Tranexamic Acid in the Treatment of Melasma: A Review of the Literature

Abstract

Melasma is a common acquired pigmentary disorder marked by irregular hyperpigmented macules or patches and most commonly occurs in women of darker skin color. It is a chronic often-relapsing condition that causes negative psychosocial effects in those affected. Current treatments such as hydroquinone, kojic acid, and retinoids, among others, demonstrate variable efficacy and side-effect profiles. We conducted a comprehensive literature review examining the use of tranexamic acid (TA), a well-known anti-fibrinolytic agent, in the treatment of melasma. TA delivered orally, topically, and through physical methods works via the inhibition of ultraviolet (UV)-induced plasmin activity in keratinocytes. Predefined search terms were entered into PubMed. Articles were then independently screened by two authors to include only those written in the English language and relating to human subjects with at least mild melasma. The search identified 28 articles, 15 of which met the criteria for full review. The review revealed that TA treatment for melasma is equally effective or more effective than other standard therapies and may induce fewer side effects. Our comprehensive review suggests that TA may be a promising treatment option for melasma because of its demonstrated effectiveness alone and in combination with other modalities as well as its limited side-effect profile.

Melasma Tipe Epidermal Diterapi Dengan Injeksi Asam Traneksamat Intradermal Serial Dan Tabir Surya

“…Melasma merupakan kondisi kronis yang sering kambuh dan menyebabkan efek psikososial negatif pada orang yang mengalaminya. 1 Kelainan ini terlihat pada wanita usia reproduktif dengan onset biasanya setelah kehamilan. 2,3 Peningkatan pigmentasi merupakan ciri utama melasma.…”

“…9,12 Makula hiperpigmentasi berwarna coklat muda sampai dengan tua pada 71elisma ditandai dalam tiga pola distribusi yang berbeda: sentrofasial 63% (dahi, pipi, hidung, bibir atas, dan dagu), malar 21% (mempengaruhi pipi dan hidung), atau mandibular 16% (sepanjang garis rahang). 1,8,11 Pemeriksaan lampu wood menunjukkan tipe epidermal (8-66%) terjadi peningkatan deposisi melanin epidermal (8-66%), tipe dermal (11-12%) dan tipe campuran (23-80%). 11,13,14 Beberapa faktor yang dapat memperparah atau mempercepat melasma antara lain paparan sinar ultraviolet (UV), hormon seks, kerentanan genetik, kehamilan, pil kontrasepsi oral, kosmetik, obat-obatan (agen fototoksik, antikonvulsi, fenotiazin), kelainan ovarium dan tiroid ringan.…”

“…11,13,14 Beberapa faktor yang dapat memperparah atau mempercepat melasma antara lain paparan sinar ultraviolet (UV), hormon seks, kerentanan genetik, kehamilan, pil kontrasepsi oral, kosmetik, obat-obatan (agen fototoksik, antikonvulsi, fenotiazin), kelainan ovarium dan tiroid ringan. 1,3,8,13 Kecenderungan genetik ditunjukkan dengan 54% pasien memiliki riwayat keluarga. 13 Onset melasma setelah kehamilan atau penggunaan kontrasepsi oral menunjukkan hormon sebagai faktor presipitasi melalui upregulasi reseptor estrogen dan efek downstream yang bervariasi.…”

The use of tranexamic acid for on‐demand and prophylactic treatment of hereditary angioedema—A systematic review

“…As such, TXA blocks the activation of the complement system and immune cells such as neutrophils, thus attenuating the symptoms of HAE . TXA can be administered orally or intravenously and is utilized in the management of perioperative bleeding, trauma, and also in the treatment of melasma . Although TXA is generally well tolerated with a low adverse event rate, there are concerns regarding lack of efficacy compared with other widely available treatment options, that is, C1‐INH replacement therapy and attenuated androgens .…”

“…21 TXA can be administered orally or intravenously 19 and is utilized in the management of perioperative bleeding, 22 trauma, 23 and also in the treatment of melasma. 24 Although TXA is generally well tolerated with a low adverse event rate, there are concerns regarding lack of efficacy compared with other widely available treatment options, that is, C1-INH replacement therapy and attenuated androgens. 25 Moreover, many patients continue to experience intermittent swellings and require additional use of rescue medication while on TXA prophylaxis.…”