Topical tranexamic acid is a promising treatment for melasma. Tranexamic acid (TA) has been reported to have whitening effects especially for ultraviolet-induced hyperpigmentation including melasma. The aim of a 12-week double-blind split-face trial was to evaluate a topical solution of TA and compare it with combined solution of hydroquinone and dexamethasone as the gold standard treatment of melasma. Fifty patients applied topical solution of 3% TA on one side of the face, and topical solution of 3% hydroquinone + 0.01% dexamethasone on the other side twice daily. The Melasma Area and Severity Index (MASI) and the side effects were evaluated at baseline and every 4 weeks, and photographs taken before and after were compared by a dermatologist. A significant decreasing trend was observed in the MASI score of both groups with no significant difference between them during the study. No differences were seen in patients’ and investigators’ satisfaction of melasma improvement between two groups. However, the side effects of hydroquinone + dexamethasone were significantly prominent compared with TA. This study’s results suggest that topical tranexamic acid may be preferred over hydroquinone + dexamethasone for the treatment of melasma.

Topical tranexamic acid has also been studied as an adjuvant treatment in melasma. The main objective of the following study was to evaluate the benefits of topical TA combined with intense pulsed light (IPL) treatment in Asians with melasma. A randomized, split-face (internally controlled) study was conducted in 15 women who received four monthly sessions of IPL to both sides of the face. Topical TA or vehicle was applied to a randomly assigned side during and after IPL treatment. Patients were followed up for 12 weeks after completing the IPL treatments. Baseline and follow-up melanin index (MI) and modified melasma area and severity index (mMASI) scores were determined. Thirteen subjects completed the study without serious adverse events. MI and mMASI decreased significantly from baseline to 12 weeks after the last IPL treatment on the topical TA side but not on the vehicle side. The prevention of rebound pigmentation by topical application of TA after IPL treatment was also statistically significant. Topical TA can be considered as an adjuvant to conventional treatment for melasma.


J Res Med Sci. 2014 Aug;19(8):753-7.
J Dermatolog Treat. 2015 Dec 4:1-5. [Epub ahead of print]