Tranexamic Acid for Adults with Melasma: A Systematic Review and Meta-Analysis

Abstract

Objective Melasma is a highly prevalent, chronic, and pigmentary disorder. This systematic review aims to evaluate the efficacy and safety of tranexamic acid (TA) for the treatment of adults with melasma. Methods We independently searched 3 databases from beginning to 26 April, 2018. The study included 21 eligible trials. Two writers extracted data at the same time independently. Study outcomes were calculated by standardized mean differences (SMD) with 95% confidence intervals (CIs). All statistical analyses were performed using Review Manager Version 5.3 and STATA Version 15.1. Results The combined results showed that the use of TA was associated with reduced Melasma Area and Severity Index (MASI) and Melanin Index (MI). No significant difference in Erythema Index (EI) was observed with TA treatment. Side effects were minor, with a few cases reporting mild gastrointestinal reaction, oligomenorrhoea, hypopigmentation, urticarial rash, and skin irritation xerosis. Conclusion The meta-analysis suggested that TA treatment appeared to be a promising therapeutic approach for melasma.

Randomized control trial outcomes of tranexamic acid combination serum as a depigmenting agent for the use in healthy individuals

“…In recent years, tranexamic acid (TA) has emerged as a promising depigmenting agent with multiple mechanisms of action. The depigmenting property this agent has been extensively studied, particularly in the field of hyperpigmentation disorders, such as melasma (Zhang et al, 2018). As a novel agent, different preparations and concentrations have been used, either alone or as an adjunctive treatment, in multiple clinical trials, producing variable results (Kim, Moon, Cho, Lee, & Sung Kim, 2017;Zhang et al, 2018).…”

Clinical observation and dermoscopy evaluation of fractional CO2 laser combined with topical tranexamic acid in melasma treatments

“…As for the adverse reactions of oral TXA, local microneedle injection or intradermal injection of TXA 25 can make the drug directly acting on the skin lesion, while reducing the adverse reactions caused by oral administration and percutaneous absorption disorders of topical drugs. Although the value of TXA in treatment is controversial, it is a safe and effective method for melasma treatment 26 …”

In vitro human skin concentrations following topical application of 2% tranexamic acid in co‐enhancer cream and branded cream formulations

“…[13][14][15][16][17] 3 and 24 hours respectively were P < .001, P < .025, P < .025, P = .18, P < .01, and P < .005 respectively, significant at P ≤ .05. Figure 1 shows this same data but transformed into μg/cm 3 *Compared to Japanese branded tranexamic acid cream at same time and tissue; significant at P ≤ .05.…”

“…Over the last 10 years, tranexamic acid has been extensively studied in the treatment of melasma. Recent 2017‐18, comprehensive reviews of oral, dermally injected, and topical administrations of tranexamic acid in the treatment of melasma support the general therapeutic potential of this agent in melasma. The 2018 review of Bala et al, focusing on the use of oral tranexamic acid in the treatment of melasma, concludes that it is a safe and efficacious treatment for refractory melasma.…”