Effectiveness of Oral Tranexamic Acid in the Treatment of Melasma: A Systematic Review

Ahmad Azrul  Zuniarto; Siti Pandawangi  TW; Vidya Putri Kinanti

doi:10.37899/journallamedihealtico.v6i2.1929

Ahmad Azrul Zuniarto Faculty of Pharmacy, YPIB University of Majalengka
Siti Pandawangi TW Faculty of Pharmacy, YPIB University of Majalengka
Vidya Putri Kinanti Faculty of Pharmacy, YPIB University of Majalengka

DOI: https://doi.org/10.37899/journallamedihealtico.v6i2.1929

Keywords: Oral Tranexsamat Acid, Effectiveness, Melasma

Abstract

Melasma is a skin condition characterized by hyperpigmented patches, generally appearing on facial areas such as the cheeks, forehead, and upper lip. This condition is more common in women, especially during pregnancy or when using hormonal contraceptives. The factors that cause melasma include sun exposure, hormonal changes, and genetic factors. The purpose of this study is to examine the effectiveness and safety of the use of oral Tranexamic acid (TXA) in the treatment of melasma based on recent studies. The method used by literature search in journals published between 2022–2024 used keywords related to oral TXA and melasma. Studies that met the inclusion criteria were evaluated to compare the outcomes of oral TXA therapy based on dose, duration, and side effects. The results showed that oral TXA was proven to be effective in reducing the Melasma Area Severity Index (MASI) score with a dose of 500–1500 mg/day for 8–12 weeks. A significant decrease in MASI scores was achieved at week 12, showing consistent results across multiple studies. The most commonly reported side effects are gastrointestinal disorders, such as nausea and abdominal pain. Oral TXA does not cause serious side effects at doses up to 4 g/day. Tranexamic acid (TXA) in oral form is an effective and safe therapy in managing melasma. However, further research is needed to determine the ideal duration of treatment and strategies in preventing melasma recurrence.

References

AbdElrahman, S. E. A., Mohamed, M., Farag, M., Ali, A., Abdallah, E., Moussa, H. M., & Mohamed, A. (2023). Clinical and dermoscopic evaluation of the efficacy of melasma treatment with oral tranexamic acid. NILES Journal for Geriatric and Gerontology, 6(2), 517–545.

Agrawal, M., Varma, K., Kumar, U., Bhargava, S., Mahadik, A., & Agrawal, V. (2023). Comparison of oral versus topical tranexamic acid for treatment of melasma. Age (Years), 30, 28. http://dx.doi.org/10.18231/j.ijced.2023.015

Akl, E. M. (2022). Liposomal azelaic acid 20% cream vs hydroquinone 4% cream as adjuvant to oral tranexamic acid in melasma: A comparative study. Journal of Dermatological Treatment, 33(4), 2008–2013. https://doi.org/10.1080/09546634.2021.1905765

Asditya, A., & Sukanto, H. (2017). Studi retrospektif: Profil pasien melasma (Profile of melasma patients: A retrospective study). Laser, 1, 2.

Bala, H. R., Lee, S., Wong, C., Pandya, A. G., & Rodrigues, M. (2018). Oral tranexamic acid for the treatment of melasma: a review. Dermatologic Surgery, 44(6), 814-825. https://doi.org/10.1097/dss.0000000000001518

Batra, J., Brar, B. K., Kumar, S., & Arora, H. (2022). Tranexamic acid in melasma: Comparative evaluation of therapeutic efficacy of oral tranexamic acid versus its transepidermal administration. Journal of Cutaneous and Aesthetic Surgery, 15(4), 394–399. https://doi.org/10.4103/jcas.jcas_237_20

Botsali, A., Esme, P., Erbil, H., & Caliskan, E. (2022). Comparison of fractional erbium: YAG laserassisted tranexamic acid delivery alone and in combination with oral tranexamic acid in melasma. Lasers in Medical Science, 37(7), 2823–2830. https://doi.org/10.1007/s10103-022-03547-7

Cassiano, D. P., Espósito, A. C. C., Hassun, K. M., de Andrade Lima, M. M. D., de Andrade Lima, E. V., Miot, L. D. B., Miot, H. A., & Bagatin, E. (2022). Histological changes in facial melasma after treatment with triple combination cream with or without oral tranexamic acid and/or microneedling: A randomised clinical trial. Indian Journal of Dermatology, Venereology and Leprology, 88(6), 761–770. https://doi.org/10.25259/ijdvl_126_2021

Guo, L., Liu, X., Liu, Q., Xie, X., & Jiang, X. (2024). Treatment of melasma with tranexamic acid essence combined with iontophoresis: A randomized, double-blind, placebo-controlled clinical trial. Drug Design, Development and Therapy, 3659–3666. https://doi.org/10.2147/dddt.s472922

Gupta, A., Sharma, V., & Verma, R. (2022). Epidemiology and pathogenesis of melasma. Journal of Dermatology.

