Tranexamic Acid For Melasma Research Articles

Tranexamic acid in melasma: A focused review on drug administration routes.

Melasma is a disorder of hyperpigmentation and vascularization often found in women between the ages of 20 and 40. The pathogenesis is unknown, but melasma often occurs in sun-exposed areas of the face, forearms, and back. Risk factors include family history, increased estrogen/progesterone, certain medications, and UV exposure. Melasma is typically treated with topical hydroquinone (HQ); however, it is often refractory to treatment. Tranexamic acid (TXA) is a plasmin inhibitor used off-label in the treatment of melasma. TXA can be administered orally, topically, or intralesionally. The purpose of this review is to characterize the wide variety of TXA delivery methods for melasma treatment and the efficacy of these methods compared with traditional treatments. A comprehensive PubMed and Embase search was conducted in May 2022 using the phrases tranexamic acid and melasma. Forty-six articles were included in this review. Oral, intralesional, and topical TXA is safe and effective treatments for melasma. They have been studied in a variety of randomized controlled trials and have been compared with several traditional treatments. Overall, MASI scores in patients using TXA in any form improved. Oral TXA was found to be the most effective, especially in cases of refractory melasma; however, it caused GI upset and menstrual irregularities in many patients. The pro-thrombotic nature of this drug must be considered before safely prescribing to patients. Intralesional injections and microneedling with topical TXA were found to be effective alternatives to oral treatment. Lastly, topical TXA alone was found to be the least effective method but can be combined with other cosmeceuticals to improve outcomes. Topical TXA was also found to be better tolerated than hydroquinone, a traditional topical melasma treatment.

Oral Tranexamic Acid for the Treatment of Melasma: Evidence and Experience-Based Consensus Statement from Indian Experts.

Melasma, a chronic pigmentary skin condition mainly affecting the face, remains a challenge despite the availability of several options for treatment. Many melasma patients are not satisfied with treatment outcomes. Tranexamic acid (TXA), an anti-fibrinolytic drug has shown promising results in patients with melasma. Evidence from several clinical studies has surfaced on efficacy and tolerability of TXA in these patients. It can be used as monotherapy or adjuvant with other therapies. Currently, there is no published consensus or guideline document for its use in the treatment of melasma. TXA is available for oral use, topical use as well as an injection. In this article, a consensus of Indian experts is prepared based on the available literature and experience with use of oral TXA in melasma. This review article might help clinicians for use of oral TXA appropriately while treating melasma.

Efficacy of intralesional tranexamic acid in melasma: Assessment with Melasma Area Severity Index and Dermatology Quality of Life Index

Efficacy of intralesional tranexamic acid in melasma: Assessment with Melasma Area Severity Index and Dermatology Quality of Life Index

Comparison of fractional erbium:YAG laser-assisted tranexamic acid delivery alone and in combination with oral tranexamic acid in melasma.

Tranexamic acid (TA) emerged as a promising agent for melasma. However, due to its hydrophilic structure, topical TA should be combined with a penetration-enhancing strategy to augment efficacy. To evaluate the efficacy of fractional erbium:YAG laser-assisted delivery (LAD) of topical TA 5% either with or without oral TA treatment in recalcitrant melasma patients. The authors retrospectively assessed the treatment outcomes of melasma patients treated by fractional erbium:YAG LAD of topical TA 5%. Patients receiving a standard protocol including four biweekly laser sessions were eligible. The study included two groups: group 1 patients received oral TA and LAD of topical TA 5%, and group 2 patients received only LAD of topical TA 5%. Two blinded dermatologists reported pre-treatment and post-treatment modified MASI (mMASI) scores. Mean mMASI scores in both group 1 (n = 15) and group 2 (n = 19) were significantly lower at the end of the treatment than baseline values (p = 0.001; p = 0.022, respectively). The decrease of mMASI scores were higher in group 1 (median = 2.1) (64.7%) than in group 2 (median = 1.2) (41.8%) (p = 0.027). Fractional erbium:YAG LAD of topical TA 5% is an efficient treatment regimen for melasma patients recalcitrant to conventional treatment approaches. The implementation of oral TA to this regimen improves the therapeutic outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10103-022-03547-7.

Tranexamic Acid in Melasma: Comparative Evaluation of Therapeutic Efficacy of Oral Tranexamic Acid versus Its Transepidermal Administration.

