Oral Tranexamic Acid May Be a Treatment for Melasma in Patients With Concomitant Vitiligo

Woman with melasma and magnifying glass
A multimodality approach to treating melasma may be the most successful.
Treatment outcomes and adverse events of oral tranexamic acid (TA) in patients with vitiligo and melasma were assessed.

The feasibility of oral tranexamic acid (TA) for the treatment of melasma in patients with concomitant vitiligo found support in study data published in Dermatologic Therapy.

Although oral TA is effective for refractory melasma, its use in patients with comorbid vitiligo is understudied. Investigators conducted a retrospective analysis of patients with vitiligo and melasma who received care at a dermatology center in Taiwan from January 2017 to August 2020. Patients were treated with oral TA at a starting dose of 250 mg twice daily for at least 2 months. Patients were followed up at 4- to 8-week intervals for 24 total weeks. Melasma and vitiligo improvement were defined by lesion repigmentation. The Physician Global Assessment (PGA) was used to evaluate improvements in both melasma and vitiligo over follow-up.

The study cohort comprised 32 patients with concomitant vitiligo and melasma of the face. Mean age at enrollment was 54.1 ± 10.0 years; 87.5% were women; and 12.5% were men. Patients experienced improvement of melasma after a mean treatment duration of 1.6 ± 0.8 months. First sign of vitiligo lesion repigmentation occurred after a mean treatment duration of 1.0 ± 0.4 months. The majority of patients (84.4%) achieved “mild” to “good” improvement of melasma at the end of follow-up per PGA scores. Similarly, 81.3% of patients achieved at least 25% improvement in vitiligo lesions. No significant adverse events were observed, nor any worsening of vitiligo symptoms. There were 3 patients who reported treatment-emergent side effects; 2 experienced headache and 1 experienced abdominal bloating.

Study limitations include the small study cohort and retrospective design.

Per these results, patients with melasma and co-occurring vitiligo may still benefit from TA as a melasma treatment. “Oral TA may be a feasible option for melasma in vitiligo patients,” investigators wrote. “A larger scale and prospective, randomized study are warranted to confirm the beneficial effect.”


Chiang PH, Lin YJ, Chiu YC, Chung WH, Ku CL, Ng CY. Feasibility of oral tranexamic acid (TA) for vitiligo patients with melasma. Dermatol Ther. Published online June 30, 2021. doi:10.1111/dth.15047