why tranexamic acid, a clotting agent, can help with pigmentation in the skin.”

The journey to clear and radiant skin, especially when combating melasma, demands patience, knowledge and a personalized approach. Whether oral or topical, this treatment holds promise for individuals striving to reclaim their skin’s natural beauty. Remember, a dermatologist’s guidance is essential to tailor the best treatment plan for your unique needs.

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