Melasma is a common disorder of hyperpigmentation mainly affecting the face. It is difficult to treat and is a cause for great cosmetic concern for the patient. So, we did this research to compare the therapeutic efficacy of tranexamic acid (TXA) through oral route versus its transepidermal administration with a dermaroller in melasma. This was a hospital-based, interventional study carried over a span of 1 year on 40 patients with facial melasma. The enrolled patients were randomly divided into 2 groups of 20 patients each. Group A patients received oral tablet TXA in a dose of 250 mg twice daily for 12 weeks and Group B patients were given TXA solution transepidermally into the melasma lesions using a dermaroller at 2 weekly interval for 12 weeks. Thereafter, all patients were followed up for improvement in Melasma Area and Severity Index (MASI) score, adverse effects and relapse at 4 weekly intervals till 24 weeks. All the patients were evaluated for therapeutic outcome both objectively (by MASI) and photographically at 4, 8, 12, 18, and 24 weeks. Grading of improvement was done by assessing percentage reduction in MASI score. Majority of the patients, 24 (60%) in our study had centrofacial pattern of melasma followed by malar pattern seen in 16 (40%) patients. The baseline MASI score was 11.98 (± 5.47) in Group A and 12.13 (± 3.16) in Group B. The mean MASI score in Group A at the end of 4, 8, 12, 18, and 24 weeks was 9.75 (±4.83), 6.09 (±3.64), 4.21 (±2.48), 2.56 (±1.95), and 3.10 (±3.38) while these values were 9.73 (±3.32), 6.06 (±2.75), 4.55 (±1.89), 2.94 (±1.36), and 3.09 (±1.32) for Group B. At the end of 24 weeks follow-up period, good (51%-75% improvement) and very good (>75% improvement) response occurred in 5 (25%) and 14 (70%) patients in Group A and 11 (55%) and 9 (45%) patients in Group B, respectively. However, the final reduction in MASI score was similar in both the groups. Relapse was uncommon and occurred at 24 weeks in 1 patient from Group A. The major limitation was small sample size due to time limitation and long follow-up period. Oral and transepidermal TXA appear equally effective suggesting that the efficacy of TXA is perhaps independent of its route of administration. Oral therapy is convenient for the patient. Transepidermal therapy of TXA has the advantage of local action, hence systemic side effects are avoided, but it is slightly painful and the time period between consecutive microneedling sessions is left to the prerogative of the treating doctor, hence a proper quantification is lacking. Moreover, scheduling of maintenance sessions is necessary as melasma is prone for recurrence.

EFEKTIVITAS PENGGUNAAN ASAM TRANEKSAMAT ORAL PADA PASIEN MELASMA

This study aims to determine the effectiveness of using oral tranexamic acid in melasma patients, as well as to explain the definition of melasma, melasma epidemiology, melasma etiopathogenesis, and to explain the effectiveness of using oral tranexamic acid in melasma. The method used was to collect and analyze research articles on the effectiveness of the use of oral tranexamic acid topical drugs in Melasma patients. The articles are obtained through a search using Google Scholar, Pubmed. The term melasma comes from the Greek word "melas" which means black. Clinically melasma appears as macules or brown spots. Complaints of melasma usually occur symmetrically. The areas of melasma predilection are most commonly the cheeks, upper lip, chin and forehead, but can also be affected in other areas. (Debabrata, Handel et al., 2014). Research conducted for 6 months by Sufan et al ,. It is known that after therapy using Tranexamic Acid, there was a decrease in hyperpigmentation. After 6 months of treatment, the results were very good (10.8%, 8/74), good (54%, 40/74), moderate (31.1%, 23/74), and bad (4.1%). , 3/74). There were 4 patients (5.4%) who experienced mild gastrointestinal discomfort, 6 patients (8.1%) hypomenorrhea, subjects who rarely reported skin rash due to allergies as well as dizziness, alopecia, drowsiness and hyposexuality. From these results it is concluded that oral Tranexmatic Acid has good effectiveness in melasma therapy. (Sufan et al., 2012). From the results of this study it can be concluded that Tranexamic Acid has good effectiveness in the therapy of melasma. Where there are several risk factors that cause melasma, which can occur due to genetic factors, UV exposure, hormonal factors and inflammatory factors. Tranexamic acid will inhibit the action of tyrosinase activity by blocking the interaction of melanocytes and keratinocytes through inhibition of the plasminogen system.
 
