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Melasma or chloasma is a dark pigmentation of the skin whose cause is unknown, although it is associated with various racial, hormonal and genetic factors. In addition to increased melanin production by melanocytes, increased skin vascularization and increased expression of angiogenic factors in the epidermis have been observed in melasma.

Melasma manifests as irregular, ill-defined dark spots that are symmetrically distributed on the cheekbones, cheeks, forehead or upper lip. Occasionally it also appears on the neckline and arms. It is a problem that affects women more frequently than men.

Classic treatments for melasma include topical active ingredients such as hydroquinone, vitamin C, glycolic acid and retinol. Mild chemical peels and some types of lasers performed by dermatologists are also used for the treatment of melasma with varying degrees of efficacy.

Tranexamic acid is a drug commonly used as a hemostatic agent to prevent bleeding in different situations such as dental extractions in patients with hemophilia or situations of hyperfibrinolysis. Side effects of tranexamic acid are rare and include allergic reactions, thrombosis formation in predisposed individuals, abdominal pain or migraine.

In recent years, several cases of patients with resistant melasma treated with tranexamic acid orally, off-label, have been published with good cosmetic results, but the number of cases studied has always been small.

Last August of this year 2016, a scientific article has been published in the American Journal of Dermatology on a retrospective study on 561 patients treated with tranexamic acid orally for an average of 4 months. Oral tranexamic acid in the treatment of melasma: A retrospective analysis. ( J Am Acad Dermatol 2016;75:385-92.)

The results were surprisingly good with improvement of melasma in almost 90% of patients. The best results were achieved by those without a family history of melasma. Interestingly, patients whose melasma first appeared at an older age and those whose melasma had been present for a longer period of time also responded better to tranexamic acid.

Only 7% of the patients treated had side effects that were mild and transient such as abdominal pain or migraines. There was a case of deep vein thrombosis in a patient with a previously unknown genetic coagulation problem (familial protein S deficiency).

It is important to note that most of the patients treated in this study with tranexamic acid underwent concomitant topical treatment with depigmenting creams. Only 10 patients out of 561 used tranexamic acid in monotherapy, of which all improved.

The truth is that the results are very encouraging, but it would be interesting to wait to see the results of new studies with more patients treated with tranxemic acid monotherapy. In addition, in this study, a relapse of melasma was observed in almost 30% of patients who had improved after cessation of treatment.

We will be watching for new publications to inform you of the latest research on this aesthetic problem, which is so frequent and complicated in its treatment.