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Refractory melasma symptoms improve with tranexamic acid

Oral tranexamic acid may improve symptoms of refractory melasma in Asian patients without risk factors or a family history of the disease, according to recent research.

“A detailed history to screen for risk factors of thromboembolism, stroke, or heart disease is essential for the attending clinician before initiating therapy,” Hwee Chyen Lee, MRCP, from the National Skin Center in Singapore, and colleagues wrote in their study. “The mean dose used is 250 mg twice a day, and clinicians may expect first lightening at approximately 2 months, with treatment duration of about 4 months.

“If there is no response within 3 months of treatment, one should consider stopping oral [tranexamic acid (TA)]. Patients should be counseled about possible relapse, and to maintain follow-up after completion of therapy.”

Lee and colleagues retrospectively analyzed 561 patients (91.4% women) in an Asian population who received oral TA from January 2010 to June 2014 for treatment of melasma. The mean age of patients in the study was 40.7 years at onset, and they started oral TA treatment after a median of 6 years of melasma. Treatment duration lasted a median of 4 months.

The researchers wrote that almost 90% of patients experienced improvement, 10% showed no improvement, and two patients showed worsened symptoms. Patients experienced improved symptoms after 2 months of therapy, and the relapse rate was 27.2%.

There was stronger treatment response among patients without a family history of melasma (90.6%) vs. those with a family history (60%) of the disease (P = .01). About 7% of patients experienced transient adverse events, including bloating and headache, while one patient developed deep vein thrombosis during the study period, and treatment was halted. – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.