Treatment-Resistant Melasma Response to Oral Tranexamic Acid

Melasma, a common acquired hyperpigmentation disorder primarily affecting facial skin, poses significant therapeutic challenges due to the limited efficacy and potential side effects of available treatments. Tranexamic Acid (TXA), traditionally used for its hemostatic properties by inhibiting plasminogen activation, has emerged as a promising addition to protocols for treatment-resistant melasma. This study aims to evaluate the efficacy and safety of TXA in combination with Hydroquinone (HQ) and Kojic Acid (KA) in patients with treatment-resistant melasma. We present here a case series of fourteen patients with recurrent melasma refractory to common treatments who achieved successful outcomes with the addition of TXA to their treatment regimen. These patients received 650 mg of TXA in combination with 16% HQ and 6% KA. All patients exhibited a symmetrical reduction in their hyperpigmented patches following treatment and no significant adverse effects were reported. These cases contribute valuable input to the growing body of evidence on the use of TXA for melasma and the combination of treatments and dosing, suggesting its potential as a therapeutic option for this condition. Further research is warranted to explore the mechanisms by which TXA exerts its beneficial effects in melasma and to determine the optimal treatment protocols for achieving effective clinical outcomes.