The Results of Tranexamic Acid on Melasma

Melasma, also known as pregnancy mask or chloasma, is a form of hyperpigmentation frequently seen in pregnant women, usually appearing as large brown areas on the face, especially on the cheeks, bridge of the nose, forehead and upper lip. Other parts of the body can also be affected, such as the stomach and forearms. It is the consequence of an excessive and localized production of melanin. There are three types of melasma:

• Epidermal melasma which is the most superficial form with a hyperpigmentation of the epidermis;

• Dermal melasma which affects the dermis;

• Mixed melasma which is characterized by both epidermal and dermal melasma.

The main causes of melasma are hormonal changes during pregnancy, following the use of a contraceptive pill, hormone replacement therapy, as well as the use of certain anti-epileptic drugs or endocrine disorders (e.g. thyroid disorder). Repeated sun exposure can aggravate melasma.

Tranexamic acid has shown excellent results on melasma. Researchers have demonstrated a total improvement rate of 80.9% in 256 melasma patients after long-term (6 to 15 months) oral use of tranexamic acid. There were no obvious side effects of the treatment, except for a gastrointestinal reaction in 4.3% of patients and hypomenorrhea in 3.5% of patients. Another study conducted over eight weeks demonstrated the efficacy of taking two tablets of tranexamic acid three times a day combined with the topical use of the same active ingredient twice a day on dermal melasma.

In cutaneous application alone, tranexamic acid acts on epidermal type melasmas. Thus, according to a study conducted in 2019, a topical solution of 5% tranexamic acid is as effective as a cream containing 3% hydroquinone. Tranexamic acid is now a safe alternative to hydroquinone. As a reminder, this molecule is a bleaching agent that has been banned in cosmetics since 2001 in Europe because of its carcinogenic potential.