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Oral Tranexamic Acid for the Treatment of Melasma

A Review

Bala, Harini R., MBBS*; Lee, Senhong, MBBS; Wong, Celestine, MBBS*; Pandya, Amit.G., MD; Rodrigues, Michelle, FACD*,§,‖

doi: 10.1097/DSS.0000000000001518
Review Article

BACKGROUND Melasma is a common acquired disorder of hyperpigmentation that commonly affects those with skin of color. Tranexamic acid (TXA) is a novel treatment for melasma that has a multimodal mechanism of action.

OBJECTIVE To provide a comprehensive review of the literature regarding the evidence on the mode of action, safety profile, and efficacy of TXA in the treatment of melasma.

MATERIALS AND METHODS The literature was searched for publications on TXA in the treatment of melasma using MEDLINE, Scopus, and Google Scholar.

RESULTS Oral TXA has clearly demonstrated the efficacy for melasma in Asian skin, even in low doses (e.g., 500 mg daily) over short periods (8–12 weeks). It is also a safe therapeutic option, which is easy to administer with few and mild side effects. Studies have shown that TXA does not increase the thromboembolic risk, although patients should be screened carefully for contraindications and risk factors prior to commencement of the therapy.

CONCLUSION Oral TXA is a safe and efficacious treatment for refractory melasma. It should be considered in cases that are unresponsive to topical hydroquinone and combination topical therapy over a period of approximately 12 weeks and without contraindications to oral TXA.

*Skin and Cancer Foundation Inc., Melbourne, Australia;

Department of Medicine, Monash Health, Melbourne, Australia;

Department of Dermatology, University of Texas, Southwestern Medical Center, Dallas, Texas;

§Department of Dermatology, The Royal Children's Hospital, Victoria, Australia;

Department of Dermatology, St Vincent's Hospital, Victoria, Australia

Address correspondence and reprint requests to: Harini R. Bala, MBBS, Skin and Cancer Foundation, Level 1, 80 Drummond Street, Carlton, Victoria 3053, Australia, or e-mail:

The authors have indicated no significant interest with commercial supporters.

© 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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