Exploring the Role of Tranexamic Acid in Dermatology: A literature Review
DOI:
https://doi.org/10.12775/JEHS.2025.77.56921Keywords
tranexamic acid, melasma, rosacea, hyperpigmentation, psoriasis, angioedemaAbstract
Introduction
Tranexamic acid (TXA) is a synthetic plasmin inhibitor primarily used in treating bleeding disorders. However, its use in dermatology has gained increasing attention. Due to its anti-inflammatory properties and ability to inhibit tyrosinase activity, tranexamic acid has emerged as a promising agent for treating pigmentary disorders and inflammatory skin conditions.
Purpose
This review aims to identify and summarize the current applications of tranexamic acid in dermatology, including its mechanisms of action, effectiveness, and safety in treating common conditions such as melasma, hyperpigmentation, rosacea, psoriasis, angioedema, and in scar and discoloration therapies.
State of Knowledge
An analysis of the existing literature highlights the growing interest in TXA’s dermatological applications. Clinical studies suggest that tranexamic acid effectively reduces hyperpigmentation and mitigates inflammation in rosacea cases. However, several studies exhibit limitations related to sample size and methodology, underscoring the need for further, more detailed research.
Conclusions
Tranexamic acid shows promising therapeutic potential in dermatology, particularly for pigmentary and inflammatory disorders. However, further research is needed to fully understand the mechanisms of TXA and its therapeutic potential, which could lead to the development of novel treatment strategies in dermatology.
References
Gaćina K, Krstanović Ćosić A. THE USE OF TRANEXAMIC ACID IN DERMATOLOGY. Acta Clin Croat. 2023 Aug ;62(2):368-372. doi: 10.20471/acc.2023.62.02.16. PMID: 38549597; PMCID: PMC10969640.
Chauncey JM, Wieters JS. Tranexamic Acid. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30422504.
Wang X, Wang X, Liang F, Yu Y, Han R. Safety and efficacy of intravenous or topical tranexamic acid administration in surgery: a protocol for a systematic review and network meta-analysis. BMJ Open. 2022 May 9;12(5):e058093. doi: 10.1136/bmjopen-2021-058093. PMID: 35534082; PMCID: PMC9086642.
Mota S, Rosa GP, Barreto MC, Garrido J, Sousa E, Cruz MT, Almeida IF, Quintas C. Comparative Studies on the Photoreactivity, Efficacy, and Safety of Depigmenting Agents. Pharmaceuticals (Basel). 2023 Dec 28;17(1):55. doi: 10.3390/ph17010055. PMID: 38256889; PMCID: PMC10820089.
Das A, Sil A, Ghosh S, Panda S. Unconventional uses of common conventional drugs: A review. Indian J Dermatol Venereol Leprol. 2021 Jul-Aug;87(4):592-598. doi: 10.25259/IJDVL_389_20. PMID: 33871199.
Pazyar N, Raeispour M, Yaghoobi R, Seyedtabib M. Evaluation of the effectiveness of microneedling with tranexamic acid in comparison with microneedling with vitamin C in the treatment of melasma: A prospective and single-blind clinical trial. Health Sci Rep. 2023 Oct 20;6(10):e1636. doi: 10.1002/hsr2.1636. PMID: 37867785; PMCID: PMC10588557.
Kashikar Y, Madke B, Singh A, Meghe S, Rusia K. Mesotherapy for Melasma - An Updated Review. J Pharm Bioallied Sci. 2024 Apr;16(Suppl 2):S1055-S1056. doi: 10.4103/jpbs.jpbs_1192_23. Epub 2024 Apr 16. PMID: 38882767; PMCID: PMC11174183.
Pazyar N, Dezfuly MB, Hadibarhaghtalab M, Parvar SY, Molavi SN, Mapar MA, Zeinali M. Intradermal Injection of 100mg Tranexamic Acid Versus Topical 4% Hydroquinone for the Treatment of Melasma: A Randomized, Controlled Trial. J Clin Aesthet Dermatol. 2023 Jan;16(1):35-40. PMID: 36743976; PMCID: PMC9891212.
Yan C, Xing M, Zhang S, Gao Y. Clinical Development and Evaluation of a Multi-Component Dissolving Microneedle Patch for Skin Pigmentation Disorders. Polymers (Basel). 2023 Aug 4;15(15):3296. doi: 10.3390/polym15153296. PMID: 37571190; PMCID: PMC10422440.
Zhang J, Gu D, Yan Y, Pan R, Zhong H, Zhang C, Xu Y. Potential Role of Tranexamic Acid in Rosacea Treatment: conquering Flushing Beyond Melasma. Clin Cosmet Investig Dermatol. 2024 Jun 14;17:1405-1412. doi: 10.2147/CCID.S473598. Erratum in: Clin Cosmet Investig Dermatol. 2024 Jun 26;17:1551-1552. doi: 10.2147/CCID.S484236. PMID: 38895607; PMCID: PMC11185165.
