This patient has had melasma for 10+ years and has tried treatment before with both topical medications and also with lasers. She has a particularly stubborn case of melasma, where treatment with lasers provided only temporary results, and pigment came back pretty quickly thereafter, over a period of a few weeks to a month. For a long time, we used just lasers, because that’s the best technology we had to offer, but it is expensive to treat melasma all the time this way. And eventually, patients find that it’s just frustrating to spend so much and not have results that are maintained – again, this is not the typical case, but it does happen to some.
Tranexamic Acid has been used to treat melasma topically for many years – but it has always been a struggle to get it to penetrate deeply and evenly throughout the skin, so that it could have full effect. Doctors in the middle east started prescribing oral tablets of the medication and reported good results in studies with small numbers of patients a few years back. Dr. Chasin, always being one to read up on the newest treatments, became aware of this option a few years ago. At first, he followed the prescribing guidelines of those limited studies – using the medication in certain skin types and with a set dosage – but over time, wider clinical studies have begun to come out with a wider variety of ethnicities and skin tones, and also with more dialed in dosage information, and that has allowed him to feel safe in providing this option to more of the patients who can benefit from it. Not everyone will be a good candidate for the treatment of melasma with tranexamic acid, but for those who fall into the right selection criteria, we’ve found this medication in combination with laser therapy to be extremely effective.