From the Guidelines
Tranexamic acid for melasma should be dosed at a concentration that, when combined with other treatments like PRP, yields the best therapeutic effect, as evidenced by improved mMASI scores and patient satisfaction 1. When considering the treatment of melasma with tranexamic acid, it's essential to look at the most recent and highest quality studies.
- The study from 2025 1 suggests that the combination of tranexamic acid with PRP (platelet-rich plasma) yields better results in terms of mMASI score reduction and patient satisfaction compared to using tranexamic acid alone.
- While the exact dosing of tranexamic acid is not specified in the study, the focus on combining it with PRP for enhanced efficacy implies that the dosing should be optimized for use in conjunction with other treatments.
- Given the lack of specific dosing information in the provided study, clinical guidelines would typically recommend a dose of 250 mg orally twice daily for at least 3-6 months to see significant improvement in melasma, similar to other treatments for this condition.
- However, the key takeaway is that tranexamic acid's effectiveness can be boosted by combining it with autologous treatments like PRP, leading to better outcomes in terms of melasma improvement and patient satisfaction 1.
- As with any treatment, patients should be monitored for side effects, and the treatment should be adjusted as necessary under the supervision of a healthcare provider.
- It's also crucial for patients to use broad-spectrum sunscreen during treatment to prevent UV exposure from worsening melasma.
From the Research
Dosing of Tranexamic Acid for Melasma
- The optimal dose of oral tranexamic acid for the treatment of melasma was estimated to be 750 mg per day for 12 consecutive weeks, or 250 mg three times per day for 12 weeks, with 250 mg twice daily being an acceptable option in poorly adherent patients 2.
- A study found that oral tranexamic acid at a dosage of 250 mg twice daily for 6 months was effective in treating melasma, with 64.8% of patients showing excellent or good improvement 3.
- Another study found that oral tranexamic acid at a dose of 500 mg daily for 8-12 weeks was effective in treating melasma in Asian skin, with few and mild side effects 4.
- The efficacy of oral tranexamic acid in combination with topical triple combination cream (flucinolone, hydroquinone, and tretinoin) was compared to topical triple combination cream alone, and found that the addition of oral tranexamic acid did not contribute significantly to the decrease in Melasma Area Severity Index (MASI) score 5.
- Oral tranexamic acid has been found to be a safe and effective treatment for melasma, with a multimodal mechanism of action, and can be considered in cases that are unresponsive to topical hydroquinone and combination topical therapy 4.
Administration Routes
- Tranexamic acid can be administered orally, topically, or intralesionally, with oral administration being the most effective, especially in cases of refractory melasma 6.
- Topical tranexamic acid alone was found to be the least effective method, but can be combined with other cosmeceuticals to improve outcomes 6.
- Intralesional injections and microneedling with topical tranexamic acid were found to be effective alternatives to oral treatment 6.