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Other actives

Tranexamic acid

Also listed as TXA

A bleeding drug repurposed for melasma and dark spots. Topical 2-5% shows promise in small trials; the oral prescription form is better studied.

Limited evidenceTypical strength: 2-5%

What it is

Tranexamic acid blocks plasmin, an enzyme that in skin helps UV light and hormones switch on pigment cells and new blood vessels. Low-dose oral tranexamic acid is a recognized off-label prescription treatment for melasma.

Topical versions at 2-5% avoid the systemic clotting concerns. In small trials they reduced melasma, including a split-face trial where 3% tranexamic acid matched hydroquinone plus a steroid, with fewer side effects. Results take 8-12 weeks, and melasma returns without ongoing sun protection.

How strong is the evidence?

Limited evidence

A handful of small trials (about 20-50 people, 12 weeks) show topical 2-3% tranexamic acid reduces melasma severity; one double-blind split-face trial found it comparable to 3% hydroquinone with dexamethasone. A 2017 review concluded efficacy is not yet adequately established. Evidence for other dark spots, such as sun spots and post-acne marks, is thinner.

What it's used for, checked

Melasma

Mixed

Small trials are positive; the oral form has stronger evidence than the topical.

Post-acne marks and sun spots

Unproven

Plausible, but few trials outside melasma.

Works well with

  • Daily sunscreen — tinted formulas with iron oxides also block visible light that worsens melasma
  • Niacinamide
  • Azelaic acid

Who should be careful

  • Topical use is well tolerated; mild irritation is the usual side effect.
  • Oral tranexamic acid is a different product with clotting risks; it needs a prescription and isn't for people with a history of blood clots.

The studies

Every citation is checked against its PubMed record.

  1. Topical tranexamic acid as a promising treatment for melasma.
    Ebrahimi B, Naeini FF · Journal of Research in Medical Sciences · 2014 · RCT (split-face)

    50 Iranian women with melasma applied 3% tranexamic acid to one side of the face and 3% hydroquinone + 0.01% dexamethasone to the other for 12 weeks; both improved similarly, with significantly fewer side effects on the tranexamic acid side.

  2. Efficacy and possible mechanisms of topical tranexamic acid in melasma.
    Kim SJ, Park JY, Shibata T, Fujiwara R, Kang HY · Clinical and Experimental Dermatology · 2016 · Uncontrolled clinical study

    23 people with mostly mild melasma applied 2% tranexamic acid for 12 weeks; melasma scores improved in 22, and biopsies showed less epidermal melanin and lower endothelin-1. No control group; one author was from a cosmetics company.

  3. Tranexamic acid in treatment of melasma: A comprehensive review of clinical studies.
    Taraz M, Niknam S, Ehsani AH · Dermatologic Therapy · 2017 · Review

    Reviews oral, topical and injected tranexamic acid for melasma and concludes that its efficacy is not yet adequately established; more studies are needed.