Oral Tranexamic Acid for the Treatment of Melasma: A Review

Bala, Harini Rajgopal; Lee, Senhong; Wong, Celestine; Pandya, Amit G.; Rodrigues, Michelle

doi:10.1097/dss.0000000000001518

Cited by 88 publications

(117 citation statements)

References 54 publications

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“…Melasma is an acquired type of hyperpigmentation that is displayed as asymptomatic symmetric reddish‐brown or gray‐blue macules or patches mainly localized in the sun‐exposed body areas, namely chin, cheek, forehead, and upper lip . As the sun‐exposed sites are also the visible ones, melasma is reported to negatively affect the quality of life .…”

Section: Introductionmentioning

confidence: 99%

“…As the sun‐exposed sites are also the visible ones, melasma is reported to negatively affect the quality of life . Pregnant women and those who use oral contraceptives (OCP) are reported as particularly susceptible to develop melasma . Despite ethnicity seeming to play a role, as testified by the high prevalence in Asians and Hispanics, the environmental variables remain the only proved risk factors.…”

Section: Introductionmentioning

confidence: 99%

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Melasma and thyroid disorders: a systematic review and meta‐analysis

et al. 2019

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AbstractsBackground Thyroid hormones may play a key role in melasma; however, melasma link with thyroid disorders remains controversial.Objectives To compare the serum levels of thyroid-stimulating hormone (TSH), T4, T3, anti-thyroid peroxidase (anti-TPO), and antithyroglobulin between patients with melasma and control group using meta-analysis.Methods We screened 10 databanks and search engines, searched mesh and nonmesh terms. The identified evidences were reviewed and quality assessed using the Newcastle-Ottawa Scale (NOS). The heterogeneity between the primary results was investigated using Cochrane and I-square indices. Random effect model was applied to combine the standardized mean differences of thyroid function indicators between patients with and without melasma. P values meta-analysis was used to investigate the association between anti-TPO and melasma. ResultsWe included seven studies, 473 cases, and 379 controls that had been investigated. The total standardized mean differences (95% confidence intervals) of TSH, T3, T4, and antithyroglobulin antibody between cases and controls were estimated to be 0.33 (0.18, 0.47), À0.01 (À0.20, 0.19), À1.50 (À2.96, À0.04), and 0.62 (0.14, 1.11), respectively. The corresponding figures among women were 0.35 (0.17, 0.52), 0.10 (À0.17, 0.38), À2.75 (À6.30, 0.81), and 0.99 (0.14, 1.83), respectively. P value of metaanalysis showed a significant relationship between anti-TPO serum level and melasma (Fisher = 26.80, P = 0.020).Conclusion Serum levels of TSH, anti-TPO, and antithyroglobulin antibody were significantly higher in patients with melasma than those without melasma. Moreover, these differences were more severe among women with melasma. What is new?• Melasma is an acquired type of hyperpigmentation and might be associated with thyroid disorders.• Results of the present study showed that serum levels of TSH, anti-thyroid peroxidase (anti-TPO), and antithyroglobulin antibody were significantly higher in patients with melasma than those without melasma. Moreover, these differences were more severe among women with melasma.• Serum levels of TSH, anti-TPO, and antithyroglobulin antibodies are associated with melasma, especially among women. Risk of biasThe Newcastle-Ottawa Scale (NOS) checklist was applied to determine the risk of bias in primary studies. This checklist evaluates the studies in three section including selection (four scores), comparability (two scores), and exposure (three scores). Each study was achieved between 0 and 9 scores, and studies with less than five scores were removed from the metaanalysis. The quality assessment was performed by two independent methodologists. 20

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Melasma and thyroid disorders: a systematic review and meta‐analysis

et al. 2019

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“…Oral TA is a safe and efficacious treatment for refractory melasma. It should be considered in cases that are unresponsive to topical hydroquinone and combination topical therapy over a period of approximately 12 weeks and without contraindications to oral TA [11].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Refractory Melasma with Oral Tranexamic acid: A Case Report

