Melasma are brownish, shadowy patches that typically appear on the face of women. They are usually associated with the use of contraceptives or previous pregnancy, but we also see them frequently in girls with none of these causes.
Melasma is difficult to treat, but in recent years we have a new therapy that can help us in this regard: tranexamic acid.
What is tranexamic acid?
Tranexamic acid is an antifibrinolytic agent. It reversibly binds to a molecule called plasminogen, preventing it from being converted into plasmin, which reduces bleeding. On the other hand, it interferes with the formation of new blood vessels in tissues.
It has traditionally been used by surgeons to prevent bleeding during surgery. It may also be used to reduce menstrual bleeding in women. It is considered a safe medication.
Why is it used for melasma?
Plasmin (by binding to epidermal cells and inducing these cells to release a molecule called prostaglandin E2) has the ability, when exposed to UV radiation, to activate the enzyme tyrosinase, which produces melanin (skin pigment).
Blocking the formation of plasmin by tranexamic acid reduces skin pigmentation by decreasing tyrosinase activation.
In addition, the vascular component is important in some cases of melasma. Thus, tranexamic acid’s ability to reduce the formation of small cutaneous blood vessels may also be helpful.
Is tranexamic acid effective for melasma?
To date, no fully controlled clinical trials (the most rigorous scientific studies) have been published. However, there are large series that show the efficacy of tranexamic acid in lightening melasma.
The largest study was conducted by Lee et al. They followed 591 patients with melasma who took the drug twice daily for 4 months. 87.9% of them improved and only a quarter of them had a recurrence of melasma.
Is tranexamic acid a safe treatment for melasma?
Yes, it is safe. Adverse effects reported in studies are rare and generally mild. However, there are some situations in which it should never be given:
- Pregnancy
- Personal or family history of thrombosis
- Coagulation disorders
- Severe renal insufficiency
- Impaired color vision
There are certain situations in which it is generally better not to take it, but it can be individualized and assessed on a case-by-case basis:
- Breastfeeding
- Renal or hepatic insufficiency
- Use of oral contraceptives.
How should tranexamic acid for melasma be used?
Tranexamic acid is taken twice daily. It comes in 500 mg tablets. It is advisable to divide it in two, taking half in the morning and half in the evening.
If you prefer not to take drugs or if you have any of the above-mentioned medical contraindications to their use, there is a possibility of administering them by mesotherapy (through small punctures in the area of the blemish). Some studies show an efficacy comparable to hydroquinone (the most effective depigmentation cream) with hardly any side effects.
In conclusion..
Tranexamic acid is another alternative that we can add to the usual depigmenting treatments that we use in the complex management of melasma.
