Oral Tranexamic Acid for Melasma Treatment
Oral tranexamic acid (TXA) is an effective second-line treatment option for melasma with a favorable benefit-risk profile, demonstrating 49% reduction in modified Melasma Area and Severity Index (mMASI) scores after 3 months of treatment. 1
Efficacy of Oral TXA
- Oral TXA provides rapid and sustained improvement in melasma treatment, with statistically significant decreases in MASI scores at 8 and 12 weeks compared to routine topical treatments alone 2
- Studies show TXA is effective even at low doses (500 mg daily) over short periods (8-12 weeks), particularly in patients with moderate-to-severe melasma 3
- Patients with severe melasma show greater improvement with oral TXA than those with moderate melasma 1
- Treatment effects may persist for up to 3 months after discontinuation, with a 26% reduction in mMASI scores compared to baseline 1
Recommended Dosing Protocol
- The typical dosage ranges from 250 mg twice daily to 650 mg twice daily 4, 3
- Treatment duration is generally 3 months, with follow-up evaluation one month after the last treatment 2, 1
- Maintenance treatments may be required as melasma is a chronic condition with high recurrence rates 5
Combination Therapy Approaches
- PRP combined with oral TXA demonstrates higher efficacy (90.48%) compared to TXA alone (73.68%) with lower recurrence rates 5
- TXA should be used alongside strict sun protection measures, which form the foundation of any melasma treatment regimen 6, 5
- Sun protection should include broad-spectrum sunscreen (SPF 30 or higher, preferably SPF 50+) reapplied every 2-3 hours during outdoor exposure 5
Safety Profile
- Oral TXA has a good safety profile with minimal side effects, making it suitable for long-term management of melasma 4, 1
- Common side effects include headaches, gastrointestinal upset, malaise, nausea, and menstrual irregularities 4
- Side effects are typically mild and resolve upon discontinuation of the medication 4
- Patients should be screened for contraindications and risk factors prior to starting therapy 3
Treatment Algorithm
- Begin with strict sun protection and first-line topical therapy (tretinoin, hydroquinone, corticosteroids) 6, 5
- If inadequate response after 8-12 weeks, consider adding oral TXA at 250 mg twice daily for 3 months 5, 2
- For maintenance, continue sun protection, consider intermittent use of topical agents, and evaluate the need for additional TXA courses 5
- Consider PRP injections as an alternative or adjunct to oral TXA for enhanced efficacy 7, 5
Important Considerations
- Oral TXA should be considered in cases unresponsive to topical hydroquinone and combination topical therapy over approximately 12 weeks 3
- Additional sun protection measures should include wearing wide-brimmed hats, seeking shade during peak UV hours, and using UV-protective clothing 5
- Patients should be counseled that melasma is a chronic condition requiring ongoing management 6, 5
- Regular follow-up is essential to monitor treatment response and adjust therapy as needed 6