 Keywords: Melasma, treatment for melasma, epidemiologi, etiologi, tranexamic acid,.

Liposomal azelaic acid 20% cream vs hydroquinone 4% cream as adjuvant to oral tranexamic acid in melasma: a comparative study

Background Melasma negatively impacts patient’s quality of life (QoL). Although hydroquinone 4% is the most prescribed treatment, several side effects had been reported. The traditionally used azelaic acid 20% has poor tolerability and low skin absorption rate. Aim To assess the efficacy and tolerability of the liposomal form of azelaic acid 20% as an adjuvant to oral tranexamic acid in the treatment of melasma. Patients and methods Fifty females suffering from melasma were divided into two equal groups. The first group used a liposomal form of azelaic acid 20%, and the second group used hydroquinone 4%. Oral tranexamic acid 250 mg was taken by both groups as a single oral daily dose. Melasma severity and the patient’s QoL were assessed. Results A significant improvement of melasma was detected in females who used the liposomal form of azelaic acid 20% than those who used hydroquinone 4%. This was associated with a significant positive effect on their QoL. Furthermore, the liposomal form of azelaic acid 20% was more significantly tolerable than hydroquinone 4%. Conclusion The use of the liposomal form of azelaic acid provides an effective and well-tolerated addition to the treatment of melasma.

Efficacy of topical versus intradermal injection of Tranexamic Acid In Egyptian melasma Patients: A randomised clinical trial.

Melasma is one of the common pigmentary problems affecting females in our community, owing to the frequent use of hormonal contraceptives as well as our sunny climate. A lot of treatment options are available but none of them is completely satisfactory. Many patients prefer the use of topical preparations and minimally invasive methods. Tranexamic acid (TA) is a potential treatment option for hyperpigmentation with different delivery routes. We designed the study in order to evaluate the efficacy of TA in melasma using 2 different routes of delivery. A randomised clinical trial was performed on 60 female patients with melasma, they randomly divided into three groups; A, B and C. Group (A) patients received TA (4mg/mL) intradermal injections every 2weeks with, group B received TA (10mg/mL) intradermal injections every 2weeks, group C received TA cream (10% concentration) twice daily, treatment continued for 12weeks in all groups. Melasma Area and Severity Index (MASI) scores were measured for each patient before and after completion of treatment. The percentage of MASI score reduction was highest in group B (62.7%) versus (39.1%) in group A, while the percentage of MASI reduction was the lowest in group C (4.2%). Tranexamic acid is a safe effective and well-tolerated treatment option for melasma patients. Intradermal injection of TA leads to better results than the topical application. Topical TA cream (even in a high concentration) produce fair improvement of melasma.

Evaluate the efficacy of intradermal tranexamic acid in melisma.

Objective: To evaluate the efficacy of intradermal tranexamic acid in melasma. Stduy Design: Cross-Sectional study. Setting: Out-patient Department of Dermatology at Dow University of Health Sciences. Period: January 2018 to June 2018. Material & Methods: Enrolling 73 patients the research was done on patients with resistant melasma. For this 0.2 ml tranexamic acid diluted in 0.8 ml normal saline was injected intradermally into the melasma lesion at 1 cm distance at every 2 weeks for 4 months and results were analysed by using the modified Melasma Area and Severity Index (MASI) at their first visit and then monthly with strict sun protection. A total of 73 patients were included in this study with age ranging from 22 years to 47 years. All of them had resistant melasma and had not taken any treatment for the last six months. Results: Out of 73 patient 10 (13.7%) patients had poor response, 48 (65.8%) patients had fair response, 14 (19.1%) patients had good responses and only 1 (1.4%) had excellent response. No significant side effects were observed. Out of 73 patients, 63 patients were satisfied with the treatment. Only 2 patients complained of redness over the affected area which subsided within a week without any intervention, no other side effects were noted. Conclusion: Intralesonal tranexamic acid is safe, effective and an affordable option in resistant melasma.

The efficacy of oral vs different dilutions of intradermal tranexamic acid microinjections in melasma-A randomized clinical trial.

