Tranexamic Acid in Melasma


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.

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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.



Melasma is a common skin problem presenting as dark, irregular-shaped patches with well- defined edges on face. Upper cheeks, nose, lips, upper lip, forearms, neck, and forehead are usually affected by discoloration. Melasma develops slowly but can last for many years. Sun exposure triggers melasma, so it often worsens in the summer and improves during winter.It does not cause any physical symptoms beyond the discoloration.

Who Gets Melasma

Melasma mostly affects pregnant women, and those taking birth control pills or hormonal therapy. Only 10-20 % of people who get melasma are men.

  • Those living in areas of intense sun exposure
  • People with dark skin tones including Asian and Indianshave more active melanocytes than those with light skin and thus are more prone to melasma.
  • People who have a blood relative who has melasma


The exact cause of melasma is not yet known. It occurs when the color- making cells in the skin (melanocytes) produce too much pigment (color).
Factors contributing to melasma include:

  • Family history
  • Pregnancy or use of birth control pills
  • Cosmetics or other skin care products
  • Phototoxic medicines (drugs that make the skin more sensitive to light damage, such as anti-seizure medication)
  • Sun exposure
  • Stress
  • Thyroid problems

Melasma during pregnancy (chloasma or “the mask of pregnancy”) may result from an increase in hormone production. The main risk factors of melasma in men are sun exposure and a positive family history.

Ultraviolet (UV) light from the sun exposure stimulates the melanocytes, triggering melasma. Sun exposure is the main reason for recurrence of melasma after fading.

Skin care products that irritate the skinmay trigger an increase in melanocytes and worsen melasma. Melasma does not cause any internal diseases or organ malfunction.


Dermatologists diagnose (detect) melasma by visual examination.


Sometimes melasma fades on its own, such as after a pregnancy or stopping birth control pills. Some patients can have it for years or even a lifetime.

Skin-Lightening Agents

The most common is skin-lightening medicine is hydroquinone. The effect hydroquinone treatment usually become evident after 5 to 7 weeks and treatment often continues for at least 3 months.

Your dermatologist may combine different skin-lightening agents to enhance the lightening effect.

Chemical Peels

Chemical peeling involves applying compounds to the skin to induce exfoliation (removal of dead skin cells).


Microdermabrasion is a skin resurfacing method which uses rough, but very fine crystals to buff away (abrade) the outermost layers of the skin. This procedure uses a vacuum-like device to apply the particles and then remove the unwanted skin with suction.

Maintenance Treatment

Though treatments are effective, they do not always cure melasma. Skin discoloration may not go away completely. Depending on how much pigmentation you have and how sensitive your skin is, you may need more than one treatment to see a good result. The effectiveness over time varies from patient to patient and it may take a few months to see improvement. Even after your melasma clears, you may need maintenance therapy can prevent melasma from returning.

Sun Protection

Daily sunscreen use is an essential part of melasma treatment. When selecting a sunscreen, select one that offers board-spectrum protection protects against UVA and UVB rays. It should have an SPF (sun-protection factor) of 30 or more. Products that contain zinc oxide or titanium oxide physically block the sun’s rays. Even after your melasma clears, continue to wear sunscreen to prevent the melasma from recurring.

It is important not to use products that irritate the skin. Any cosmetics (facial cleanser, cream, makeup, etc.) that irritate the skin may worsen melasma.

Treating melasma requires a multifaceted approach, under the care of a dermatologist, many people have a successful outcome.

25-09-2019 Dermatologist In Janakpuri, Melasma Causes, Melasma Diagnosis, Melasma Treatment In Janakpuri, Skin Specialist In Janakpuri,