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Tranexamic Acid Therapy (TXA)

Plasminogen pathway control for stubborn pigmentation & melasma

Duration
oral/topical/injection (varies by method)
Downtime
0 days
Sessions
3-6 months (oral)/ 4-6 sessions (injection)

About This Treatment

Tranexamic acid (TXA) is a lysine analog that inhibits the plasminogen activation pathway. Originally a hemostatic agent, TXA calms melanocyte hyperreactivity and suppresses prostaglandin/arachidonic acid production for fundamental pigmentation improvement.

Particularly effective for treatment-resistant melasma via oral, topical, and intradermal injection. Different mechanism from hydroquinone enables synergistic combination therapy.

Mechanism of Action

TXA inhibits plasminogen-to-plasmin conversion, blocking pigmentation signaling from keratinocytes to melanocytes (UV-stimulated plasmin→arachidonic acid→PGE2 pathway). Fundamentally suppresses melanocyte activation and melanin synthesis while reducing dermal inflammation.

Indications

Pigmentation / dullness

Expected Results

Oral (250-500mg/day): significant melasma improvement at 8-12 weeks. Topical (2-5% cream): pigmentation score improvement at 12 weeks. Intradermal injection: effective for stubborn melasma in 4-6 sessions. PIH prevention when combined with laser.

Clinical Evidence

Bala HR, Lee S, Wong C, et al. (2018)
Oral tranexamic acid for the treatment of melasma: A review. Dermatol Surg
Clinical improvement was reported in this study (see original paper for details).
Karn D, et al. (2012)
Oral tranexamic acid for the treatment of melasma. Kathmandu Univ Med J
Clinical improvement was reported in this study (see original paper for details).
Del Rosario E, et al. (2018)
Randomized, placebo-controlled, double-blind study of oral tranexamic acid in melasma. J Am Acad Dermatol
Clinical improvement was reported in this study (see original paper for details).

Risks & Side Effects

Oral: rare GI symptoms. Thrombosis risk (caution with history/OCP users). Long-term safety data limited to 3-6 months. Topical: rare irritation. Injection: transient redness/swelling. Contraindicated in renal impairment.

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