Monthly Intradermal Microinjections of Tranexamic Acid Reduce Rosacea Symptoms

Intradermal microinjections of antifibrinolytic drug tranexamic acid were shown to safely and effectively reduce rosacea severity in patients with erythematotelangiectatic rosacea (ETR), according to study findings published in the Journal of Cosmetic Dermatology.

In this study, researchers retrospectively examined safety and efficacy outcomes in 6 patients with ETR who received 5 mg/ml tranexamic acid intradermal microinjections each month from 2019 to 2020. Subjective symptoms, clinical photographs, and the Investigator Global Assessment of Rosacea Severity Score (IGA‐ RSS) were assessed at baseline and after the final treatment. Investigators also examined tolerability of the microinjections.

The mean age of the participants was 49.5±14.6 years. Patients had rosacea for an average of 2.4 years before treatment. The average number of monthly microinjections was 5.1. Microinjections of monthly tranexamic acid was proposed as first-line treatment for 1 woman with both ETR and melasma.

Overall, the mean decrease of IGA-RSS for study participants was 2.4±0.5. A total of 5 patients who were refractory to oral doxycycline and/or topical metronidazole had a response responsive to the TXA microinjections.

Transient erythema and swelling were the primary local side effects reported in 3 patients. The investigators reported no systemic effects related to therapy. The duration of clinical improvement in rosacea in patients who responded to therapy was 3 months or more.

Limitations of this case series included its retrospective nature as well as the small number of patients in the overall cohort.

Given these limitations, the researchers noted that “randomized trials are needed to determine the optimal injection protocol and evaluate the long-term risk-benefit profile.”


Daadaa N, Litaiem N, Karray M, et al. Intradermal tranexamic acid microinjections: a novel treatment option for erythematotelangiectatic rosacea. Published online May 10, 2021. J Cosmet Dermatol. doi:10.1111/jocd.14209