Tranexamic Acid Dosing for Microneedling in Melasma
For topical application with microneedling, use a 4% tranexamic acid solution applied immediately after the procedure, with no specific total dose limit for topical use; if using intradermal injection technique instead, the maximum total dose is 8-16 mg per treatment session. 1
Topical Application Protocol (Preferred Method)
- Apply 4% tranexamic acid solution topically immediately after microneedling to achieve comparable efficacy with less invasiveness than injection techniques 2, 1
- The topical route does not have a specified maximum total dose per session, as systemic absorption is minimal 1
- Treatment sessions should be performed at 2-week intervals for optimal results 3
- Studies demonstrate 65.92% improvement in mean mMASI scores with 10% topical TXA solution combined with microneedling 3
Intradermal Injection Protocol (Alternative Method)
If choosing the intradermal injection approach rather than topical application:
- Prepare a 4 mg/mL TXA solution by diluting with normal saline 1
- Maximum total dose per session: 8-16 mg 1
- Administer 0.05 mL intradermal injections spaced 1 cm apart throughout melasma-affected areas 1
- Treatment frequency is monthly sessions for 3-5 treatments 1
- Critical safety point: Do not exceed 16 mg total dose per session to minimize systemic absorption and potential thrombotic risk 1
Adjunctive Oral Therapy for Enhanced Efficacy
- Consider adding oral TXA 250 mg twice daily for 12-16 weeks as adjunctive therapy to maximize treatment response, particularly for moderate-to-severe melasma 1
- Oral TXA combined with procedural approaches yields 90.48% total efficacy versus 73.68% with TXA alone 2, 1
Pre-Treatment Safety Screening
Before any TXA administration, screen for absolute contraindications:
- Recent thrombosis and active thromboembolic disease 2
- Relative contraindications include atrial fibrillation, known thrombophilia, and history of venous thromboembolism 2, 1