Topical tranexamic acid may be alternative for long-term treatment of mild melasma

Key takeaways:

• Dermatologists should understand the chronicity of melasma.
• Topical tranexamic acid may be considered for patients with mild to moderate melasma.

Topical tranexamic acid may be an alternative to hydroquinone for the long-term management of mild to moderate melasma, according to an expert consensus.

“Because of its complex pathogenesis, chronicity and high rates of recurrence, melasma is regarded as a challenging skin disorder,” Seemal R. Desai, MD, of the department of dermatology at the University of Texas Southwestern Medical Center, and colleagues wrote.

While patients are commonly treated with topical interventions as first-line therapy, many are unaware that melasma may recur. Long-term management is necessary.

Hydroquinone has shown efficacy in controlling melasma relapses. However, its adverse event profile has limited its use in some scenarios.

For this reason, topical tranexamic acid (TXA) alone or in combination with other therapies may be a more attractive option for certain patient populations, including those with relapsed or refractory melasma or those who have failed on other treatments.

Desai and colleagues offered practice points for dermatologists to consider in managing these patients.

First, clinicians should understand the chronicity of melasma, and patients should be counseled on the importance of sun protection.

Second, melasma severity should be evaluated at the outset of treatment, and skin erythema should be assessed. It is also important to determine if the patient has vascular involvement, such as clinical and/or dermoscopic telangiectasia, and whether this affects patient quality of life.

Third, topical TXA should be considered in patients with less severe disease associated with vascular involvement/telangiectatic pattern.

Fourth, therapeutic success is suggested as an improvement of 75% to 80%. However, patient satisfaction should also be considered as a parameter of success.

Fifth, long-term success rather than short-term success should be paramount, along with a balance between benefit and risk.

Finally, long-term TXA treatment may be needed.

“Topical TXA can be offered as first-line monotherapy for induction of mild to moderate melasma,” the researchers wrote. “Current experience and data also suggest that topical TXA can be used as a monotherapy for long-term maintenance in melasma.”