If you want to lighten dark spots caused by melasma, new treatments are available
Tranexamic acid has been used as a topical ingredient to help lighten dark spots caused by melasma for some time, though recent research shows that its oral and intradermal (injectable) forms are more effective.
In my Miami dermatology practice, I have seen excellent results using oral and/or intradermal tranexamic acid to treat melasma. Moreover, a recent long-term study has shown that these forms of tranexamic acid are both safe and effective.
Note that tranexamic acid is not approved by the FDA for the treatment of melasma. This article will discuss how physicians are using it off-label. Although the studies mentioned below have demonstrated safety and efficacy, the FDA has not evaluated this data.
STUDIES SHOW SAFETY OF TRANEXAMIC ACID
Several recent studies have examined the effects of topical, oral and injectable forms of tranexamic acid in treating melasma, finding that not only are the oral and injectable forms more effective, but all forms of tranexamic acid appear to be safe treatments, with minimal side effects reported.
One 2016 study published in the Journal of the American Academy of Dermatology included data from melasma patients from January 2010 to June 2014. In this study, oral tranexamic acid was used on its own or following topical or laser treatments. Nearly 90% of the 561 patients included in the study saw a significant improvement in the appearance of melasma after oral tranexamic treatment, which was well-tolerated among the group.
TRANEXAMIC ACID IS IN ORAL AND INJECTABLE FORMS
Tranexamic acid can be taken as a pill or injected directly into the affected area. Both of these methods have been shown to be safe and effective at treating melasma. Some studies have found that tranexamic acid may also be effective when applied during microneedling treatments.
While tranexamic acid is also used in topical skin-lightening products, studies show that it is not as effective as when taken orally or injected into dark spots in the face.
I personally do not like using laser or light treatments for melasma because they tend to make melasma worse. Instead, I have been using tranexamic acid for many of my melasma patients with incredible results.
WHO SHOULD NOT USE TRANEXAMIC ACID
If you are on estrogen, such as oral contraceptives or hormone replacement therapy, discuss tranexamic acid use with your doctor. You should also let your doctor know if you are currently pregnant prior to beginning tranexamic acid treatment to discuss potential risks.
BOTTOM LINE
Tranexamic acid is a safe and effective treatment option for melasma patients and is particularly effective in its oral and intradermal forms. However, you will need to continue wearing daily sunscreen, preferably a tinted SPF, and avoid sun exposure to reduce the risk of recurrent melasma, even after treatment.
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