Melasma and tranexamic acid: another study

Effect of tranexamic acid on melasma: a clinical trial with histological evaluation.

Na JI, Choi SY, Yang SH, Choi HR, Kang HY, Park KC.

J Eur Acad Dermatol Venereol. 2013 Aug;27(8):1035-9. doi: 10.1111/j.1468-3083.2012.04464.x. Epub 2012 Feb 13.

• Melasma is associated with an increased density of blood vessels
• Tranexamic Acid (TA) acts on inhibition of plasmin and has shown efficacy when taken orally.

• In this study, the authors sought to study the effect of topical and oral TA.
• In this prospective study, 25 women were enrolled for a duration of 8 weeks:
  • orally (125mg of TA, 50mg of ascorbic acid, 40mg og l-cysteine, 4mg of calcium panthothenate, 1mg of pyridoxine chloride): took 2 tablets three times a day
  • topically: applied a cream containing TA (2% TA and 2% niacinamide) 3 times a week + sunscreen
• Erthema and pigmentation were measured with a mexameter.
• Biopsies were done at baseline and after 8 weeks in 8 subjects

• Results:
  • 3 patients didn’t complete the study
  • Melanin index (MI) scores as well as erythema (EI) decreased in lesions but increased in perilesional skin
  • MI:
    • Lesional skin decrease from 191.48 to 184.82 (statistically significant)
    • Perilesional skin increase from 120.3 to 129.70 (statistically significant)
  • Histology showed reduced epidermal pigmentation, reduced dermal vessels and increased mast cell numbers.

• Comments:
  • Note that in this study oral AND topical TA are used together
  • Decrease of melanin index by just over 5% is very low and the result is not very impressive. However normal skin already has an index of 120.