Luminous Booster Programme
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.
People, especially older women who are concerned about brown or grayish patches on the face which cannot seem to go off even with topical medications or laser treatments.