Melasma is a common acquired disorder of pigmentation, remains challenging despite numerous treatment modalities. Tranexamic acid (TXA) has emerged as a potential treatment for melasma. Different forms of TXA (oral, topical, and intradermal microinjections) have shown promising results. To evaluate and compare the efficacy of oral vs different dilutions of intradermal TXA in melasma. A total of 45 female patients with melasma were randomly and equally assigned to three treatment groups. Group A (oral TXA 250 mg bid), Group B (100 mg/mL intradermal TXA) & Group C (4 mg/mL intradermal TXA) every 2 weeks, treatment period was 8 weeks. At 8 weeks, a significant reduction in the mMASIwas noted in groups A, B, and C (P value .002, .003, and .005). Melanin index (MI) was significantly reduced in groups A, B, and C (P value .016, .005, and .003). Erythema index (EI) showed significant improvement in group A (P value .028), however was statistically insignificant for groups B and C. No statistically significant difference was found between the three groups as regards changes in mMASI, MI, and EI at 8 weeks. Both oral and intradermal microinjections of TXA regardless dilution appear to be effective and safe in treatment of melasma with comparable results.

Tranexamic Acid in the Treatment of Postsclerotherapy Hyperpigmentation

Tranexamic acid (TA) is a well-known antifibrinolytic drug used in several medical fields. In Dermatology, it has been proposed as an off-label indication in acquired hyperpigmentation, especially for the treatment of melasma, a condition that shares similar histologic features with postsclerotherapy hyperpigmentation (PSH). TA has antiangiogenic effects that reduce the expression of vascular endothelial growth factor (VEGF), endothelin-1, and antimelanogenic effects by inhibiting the tyrosine kinase receptor. Sclerotherapy is a common treatment for chronic venous insufficiency that obliterates the vessels by a chemical endothelial reaction. One of its adverse effects is hyperpigmentation due to an accumulation of hemosiderin in the superficial dermis following erythrocyte extravasation; however, both, melasma and PSH patients, express an elevated number of melanocytes and blood vessels in the affected areas. Since there is a lack of studies in this field, we present a systematic review of TA usefulness in acquired hyperpigmentation. We conducted a systematic review of studies published between 1962 and 2020, available in the databases Pubmed, Web of Science, Scopus, and Google Scholar after searching the following MeSH terms: "tranexamic acid" and "sclerotherapy" or "hyperpigmentation" or "melasma." After extensive review 12 studies met eligibility criteria and were included. Despite no studies having been conducted assessing the role or effectiveness of TA in PSH, we found 12 articles about the use of TA in melasma, which is also an acquired pigmentary disorder with several histologic similarities with PSH. According to these studies, patients treated with TA 250 mg by mouth two times per day for 4 months reached a 90% rate of improvement, with a 27.2% rate of recurrence. Treated patients also expressed histologic resolution of the pigmentations, given by a reduced number of vessels, mast cell counts, and epidermal pigmentation. In vitro results exhibit effects on the neutralization of VEGF-1 and VEGF-2 and inhibiting tyrosinase activity, melanin production, and melanogenic proteins. TA has been proved to be effective in the treatment of melasma, due to its antiangiogenic and antimelanocytic properties. Therefore, we believe that TA might also be effective for treating PSH. We propose this agent as a valuable tool in vascular surgery due to its antiangiogenic and antimelanogenic properties. This study is the first step for the assessment of the clinical effectiveness of TA in PSH. It is also necessary to investigate if it could also help to remove hemosiderin residues from the epidermis in PSH.

Role of oral tranexamic acid in melasma

Context: Melasma is a chronic, acquired hyperpigmentary disorder. Plethora of treatment options are available but none is promising and recurrence is common. Treatment of melasma using oral tranexamic acid is a novel concept.
 Aims: To compare the efficacy of oral tranexamic acid with conventional topical therapy for the treatment of melasma.
 Design: Prospective, parallel, randomized, comparative, clinical study.
 
 Methods and Material: It was a prospective, randomized controlled trial conducted among 104 melasma patients. Patients were assigned into two groups (group A and group B) consisting of 52 patients each. Group A was given routine treatment measures along with oral Tranexamic Acid and photoprotection while Group B was treated only with routine topical measures and photoprotection. Oral Tranexamic Acid was prescribed at a dose of 250 mg BD for three months and patients were followed for three months. Clinical response was evaluated on the basis of Melasma Assessment Severity Index (MASI). Mean scores between the two groups were then compared.
 Results: The MASI scores at baseline, 8 weeks and 12 weeks in group A were 18.24 + 1.05,6.13 + 4.9 and 2.19 + 2.3 respectively and in group B were 15.42 + 1.09,11.07 + 9.16 and 7.99 + 6.05. MASI score reduction percentage at the end of 12 weeks was 88% and 54.6% respectively indicating a greater decrease in the group taking Tranexamic acid and was statistically significant for both the groups with P< 0.05
 Conclusion: Addition of oral tranexamic acid with the triple combination results in rapid and sustained response with less chances of relapse. So tranexamic acid is a great boon for the melasma patient as well as for the clinicians.

