Melasma occurs as symmetrical and irRegular tan-brown macules on the face. It is predominantly seen on the malar areas of cheek, forehead and chin. Ultraviolet (UV) radiation exposure, genetic susceptibility, and hormonal imbalance are considered to be most important aetiological factors. Melasma is more common in women and is a common cosmetic concern among indian population.
Topical medications have some efficacy in treating the epidermal-type melasma, but not in the dermal or mixed types. Prolonged application duration, slow response, limited efficacy, and undesirable recurrence are the major disadvantages of topical therapies causing patients to stop treatment. Topical bleaching agents may irritate the skin and cause PIH or result in exogenous ochronosis. The most effective and safe treatment for melasma is yet to be determined.
There is increased evidence showing interaction between keratinocytes and melanocytes in the process of melanogenesis through the PA (plasminogen) activation system. Thus rationale to adding TA (tranexamic acid) , a PA inhibitor, as an adjuvant in the treatment of melasma to increase the efficacy of previous treatments and reduce the chances of recurrence. TRANEXAMIC ACID is used as an antifibrinolytic agent, and is found to inhibit plasminogen-keratinocyte interaction by decreasing the tyrosinase activity, causing decreased melanin synthesis from the melanocytes. Its use in melasma is a novel concept. The patients should be screened for contraindications and risk factors prior to the commencement of oral therapy.
Intralesional tranexamic acid is a safe and effective treatment option of melasma with no risk of PIH, thrombotic or bleeding tendency; 6-12 MONTHLY SESSIONS ARE RECOMMEDNDED. The inclusion of maintenance topical therapy and strcit sun protection is strongly recommended to improve efficacy and decrease the recurrence of melasma.