33031 Use of topical tranexamic acid in patients with melasma: A narrative review

Abstract

Background: Oral tranexamic acid (TXA) is an effective treatment for melasma likely via its effects on the plasminogen pathway. However, there are several potential side effects including thromboembolism. Topical TXA may be useful for melasma, but the efficacy is largely unknown. Objectives: To determine the efficacy of topical TXA for melasma by reviewing studies comparing topical TXA to oral TXA and other topicals. Additionally, to determine if methods that may improve penetrance increase the potential benefit and to summarize any reported side effects. Methods: A review of the literature was performed for studies using topical TXA for melasma. Results: Only one study compared oral to topical TXA, with superior results from oral TXA. But several studies compared withpical TXA to topical hydroquinone (HQ) and all found similar decreases in Melasma Area Severity Index scores. However, there were more side effects (erythema and irritation) and lower patient satisfaction with HQ. Two studies found that topical TXA with micro-needling may significantly improve results compared with topical TXA alone and one study found that combined use with a fractional CO2 laser also improved results. Most studies used 5% TXA solution twice daily. Discussion: Overall, topical TXA may be as effective as topical HQ, but TXA may be better tolerated. Concomitant micro-needling or laser treatment likely increases the benefit but there are limited studies. There is also limited evidence comparing oral to topical TXA but given the known risks with oral TXA, topical TXA may be a reasonable and safe treatment option for melasma.