From the Guidelines
Topical Tranexamic Acid (TXA) is not the most effective treatment for hyperpigmentation, specifically melasma, as PRP is significantly better than intradermal tranexamic acid in management of melasma. When considering treatment options for hyperpigmentation, it's essential to prioritize morbidity, mortality, and quality of life as the outcome. According to the most recent and highest quality study, 1, PRP is more effective than intradermal tranexamic acid in managing melasma.
Key Points to Consider
- The study published in 2025 in the journal Periodontology 2000, 1, found that PRP is significantly better than intradermal tranexamic acid in management of melasma.
- Another study, 1, found that PRP combined with oral TXA can improve the treatment effect of TXA alone in the treatment of melasma, maintaining normal levels of VEGF, ET-MSH, reducing disease recurrences.
- However, the most recent and highest quality study, 1, suggests that PRP is a more effective treatment option for melasma compared to intradermal tranexamic acid.
Treatment Recommendations
- Consider using PRP as a treatment option for hyperpigmentation, specifically melasma, as it has shown to be more effective than intradermal tranexamic acid.
- If TXA is still considered as a treatment option, use products containing 2-5% tranexamic acid applied once or twice daily for at least 8-12 weeks.
- Sun protection is essential while using any treatment for hyperpigmentation, as UV exposure can counteract its benefits.
- For enhanced results, consider combining TXA with other brightening agents like vitamin C, niacinamide, or alpha arbutin, but prioritize PRP as the most effective treatment option.
From the Research
Effectiveness of Topical Tranexamic Acid for Hyperpigmentation
- Topical Tranexamic Acid (TXA) has been studied as a treatment for melasma, a disorder of hyperpigmentation, and has shown to be safe and effective, although less effective than oral TXA 2.
- When compared to traditional treatments like hydroquinone, topical TXA was found to be better tolerated, but its efficacy as a standalone treatment was lower 2.
- Novel formulations and delivery systems, such as liposomes and microneedles, are being explored to improve the penetration and availability of TXA in the epidermal layer, potentially enhancing its effectiveness for hyperpigmentation disorders 3.
- A clinical study comparing topical TXA and vitamin C after microneedling for melasma treatment found both treatments to be effective and safe, with TXA showing improvement in the vascular component of melasma 4.
Comparison with Other Treatments
- Oral TXA has been found to be more effective than topical TXA for treating melasma, but it can cause gastrointestinal upset and menstrual irregularities, and its pro-thrombotic nature must be considered 2, 5.
- Hydroquinone, a traditional topical treatment for melasma, is effective but can have adverse effects, and oral TXA may be a promising alternative for refractory cases 5.
- Topical TXA can be combined with other cosmeceuticals to improve outcomes, and its use in conjunction with microneedling has shown potential for treating melasma 2, 4.
Future Directions
- Further research is needed to determine the long-term safety and efficacy of TXA for hyperpigmentation disorders, including melasma and other conditions like postinflammatory hyperpigmentation and lichen planus pigmentosus 5, 6.
- The development of novel formulations and delivery systems for topical TXA may improve its effectiveness and expand its use for various hyperpigmentation disorders 3.