Melasma – common dermatological disease, difficult to treat.
Topical bleaching agents and photoprotection combined with adjuvant treatments such as chemical peels and laser therapy provide minimal improvement in patients.
In the context of the treatment of melasma, tranexamic acid (TA), intended for intradermal administration, as well as for topical and oral administration, is promising.
This article estet-portal.com provides an overview of the various forms of tranexamic acid presented by Dr. Jordan V. Wang, Nikita Jhawar and Nazanin Saedi.
- Melasma: methods of treatment of the disease and the mechanism of development
- What makes tranexamic acid effective for melasma
- Tranexamic acid for intradermal injection and topical use in the treatment of melasma
- Tranexamic acid for oral use in the treatment of melasmas
Melasma: methods of treatment of the disease and development mechanism
Melasma – a chronic dermatosis characterized by hyperpigmentation of sun-exposed areas of the skin, especially the cheeks, forehead, nose and upper lip.
Safe alternative to hydroquinone: tranexamic acid for skin whitening
While mechanisms of melasma development remain poorly understood, there is a theory that describes an increase in plasmin activity in keratinocytes under the influence of ultraviolet radiation, which leads to an increase in the number of melanocyte-stimulating mediators, such as arachidonic acid and alpha melanocyte stimulating hormone.
Traditionally, melasma has been treated with topical whitening agents and a maximum photoprotection regimen.
Additional treatments with limited efficacy include:
What is the reason for the effectiveness of tranexamic acid in melasma
Tranexamic acid – fibrinolytic substance that inhibits the action of plasmin. There is a hypothesis that TA may inhibit the release of paracrine melanogenic factors that stimulate melanocytes.
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Tranexamic acid treatment of melasma results available for:
- topical application;
- intradermal administration;
- oral use.
Authors of existing papers report safety and effectiveness of TA, but there are few studies with sufficient statistical power.
How tranexamic acid treats age spots
To date, there is no consensus on the use of TA for the treatment of melasma, which indicates the need for large randomized, placebo-controlled trialsth.
Tranexamic acid for intradermal injection and topical use in the treatment of melasma
In 5 of 6 studies evaluating the effectiveness of TA in the treatment of melasma (n = 13-50), a significant reduction in the area and severity of melasma (MASI index) was demonstrated after treatment with various forms and modes:
- TC cream 3% – 12 weeks;
- TC gel 5% – 12 weeks;
- TC solution 3% – 12 weeks;
- liposomes with TC 5% – 12 weeks;
- formula with TC 2% – 12 weeks.
According to analysis of available studies:
- after the use of tranexamic acid, there was a lightening of dyschromia and a decrease in the MASI index;
- no statistically significant differences were observed between TC forms and carrier media;
- topical TA is as effective as intradermal TA, hydroquinone, and the combination ofand hydroquinone with dexamethasone.
Tranexamic acid for oral use in the treatment of melasma
From 2011 to 2016 9 uncontrolled studies were conducted, in which the effectiveness of TA in the treatment of melasma was evaluated based on information provided by patients and the MASI index.
Since 2016, there have been 3 other clinical studies that reported a 49-69% reduction in pigmentation after taking oral tranexamic acid, but after stopping TA melasma recurred.
Therefore, further research should be aimed at finding the most effective methods for maintaining the results of the treatment of melasma TK for oral use.
To date, there is no consensus on the use of TA for the treatment of melasma.
In general, oral tranexamic acid is well tolerated by patients.
The most common side effects are from the gastrointestinal tract. More serious and rare side effects include:
- venous thrombosis;
- acute cortical necrosis of the kidneys;
- pulmonary embolism.
Before prescribing tranexamic acid for oral use, it is advisable to study the patient's history and order laboratory tests (for blood clotting time, proteins C and S, antibodies to phospholipids and Leiden factor).
Cysteamine-based cream in the treatment of melasma: case studies
Large randomized, placebo-controlled trials.
Adapted from The Journal of Clinical and Aesthetic Dermatology.
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