Comparison of the therapeutic efficacy and safety of combined oral tranexamic acid and topical hydroquinone 4% treatment vs. topical hydroquinone 4% alone in melasma: a parallel‐group, assessor‐ and analyst‐blinded, randomized controlled trial with a short‐term follow‐up

Abstract

Oral TA can enhance the efficacy of hydroquinone 4% cream in melasma treatment, but the high incidence of relapse suggests that treatment effects may be temporary, warranting more investigation.

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

“…TA was delivered orally, topically, and through physical methods in these articles. The oral groups patients received a daily dose of 500mg or 750mg [ 11 , 13 , 15 , 18 – 22 , 24 , 27 ]. And the dose of injection TA ranged from 2-8mg to the entire affected area or was 0.2mg/cm 2 in affected area [ 12 , 17 , 24 , 27 – 29 ].…”

“…MASI score change was also compared to the routine treatment of melasma combined with or without TA adjuvant treatment in 6 studies [ 11 , 13 , 18 , 19 , 22 , 26 ]. Among these studies, routine treatment included low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet (QSNY) [ 11 , 22 ], topical 4% hydroquinone [ 13 , 18 , 19 ], and intense pulsed light (IPL) [ 22 , 26 ]. Oral TA was applied as an adjuvant treatment in 5 studies [ 11 , 13 , 18 , 19 , 22 ].…”

“…Among these studies, routine treatment included low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet (QSNY) [ 11 , 22 ], topical 4% hydroquinone [ 13 , 18 , 19 ], and intense pulsed light (IPL) [ 22 , 26 ]. Oral TA was applied as an adjuvant treatment in 5 studies [ 11 , 13 , 18 , 19 , 22 ]. And topical TA was applied only in 1 study [ 26 ].…”

“…In the included 21 studies, 10 trials were related to the side effects ( Table 1 ). The side effects of patients with melasma after oral TA application mainly showed gastrointestinal reaction such as heartburn, nausea, abdominal pain, and epigastric discomfort [ 11 , 13 , 19 , 24 ]. And some patients showed oligomenorrhoea, hypopigmentation, urticarial rash with angioedema, moderate myalgias, transient headache, anxiety, and depression [ 18 , 21 , 22 ].…”

“…A recent meta-analysis published during the last few years assessed the effectiveness and safety of TA for melasma [ 40 ]. Compared with previous systematic review, 12 studies [ 11 , 13 – 16 , 21 , 23 , 24 , 27 , 28 , 30 , 37 ] of this review were newly included. And most of these articles are published in 2017 or 2018.…”