Oral tranexamic acid (TA) in the treatment of melasma: A retrospective analysis

J Am Acad Dermatol. 2016 Aug;75(2):385-92. doi: 10.1016/j.jaad.2016.03.001. Epub 2016 May 17.


Background: Melasma is a common pigmentary disorder among Asians and treatment is challenging. Oral tranexamic acid (TA) has emerged as a potential treatment for refractory melasma. Large-scale studies on its use, outcomes, and safety are limited.

Objective: We sought to evaluate treatment outcomes and adverse effects of oral TA in melasma in an Asian population.

Methods: We conducted a retrospective analysis of patients who received oral TA for melasma in a tertiary dermatologic center from January 2010 to June 2014.

Results: In all, 561 patients (91.4% female, 8.6% male) were enrolled. Median duration of treatment was 4 months. The majority (503 [89.7%]) improved, 56 (10.0%) had no improvement, and 2 (0.4%) worsened. Patients without family history of melasma had better response rates than those with family history (90.6% vs 60.0%, P = .01). Of the 503 who improved, response was seen within 2 months of TA initiation, with a relapse rate of 27.2%. Adverse events occurred in 40 (7.1%). Most were transient, but 1 developed deep vein thrombosis requiring prompt discontinuation. She was later given the diagnosis of familial protein S deficiency.

Limitations: This was a retrospective study.

Conclusion: Oral TA may be an effective adjunct for refractory melasma. Careful screening for personal and familial risk factors for thromboembolism should be done before initiation.

Keywords: angiogenesis; chloasma; facial pigmentation; melanogenesis; melasma; tranexamic acid.

MeSH terms

  • Administration, Oral
  • Adult
  • Asian People
  • Dermatologic Agents / adverse effects
  • Dermatologic Agents / therapeutic use*
  • Facial Dermatoses / drug therapy*
  • Facial Dermatoses / ethnology
  • Female
  • Gastrointestinal Diseases / chemically induced
  • Headache / chemically induced
  • Humans
  • Male
  • Melanosis / drug therapy*
  • Melanosis / ethnology
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Singapore
  • Tranexamic Acid / adverse effects
  • Tranexamic Acid / therapeutic use*
  • Treatment Outcome
  • Venous Thrombosis / chemically induced


  • Dermatologic Agents
  • Tranexamic Acid