Efficacy and safety of tranexamic acid 5% cream vs hydroquinone 4% cream in treating melasma: A split-face comparative clinical, histopathological, and antera 3D camera study

Dermatol Ther. 2020 Nov;33(6):e14240. doi: 10.1111/dth.14240. Epub 2020 Sep 14.


Various tranexamic acid (TA) formulations have been evaluated for treating melasma, yet the effectiveness of this therapy has not been efficiently comparatively analyzed. To assess and compare the therapeutic efficacy and safety of TA 5% vs hydroquinone (HQ) 4% creams in treating melasma. 100 melasma female patients were treated with daily application of TA 5% cream on right-sided facial lesions and HQ 4% cream on left-sided lesions for 12 weeks. Photographic documentation using digital and Antera 3D camera, Wood's light examination, calculation of Hemi Melasma Area and Severity Index (Hemi MASI), Melasma quality of life (MELASQOL) scores and area% of melanin through histopathological examination was done before and after treatment. Both TA 5% and HQ 4% creams yielded significant improvement of all melasma lesions after 12 weeks of treatment, with no significant difference in treatment response regarding Hemi MASI, MELASQOL scores and Antera average level of melanin (P > .05); however, significant reduction in area % of melanin was recorded with TA 5% than HQ 4% creams (P = .000). TA appears to be a promising therapeutic option in treating melasma with fewer adverse effects, same or even better results in comparison to HQ cream.

Keywords: hydroquinone; melasma; tranexamic acid.

MeSH terms

  • Female
  • Humans
  • Hydroquinones / adverse effects
  • Melanosis* / diagnosis
  • Melanosis* / drug therapy
  • Quality of Life
  • Tranexamic Acid* / adverse effects
  • Treatment Outcome


  • Hydroquinones
  • Tranexamic Acid