Kim, H. J., Moon, S. H., Cho, S. H., Lee, J. D., & Kim, H. S. (2017). Efficacy and safety of tranexamic acid in melasma: a meta-analysis and systematic review. Acta Dermato-Venereologica, 97(7), 776-781.. https://doi.org/10.2340/00015555-2668

Liu, L.-X., Liao, Z.-K., Dong, B.-Q., Jiang, S., & Lei, T.-C. (2024). Tranexamic acid ameliorates skin hyperpigmentation by downregulating endothelin-1 expression in dermal microvascular endothelial cells. Annals of Dermatology, 36(3), 151. https://doi.org/10.5021/ad.23.108

Maeda, K. (2022). Timeline of the development of skin-lightening active ingredients in Japan. Molecules, 27(15), 4774. https://doi.org/10.3390/molecules27154774

Mushtaq, F., Marwat, R. K., Saleem, M., Khan, A., Khan, S., & Imran, H. (2024). Comparison of efficacy of 5% tranexamic acid vs 20% azelaic acid in patients with melasma. Journal of Health and Rehabilitation Research, 4(1), 591–595. https://doi.org/10.61919/jhrr.v4i1.465

Mustofa, A., Hapsari, A. N., Nabiila, A., Putri, A. K., Nurissyita, A. M., & Catur, E. (2021). Faktor risiko depresi pasca persalinan di negara-negara Asia Tenggara. Medica Arter, 3(2), 62–67. https://doi.org/10.26714/medart.3.2.2021.62-67

Prathyoosha, S., Ananditha, K., Rao, T. N., Gopal, K. V. T., & Raju, P. V. K. (2024). A randomized study to evaluate the efficacy of oral tranexamic acid, modified Kligman’s formula, and placebo cream in melasma. Indian Dermatology Online Journal, 15(5), 787–793. https://doi.org/10.4103/idoj.idoj_797_23

Rao, S. K., Rajashekar, T. S., & Ashraf, A. (2022). Efficacy of intralesional tranexamic acid in melasma: Assessment with melasma area severity index and dermatology quality of life index. Turkderm-Turk Arch Dermatol Venereol, 56, 58–63. http://dx.doi.org/10.4274/turkderm.galenos.2022.42709

Raza, M. H., Iftikhar, N., Anwar, A., Mashhood, A. A., Tariq, S., & Hamid, M. A. B. (2022). Split-face comparative analysis of micro-needling with tranexamic acid vs vitamin c serum in melasma. Journal of Ayub Medical College Abbottabad, 34(1), 169-172. https://doi.org/10.55519/jamc-01-9840

Sarwar, U., Munir, A., Ashraf, A., Khan, I. H., Tariq, H., Rashid, S., & Bokhari, M. A. (2023). Efficacy of oral tranexamic acid in patients with melasma. Journal of Pakistan Association of Dermatologists, 33(2), 519–524.

Tawanwongsri, W., Siri-Archawawat, D., Sindhusen, S., & Eden, C. (2024). Therapeutic efficiency and safety assessment of intradermal platelet-rich plasma combined with oral tranexamic acid in patients with facial melasma. Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University. https://doi.org/10.17219/acem/187874

Triyanti, M. N. (2022). Tinjauan Atas Efikasi Asam Traneksamat Oral untuk Terapi Melasma. Cermin Dunia Kedokteran, 49(8), 465-468. http://dx.doi.org/10.55175/cdk.v49i8.290

Wikurendra, E. A. (2018). Pengaruh penyuluhan cuci tangan pakai sabun terhadap sikap mencuci tangan siswa. Jurnal Ilmiah Kesehatan Media Husada, 7(2), 64–69. https://doi.org/10.33475/jikmh.v7i2.21

Wulandari, P. (2021). Asam traneksamat oral sebagai terapi melasma. Cermin Dunia Kedokteran, 48(4), 255–260. https://doi.org/10.55175/cdk.v48i4.69

Zhang, C., Wu, T., & Shen, N. (2022). Effect of platelet-rich plasma combined with tranexamic acid in the treatment of melasma and its effect on the serum levels of vascular endothelial growth factor, endothelin-1, and melatonin. Pakistan Journal of Medical Sciences, 38(8), 2163. https://doi.org/10.12669/pjms.38.8.6786