Treating Melasma with Intradermal Tranexamic Acid Injection
Melasma is a common pigmentary disorder that is more common in women, though it can also affect men. It appears when these cells become hyperactive and produce too much pigments in certain areas of the skin such as cheeks, bridge of the nose, forehead, upper lip and sun-exposed areas such as forearms.
Traditionally, the first line of treatment for melasma includes skin bleaching agents, chemical peel, lasers and dermabrasion. However, these treatments yield varying results with may also cause adverse side effects such as skin irritation, mottled hypopigmentation and worsening of hyperpigmentation.
How does tranexamic acid work?
Tranexamic acid is a FDA approved medication to treat bleeding associated with heavy periods as well as to prevent excessive blood loss in susceptible patients with clotting disorders undergoing tooth extractions.
Coincidentally, tranexamic acid has been found to be a very useful derivative of the amino acid lysine that inhibits the activity of melanocytes that contribute to stubborn brown patches and dark spots in melasma. The largest study on the use of oral tranexamic acid for treatment of melasma was a retrospective chart review of 561 melasma patients, who received oral tranexamic acid in Singapore.1 The majority of patients also received other forms of treatment of their melasma, including bleaching creams and energy-based treatment.
However, it is important to note that among patients who received oral tranexamic acid over a 4-month period, 90% of patients demonstrated improvement in their melasma severity. 7% of patients experienced side effects; the most common side effects were abdominal bloating and pain. Notably, 1 patient developed deep vein thrombosis (DVT) during treatment and was later found to have protein S deficiency, a risk factor for developing DVT.1
Utility of Tranexamic Acid
There has been great interest in developing topical tranexamic acid treatments for melasma, considering the potential of side effects of the oral option. Various studies have shown efficacy of using topical tranexamic acid in conjunction with other treatments to increase absorption, including intradermal injection, micro-needling, and fractionated CO2 laser.
How often should I undergo this treatment?
At Radium Medical Aesthetics, we propose fortnightly treatments over a 3- month period. This can be done together with the current laser or other energy-based treatments. Important side effects include localised pain, redness, irritation swelling, bruising, which should settle within a few hours post-treatment. However do note that tranexamic acid treatments are not standalone treatments, and maintenance therapy and sun protection should be considered for patients with melasma.
Who should avoid this treatment?
You should avoid this treatment if you are:
- Someone with a personal or family history of blood clotting disorders;
- Someone with a personal or family history of heart attacks, strokes, DVT, pulmonary embolism; or
- Pregnant or currently breastfeeding
What is the downtime?
This is a simple and straightforward treatment that involves administering tiny amounts of TA intradermally into the skin. You may experience some skin redness but it should resolve on its own within the day.
Are there any side effects associated with this treatment?
You may experience skin redness for a longer period of time if you have sensitive skin. Some patients may experience erythema and swelling which should disappear within 1 to 2 hours after the treatment. Other common minor side effects reported include irritation, bruising and some pain at the injection site.
Lee HC, Thng TG, Goh CL. Oral tranexamic acid (TA) in the treatment of melasma: a retrospective analysis. J Am Acad Dermatol.2016;75:385-392.