Dermatologic Therapy, Vol. 00, 2016, 00–00
V
DOI:10.1111/12332
JOURNAL HIGHLIGHTS
Efficacy of topical tranexmic
acid in the treatment of
melasma
KEYWORDS: melasma, topical tranexamic acid, treatment
Melasma is a common acquired dyspigmenta-
tion, characterized by light to dark brown
patches in the sun-exposed areas. The role of
factors such as genetic susceptibility, ultraviolet
exposure, hormonal factors, phototoxic drugs,
and cosmetics have been reported in its appear-
ance. Its therapy is a big challenge. Sunscreens,
bleaching agents, tretinoin, topical corticoste-
roids, peeling agents, and lasers have been used
in treating melasma (1).
Tranexamic acid (TA) is a hemostatic drug.
This agent seems to be effective in treating mel-
asma through its antiplasmin activity and subse-
quent decreased levels of arachidonic acid and
alpha-melanocyte-stimulating hormone (1).
Herein, we have summarized studies which have
assessed the efficacy of topical TA in treating
melasma:
1. In a split-face trial, Kanechorn Na Ayuthaya
evaluated the efficacy of topical 5% TA in com-
parison with its vehicle. This study revealed
that not only the therapeutic response induced
by TA was not superior, but also erythema as
side effect was seen only with TA (2).
2. Na et al. assessed the effect of oral and topical
TA combination. This study revealed its clini-
cal effectiveness and also showed reversion of
melasma-related pathologic changes like ves-
sel number and increased numbers of mast
cells (3).
Address correspondence and reprint requests to: Nooshin
Bagherani, MD, Dermatologist, Dr. Nooshin Bagheran’s Office,
Taha Physicians’ Building, P.O. Box 6414715878,
Khoramshahr, Khuzestan Province, Iran, or email:
nooshinbagherani@yahoo.com.
C 2016 Wiley Periodicals, Inc.
DERMATOLOGIC THERAPY
ISSN 1396-0296
3. In a split-face trial, the efficacy of topical 3% TA
was compared with topical3% hydroquinone 1
0.01% dexamethasone. In this study, Ebrahimi
and Naeini concluded that the topical TA was
effective and safe therapeutic option (1).
4. In a split-face trial, Banihashemi et al. com-
pared the efficacy of topical 5% liposomal TA
with 4% hydroquinone cream. The authors
showed that topical TA can be as an effective
and safe therapeutic option (4).
5. In combination with intense pulsed light ther-
apy, Chung et al. in a randomized split-face
clinical trial compared topical TA with pla-
cebo. The authors revealed the effectiveness
and safety of TA as adjuvant to conventional
therapy (5).
Commentary: Although most of the mentioned
therapy revealed the effectiveness of TA in treating
melasma, more robust studies with more cases are
needed to confirm this effectiveness.
NOOSHIN BAGHERANI* & BRUCE R. SMOLLER†‡
*Dr. Nooshin Bagheran’s Office, Taha Physicians’
Building, Khoramshahr, Khuzestan Province,
Iran, †Department of Pathology
‡
and Department of Dermatology, University of
Rochester, School of Medicine and Dentistry,
Rochester, New York
References
1. Ebrahimi B, Naeini FF. Topical tranexamic acid as a prom-
ising treatment for melasma. J Res Med Sci 2014: 19 (8):
753–757.
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2. Kanechorn Na Ayuthaya P, Niumphradit N, Manosroi A,
Nakakes A. Topical 5% tranexamic acid for the treatment of
melasma in Asians: a double-blind randomized controlled
clinical trial. J Cosmet Laser Ther 2012: 14 (3): 150–154.
3. Na JI, Choi SY, Yang SH, Choi HR, Kang HY, Park KC.
Effect of tranexamic acid on melasma: a clinical trial with
histological evaluation. J Eur Acad Dermatol Venereol
2013: 27 (8): 1035–1039.
4. Banihashemi M, Zabolinejad N, Jaafari MR, Salehi M,
Jabari A. Comparison of therapeutic effects of liposo-
mal tranexamic acid and conventional hydroquinone
on melasma. J Cosmet Dermatol 2015: 14 (3): 174–
177.
5. Chung JY, Lee JH, Lee JH. Topical tranexamic acid as an
adjuvant treatment in melasma: side-by-side comparison
clinical study. J Dermatolog Treat 2015: 2: 1–18.