Use of tranexamic acid in melasma

Use of tranexamic acid in melasma

Tranexamic acid in melasma: Why and how?

Tranexamic acid in melasma: Why and how?

Efficacy and Safety of Tranexamic Acid in Melasma: A Meta-analysis and Systematic Review.

Tranexamic acid is a novel treatment option for melasma; however, there is no consensus on its use. This systematic review searched major databases for relevant publications to March 2016. Eleven studies with 667 participants were included. Pooled data from tranexamic acid-only observational studies with pre- and post-treatment Melasma Area and Severity Index (MASI) showed a decrease of 1.60 in MASI (95% confidence interval (CI), 1.20-2.00; p<0.001) after treat-ment with tranexamic acid. The addition of tranexamic acid to routine treatment modalities resulted in a further decrease in MASI of 0.94 (95% CI 0.10-1.79; p = 0.03). Side-effects were minor, with a few cases reporting hypo-menorrhoea, mild abdominal discomfort, and transient skin irritation. These results support the efficacy and safety of tranexamic acid, either alone or as an adjuvant to routine treatment modalities for melasma.

Oral tranexamic acid (TA) in the treatment of melasma: A retrospective analysis

Melasma is a common pigmentary disorder among Asians and treatment is challenging. Oral tranexamic acid (TA) has emerged as a potential treatment for refractory melasma. Large-scale studies on its use, outcomes, and safety are limited. We sought to evaluate treatment outcomes and adverse effects of oral TA in melasma in an Asian population. We conducted a retrospective analysis of patients who received oral TA for melasma in a tertiary dermatologic center from January 2010 to June 2014. In all, 561 patients (91.4% female, 8.6% male) were enrolled. Median duration of treatment was 4months. Themajority (503 [89.7%]) improved, 56 (10.0%) had no improvement, and 2 (0.4%) worsened. Patients without family history of melasma had better response rates than those with family history (90.6% vs 60.0%, P=.01). Of the 503 who improved, response was seen within 2months of TA initiation, with a relapse rate of 27.2%. Adverse events occurred in 40 (7.1%). Most were transient, but 1 developed deep vein thrombosis requiring prompt discontinuation. She was later given the diagnosis of familial protein S deficiency. This was a retrospective study. Oral TA may be an effective adjunct for refractory melasma. Careful screening for personal and familial risk factors for thromboembolism should be done before initiation.

Efficacy and possible mechanisms of topical tranexamic acid in melasma.

Tranexamic acid (TA) has been suggested as an effective treatment for melasma. To investigate the effects and mechanism of action of topical TA in the treatment of melasma. In this study, 23 participants with melasma applied a 2% TA formulation to the whole face for 12 weeks. Clinical effects were evaluated using the modified Melasma Area and Severity Index (mMASI) and a chromameter. Skin biopsies were obtained from 10 participants to evaluate pigmentation, vascularity and the expression levels of possible paracrine factors contributing to the effect of TA. Most of the participants had mild melasma, with mMASI of < 5. The mMASI scores significantly improved in 22 of 23 participants after application. The L* values were increased and the a* values were decreased in both lesional and perilesional normal skin. Fontana-Masson staining showed a significant decrease in melanin content in the epidermis. The number of CD31-positive vessels and the expression of the vascular endothelial growth factor both tended to decrease. Endothelin (ET)-1 was found to be downregulated with TA. Topical TA is effective for melasma. This immunohistochemical study found that suppression of ET-1 could be one of the mechanisms of action of TA on melasma.

Tranexamic Acid in Melasma: A Review

Melasma is a localized, chronic acquired hypermelanosis of the skin. Despite several treatments available, melasma can often be refractory to treatment. Also recurrences are common. Tranexamic acid is a new addition in treatment of melasma and is effective in dosage of 250 mg BD for atleast 4 to 8 weeks. Tranexamic acid acts mainly via the plasminogen activator-plasmin system to prevent UV radiation induced pigmentation in melasma. This article reviews the mechanism of action of tranexamic acid in melasma and current evidence in literature for use of tranexamic acid in melasma.