The Use of Tranexamic Acid to Prevent and Treat Post-Inflammatory Hyperpigmentation

Abstract

The patient had no contraindications for oral TXA. Given the high concern for PIH, she was prescribed TXA 650 mg daily and clobetasol 0.05% cream twice daily. The clobetasol cream was discontinued after one week and TXA was discontinued after eight weeks. Sixteen weeks later, she presented with normalappearing skin. Her previous similar episode of PIH had been treated with clobetasol 0.05% cream for 2 weeks followed by hydroquinone 4% and monthly light chemical peels, leading to resolution only after six months. We believe the addition of TXA was responsible for her quick recovery without PIH, and without multiple chemical peels or prolonged use of hydroquinone (Figure 2). CASE 2 A 20-year-old woman with Fitzpatrick skin type 4, presented with acne, acne excorie, and PIH (Figure 3, left side). She was treated with topicals (sunscreen and tretinoin 0.05%) and daily spironolactone 100 mg. A series of light chemical peels was planned. She was prophylactically prescribed oral TXA 650 mg daily for her ongoing excoriation and concern that the peels would exacerbate her current PIH. Over a period of 2.5 years, she completed nine exfoliative chemical peels (Vitalize peels, Allergan, Irvine, CA) without any complications (Figure 3, right side). She did not develop any new PIH during this time despite continued excoriation.

Hyperpigmentation: Looking beyond hydroquinone

“…The primary constituents of Psoralea corylifolia , bakuchiol (meroterpene), and flavonoids (isobavachin and isobavachalcone) show broad antioxidative effects including protection of biological membranes against oxidative stresses 76 . Bakuchiol in particular showed protective action against oxidative hemolysis of red blood cells and excellent antibacterial activity against various oral pathogens 37–78 . Bakuchiol 0.5% cream and retinol 0.5% cream produced a comparable effect in reducing wrinkle surface area and hyperpigmentation in a randomized double‐blind study involving 44 patients.…”

“…Three percent topical solution of tranexamic acid was found comparable in efficacy to topical solution of 3% hydroquinone + 0.01% dexamethasone in terms of decrease in MASI score, patient's and investigator's satisfaction of melasma improvement. Side effects were prominent in the case of hydroquinone +dexamethasone 46,47 …”

“…Side effects were prominent in the case of hydroquinone +dexamethasone. 46,47 Cetyl tranexamate mesylate derivative of tranexamic acid improved melasma and erythema indexes and was well tolerated. 45 Three percent tranexamic acid, 1% kojic acid, and 5% niacinamide were effective for treating hyperpigmentary conditions including melasma in female subjects with Fitzpatrick skin type I-IV.…”

755-nm Alexandrite Picosecond Laser with a Diffractive Lens Array or Zoom Handpiece for Post-Inflammatory Hyperpigmentation: Two Case Reports with a Three-Year Follow-Up

“…1 Current treatments mainly include topical medications, oral tranexamic acid, chemical peels, laser therapy, and other methods. 2,3 Previous reports have described improvement in PIH after treatment with intense pulsed light, a 1064-nm Q-switched laser, a 694-nm ruby laser, and a non-ablative 1927-nm fractional laser. 4,5 However, as laser therapy itself may aggravate PIH, caution is required in its clinical application.…”

A Focused review on the pathophysiology of post‐inflammatory hyperpigmentation

“…Epidermal growth factor (EGF) is a ubiquitous protein involved in the growth, proliferation, and differentiation of keratinocytes and fibroblasts. (Lindgren et al, 2021) Recently, several studies have implicated EGF in melanin regulation. Although it was historically believed that melanocytes lacked EGF receptors (EGFR), an in vitro study (Bodnar, 2013) has demonstrated the wide expression of EGFR on melanocytes and suggested that EGF interferes with keratinocytes' ability to promote melanogenesis.…”