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Treatment of Melasma Using Tranexamic Acid

Melasma is an extremely common hyperpigmentation problem that affects many women and men. Common causes include chronic sun exposure, pregnancy, birth control pills, hormonal therapy, stress and thyroid conditions. Traditionally, the main forms of treatments for melasma have been topical bleaching agents and strict adherence to photoprotection. There are other adjunctive therapies such as chemical peels, dermabrasion and laser treatments. Efficacy of these adjunctive therapies have shown are variable and inconsistent. However, regardless of all these treatments, it is important to note that melasma is a chronic recurrent recalcitrant condition, prone to rebounds during different periods of our lives.

Treating patients with menorrhagia and reducing hemorrhage in patients with hemophilia undergoing tooth extraction are FDA-approved indications for Tranexamic Acid (TA). However, the efficacy of using TA for treating melasma has been widely used since the 1980s with a significant reduction in Melasma Area and Severity Index (MASI) score.

How does it work?

Prolonged sun exposure leads to synthesis of plasmin activator, which increases plasmin activity in keratinocytes. The plasmin leads to release of arachidonic acid which stimulates melanogenesis, a process by which melanin is produced. Increased plasmin elevates a melanocyte-stimulating hormone and fibroblast growth factor – both of which are potent melanocyte stimulators.

TA works by interfering with plasminogen binding to the keratinocyte. It reduces free arachidonic acid and thereby reduces the stimulation of melanogenesis. In addition, it reduces vascularity in melasma by reducing other melasma-inducing components in the skin.

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?

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.

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