Tranexamic Acid Treatment for Melasma: A Preliminary Analysis

melasma woman face
melasma woman face
The safety and efficacy of oral tranexamic acid as a treatment for melasma is assessed.

Oral tranexamic acid (TXA), used commonly in East Asia to treat hyperpigmentation during and after pregnancy, was found to be a safe and effective treatment for patients with melasma, according to data from a preliminary risk-benefit analysis published in the Journal of Cosmetic Dermatology.

Investigators retrospectively obtained adverse event data from adult patients who were prescribed oral TXA for melasma at a private dermatology practice in California. Patients were instructed to take half of a 650 mg TXA tablet twice daily, and to discontinue treatment when they were satisfied with their melasma improvement or experienced “adverse side effects” that negatively affected their quality of life. They did not screen for age, disease severity, or comorbidities aside from stroke or cardiovascular disease. Patients in the sample were given a survey to self-report any change in their melasma severity and any adverse side effects noticed while taking TXA.

There were 42 patients included in the study: 2 men with a mean age of 55.5±7.7 years and 40 women with a mean age of 48.3±7.6 years, respectively. Patients took TXA for an average of 12.7 months, and skin phenotypes ranged from Fitzpatrick type III to type VI. All patients were also currently applying other melasma treatments.

There were 7 (16.7%) patients, all women, who experienced adverse side effects, including throbbing headaches, abdominal discomfort, malaise and nausea, menstrual changes, rhinorrhea, and lower body numbness. Some patients were unsure if the adverse side effects were directly caused by TXA, and all adverse side effects resolved completely when TXA was discontinued.

In terms of melasma severity, 16 patients who took TXA for an average of 20 months reported a great deal of improvement, 3 reported “a lot” of improvement, 8 who took TXA for an average of 17.3 months reported “moderate” improvement, and 4 who took TXA for an average of 9.3 months reported “a little” improvement. There were 11 patients who reported no improvement, and the average duration of their TXA treatment was 2.5 months. Overall, 73.8% of patients reported at least “a little” improvement, the researchers found.

The study was limited by its small, homogenous patient sample, lack of follow-up, and recall bias, as some patients were surveyed as much as 5 years after TXA discontinuation.

“The collected data suggests the degree to which an individual’s melasma improved while taking TXA is correlated with the duration for which they take” the medication, the study authors wrote.


Simpson J, Peng L, Ting W. Evaluation of oral tranexamic acid as a novel treatment for melasma with a high benefit-risk ratio. J Cosmet Dermatol. Published online August 16, 2022. doi:10.1111/jocd.15305