Optimizing Melasma Management With Topical Tranexamic Acid: An Expert Consensus

Abstract

Because of its complex pathogenesis, chronicity, and high rates of recurrence, melasma is regarded as a challenging skin disorder. Topical treatments are often offered as first-line therapy. However, many patients are unaware that melasma is recurrent and requires long-term management. Hydroquinone is effective for controlling relapses and has become the standard of care for melasma in many countries. Nonetheless, it is limited by its side effect profile. Certain patient profiles who have had prior therapy and/or are refractory to treatment may be offered an alternative, that is topical tranexamic acid (TXA) alone or in combination with other modalities. This review provides a summary of current evidence on topical TXA as a treatment for certain case profiles. This paper aims to fill knowledge gaps in terms of currently available options, highlighting the role of topical TXA alone or in combination with other active ingredients (ie, topical TXA 2% with patented delivery technology).

Amber photobiomodulation versus tranexamic acid for the treatment of melasma: protocol for a double-blind, randomised controlled trial

“…TXA binds to plasminogen and inhibits the conversion of plasminogen to plasmin, reducing melanogenesis due to decreased production of prostaglandins 49. It may also act on melasma vascular component, reducing erythema 50.…”

“…It may also act on melasma vascular component, reducing erythema 50. However, TXA presents some disadvantages, especially when considering its chemical structure and properties, since due to this, some topical formulations of TXA do not achieve therapeutic concentrations at the dermal–epidermal junction where it acts in the skin 49. In this sense, alternatives to TXA are warranted and PBM might be an interesting possibility, since it may act on both melanogenesis and the vascular component of melasma.…”

“…48 TXA binds to plasminogen and inhibits the conversion of plasminogen to plasmin, reducing melanogenesis due to decreased production of prostaglandins. 49 It may also act on melasma vascular component, reducing erythema. 50 However, TXA presents some disadvantages, especially when considering its chemical structure and properties, since due to this, some topical formulations of TXA do not achieve therapeutic concentrations at the dermal-epidermal junction where it acts in the skin.…”

Image classification and auxiliary diagnosis system for hyperpigmented skin diseases based on deep learning

“…Melasma (ML) [ 1 ], naevus fusco-caeruleus zygomaticus (NZ) [ 2 ], freckles (FC) [ 3 ], cafe-au-lait spots (CS) [ 4 ], nevus of ota (NO) [ 5 ], and lentigo simplex (LS) [ 6 ] are common hyperpigmented skin diseases on the face that seriously affect the aesthetics and social activities of patients [ 7 ]. Medical doctors diagnose a disease mainly by integrating clinical symptoms, medical images, and laboratory test results [ 8 ].…”