2019

IJCED

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Melasma, an acquired disorder of hyperpigmentation is common in Indians. Though topical skin lightening agents are available, the success rates are often variable. Management of melasma is a challenge and the search for a safe and effective therapy continues. Many studies suggested the use of oral tranexamic acid (TA) as a treatment modality for melasma. Herein we report a case of female patient with refractory melasma who showed an improvement with a combination of oral tranexamic acid 250 mg and pine bark extract 50 mg twice daily during 8 weeks treatment period. Also, there was no recurrence seen in 3 month follow-up period. This treatment modality was well tolerated.

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“…11,12 More recently, systemic approaches for the treatment of melasma have been proposed. There is a growing interest in oral antioxidant supplements like extract of Polypodium leucotomos, green tea extract and vitamin C. [13][14][15] These ingredients improve photoprotection by decreasing the production or limiting the effect of the oxidative stress. Their effect in melasma is, however, poorly documented.…”

Section: Introductionmentioning

confidence: 99%

<p>A Treatment Combination of Peels, Oral Antioxidants, and Topical Therapy for Refractory Melasma: A Report of 4 Cases</p>

Piquero-Casals¹,

Granger

Piquero-Casals³

et al. 2020

CCID

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Background: Melasma is a difficult-to-treat, recurrent pigmentary disease. Combined therapy gives better, longer-lasting results. Objective: To determine the clinical effects of a treatment protocol of trichloroacetic acid, phytic acid and ascorbic acid peel combined with oral antioxidant supplement and topical treatment for refractory melasma. Patients and Methods: We present four cases of patients with melasma, who, despite multiple treatments including hydroquinone, showed no improvement. We initiated a 16week protocol involving 3 in-clinic peels (4 weeks apart) and a daily home treatment. The peels contained 30% trichloroacetic acid, 2% phytic acid, 8% L-ascorbic acid, Camellia sinensis leaf extract and Vitis vinifera seed extract. The home treatment was a depigmenting serum (4-butyl resorcinol, hydroxy-phenoxy propionic acid and niacinamide), a specific SPF50+ sunscreen, and an oral supplement (Polypodium leucotomos; green tea extract; Vitis vinifera; vitamins C, E, and D; and carotenoids), all in the morning, and, at night, a compounded gel-cream (4% hydroquinone, 0.025% tretinoin and 1% hydrocortisone). After 16 weeks, the gel-cream was stopped; the rest of the regimen (topical and oral) was continued for 12 further weeks. Melasma was assessed using the melasma severity scale (MSS) before starting the protocol, and at 4 and 12 weeks after the last peel. Photographs were taken before treatment and at the last evaluation. Patients indicated their satisfaction on a 5-point scale. Results: All patients had good tolerance to the procedures. Three showed an excellent (>75%) improvement and one showed a good (50-75%) improvement. All four were very satisfied. At follow-up (12 weeks after last peel), no patients had recurrence. Conclusion: This protocol of trichloroacetic acid, phytic acid and ascorbic acid peel combined with an oral supplement and topical daily treatment is a viable treatment option for refractory melasma.

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Oral Tranexamic Acid for the Treatment of Melasma: A Review

Abstract: Oral TXA is a safe and efficacious treatment for refractory melasma. It should be considered in cases that are unresponsive to topical hydroquinone and combination topical therapy over a period of approximately 12 weeks and without contraindications to oral TXA.

Cited by 88 publications

References 54 publications

Melasma and thyroid disorders: a systematic review and meta‐analysis

Melasma and thyroid disorders: a systematic review and meta‐analysis

Treatment of Refractory Melasma with Oral Tranexamic acid: A Case Report

<p>A Treatment Combination of Peels, Oral Antioxidants, and Topical Therapy for Refractory Melasma: A Report of 4 Cases</p>

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