Tranexamic Acid (TXA or TA)

Frequently Asked Questions About
Tranexamic Acid for Melasma

• How does tranexamic acid work for melasma?

  Tranexamic Acid (TXA) is a particular version of the amino acid Lysine, which works within the skin to prevent melanocytes from fully forming new melanin. This is a harmless effect, but by inhibiting the skin from forming new melanin, we can stop the forming of new dark spots in patients with melasma.

• Does tranexamic acid lighten skin?

  No, tranexamic acid prevents your skin from laying down new pigment (or darkening) for a short period of time. Generally, this 3-6 month application of this drug allows those with melasma to calm down the overactive melanocytes that are causing this skin disorder, and it’s often paired with laser treatments that remove the existing dark patches, to create skin that’s even with your natural complexion tone.

• Is tranexamic acid FDA-Approved for treatment of melasma?

  No, tranexamic acid has not been FDA-approved for melasma specifically, but here’s why that doesn’t matter all that much.

  TXA has been FDA-approved for patients with blood and clotting disorders. Well, as we have been using tranexamic acid to treat these patients since the early 1960s, several of them also suffered from melasma and reported this happy side effect of a clearer complexion.

  Since the 1980s, several clinical studies have shown its safe and effective use in treating melasma (both in the US and internationally, on patients of all types) – but the pharmaceutical companies have decided not to (yet) pursue FDA approval (likely because each new FDA-approval costs several million dollars to go through the process, and because there is a good deal of drugs used off-label in the way tranexamic acid is for melasma, especially when the drug has a long history of safety and efficacy, as is in this case).

• How long can you take tranexamic acid for melasma?

  It is common to prescribe Tranexamic acid for 3-6 months when used as a treatment for melasma.

• How long does tranexamic acid take to work for melasma?

  In one study, comparing daily topical hydroquinone 2% versus intradermal injections of tranexamic acid performed monthly, the tranexamic acid showed much bigger results at the one-month mark². However, you will need 3-6 months to see the full results from prescription-strength TXA, whether that’s injected or pill format.

• How effective is tranexamic acid for melasma?

  When combined with a carefully chosen laser technology, appropriate for the skin type of the individual, tranexamic acid is very effective for melasma in either pill or micro-injected form. Topical tranexamic acid is less effective (remember that skincare strength is also far less potent).

• Is tranexamic acid safe for dark skin?

  Oral tranexamic acid is safe for the treatment of melasma in skin of color, but one needs to be cautious when it is used in its injectable form due to the risk of causing pigment alteration.

• Is tranexamic acid good for sensitive skin?

  In certain individuals with sensitive skin, topical tranexamic acid might be irritating.

• Is tranexamic acid prescription only?

  There are low-potency forms of topical tranexamic acid creams and skincare products available without a prescription, but these are not very effective.

• Is tranexamic acid prescription only?

  Treatment of melasma using tranexamic acid(TA) sometimes involves the use of a skincare cream that contains the TA. Generally, these creams are far less effective (and less concentrated) than injected, microneedled, or oral applications. However, tranexamic acid creams are available over-the-counter(OTC) without a prescription, making them affordable and accessible – if not all that effective.

• Does melasma come back after tranexamic acid?

  The jury is still out on whether TA significantly reduces the recurrence of melasma after the course of the medication is completed. This is an area of active study in medicine. However, what we do know is that the recurrence rate is at least as good as in those not treated – meaning it doesn’t make you more likely to have a recurrence or flare afterward. Right now, we know short-term recurrence is around 1/3 of people with melasma in a 3-month period¹, and there have been some small studies showing TXA can extend that when used in certain ways, but we need more data to say conclusively.

  Good skincare and especially strict avoidance of sun exposure are suggested as well as year-round full spectrum sunblock. We know that avoiding sun exposure and limiting hormonal fluctuations are both very helpful in preventing future melasma patches.

• Will tranexamic acid work for my melasma? Who should not take tranexamic acid for melasma?

  There’s no guarantee that tranexamic acid will work for you – and generally it has been thought of as a last resort of sorts for treating the melasma cases that are resistant to laser therapy and other medications, because it does have potential side effects, whereas laser therapy does not.

  However, in one review of 560 melasma patients treated with tranexamic acid, 89.7% saw an improvement³. Of those, only 1 experienced a serious complication of deep vein thrombosis, and she was later found to have a rare disease.

  Patients should not take tranexamic acid if they have a history of venous or arterial clots, actively smoke, or are taking oral contraceptive pills (birth control pills with hormones). Physicians at our practice review the medical history of the patient prior to prescribing the use of tranexamic acid, whether that’s topical or oral formulations because this drug is not safe for everyone to use.