Lam K, Mansour D, Sutton A. Oral tranexamic acid treatment beyond 6 months for melasma patients - A retrospective case series. JAAD Int. 2024 Mar 25;15:195-196. doi: 10.1016/j.jdin.2024.03.006. PMID: 38707929; PMCID: PMC11066674.
Godse K, Sarkar R, Mysore V, Shenoy MM, Chatterjee M, Damisetty R, Shah S, Vedamurthy M, Aurangabadkar S, Srinivas C, Ganjoo A, Das S, Patil A. Oral Tranexamic Acid for the Treatment of Melasma: Evidence and Experience-Based Consensus Statement from Indian Experts. Indian J Dermatol. 2023 Mar-Apr;68(2):178-185. doi: 10.4103/ijd.ijd_266_22. PMID: 37275826; PMCID: PMC10238972.
Singh R, Maheshwari P, Madke B, Singh A, Jawade S. Comparative Study of Combination of Oral Tranexamic Acid With Modified Kligman's Formula Versus Oral Tranexamic Acid With Azelaic Acid 15% in the Treatment of Melasma. Cureus. 2023 Jun 24;15(6):e40908. doi: 10.7759/cureus.40908. PMID: 37496546; PMCID: PMC10366003.
Mamdouh Kamal Dawaud S, Hegab DS, Mohamed El Maghraby G, Ahmad El-Ashmawy A. Efficacy and Safety of Topical Tranexamic Acid Alone or in Combination with Either Fractional Carbon Dioxide Laser or Microneedling for the Treatment of Melasma. Dermatol Pract Concept. 2023 Jul 1;13(3):e2023195. doi: 10.5826/dpc.1303a195. PMID: 37557109; PMCID: PMC10412040.
Lawrence E, Al Aboud KM. Postinflammatory Hyperpigmentation. 2022 Oct 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32644576.
Oh SM, Lee YE, Ko MJ, Baek JH, Shin MK. Proposal of facial pigmentary unit and facial hyperpigmentation type for Fitzpatrick skin types II-IV. Skin Res Technol. 2023 Jan;29(1):e13251. doi: 10.1111/srt.13251. Epub 2022 Dec 7. PMID: 36478452; PMCID: PMC9838779.
Dhungel O, Amatya IP, Sharma P. An Unusual Presentation with Facial Hyperpigmentation on Escalation of the Dose of Sertraline. Case Rep Psychiatry. 2024 Aug 7;2024:7416277. doi: 10.1155/2024/741lase77. PMID: 39148763; PMCID: PMC11325013.
Rachadi H, Hali F, Elfatoiki FZ, Chiheb S. Successful Management of Post-Laser Hyperpigmented Scar with Intralesional Tranexamic Acid Injections. Dermatol Pract Concept. 2024 Jul 1;14(3):e2024182. doi: 10.5826/dpc.1403a182. PMID: 39122525; PMCID: PMC11313627.
Mohamed RR, Mahmoud Mohamed LG, Mansour M, Rageh MA. Topical 10% Tranexamic Acid with and without Microneedling in the Treatment of Erythematotelangiectatic Rosacea: A Split-face Comparative Study. J Clin Aesthet Dermatol. 2024 Feb;17(2):47-51. PMID: 38444423; PMCID: PMC10911261.
Bageorgou F, Vasalou V, Tzanetakou V, Kontochristopoulos G. The new therapeutic choice of tranexamic acid solution in treatment of erythematotelangiectatic rosacea. J Cosmet Dermatol. 2019 Apr;18(2):563-567. doi: 10.1111/jocd.12724. Epub 2018 Aug 11. PMID: 30099833.
Mrowietz U, Lauffer F, Sondermann W, Gerdes S, Sewerin P. Psoriasis as a Systemic Disease. Dtsch Arztebl Int. 2024 Jul 12;121(14):467-472. doi: 10.3238/arztebl.m2024.0064. PMID: 38657176.
Hseu JH, Chan CI, Vadivalagan C, Chen SJ, Yen HR, Hseu YC, Yang HL, Wu PY. Tranexamic acid improves psoriasis-like skin inflammation: Evidence from in vivo and in vitro studies. Biomed Pharmacother. 2023 Oct;166:115307. doi: 10.1016/j.biopha.2023.115307. Epub 2023 Aug 11. PMID: 37573659.
Philipp-Dormston WG. Melasma: A Step-by-Step Approach Towards a Multimodal Combination Therapy. Clin Cosmet Investig Dermatol. 2024 May 22;17:1203-1216. doi: 10.2147/CCID.S372456. PMID: 38800358; PMCID: PMC11128260.
Abd Elraouf IG, Obaid ZM, Fouda I. Intradermal injection of tranexamic acid versus platelet-rich plasma in the treatment of melasma: a split-face comparative study. Arch Dermatol Res. 2023 Aug;315(6):1763-1770. doi: 10.1007/s00403-023-02580-y. Epub 2023 Mar 1. PMID: 36856856; PMCID: PMC10338558.
Galache TR, Galache M, Sena MM, Pavani C. Amber photobiomodulation versus tranexamic acid for the treatment of melasma: protocol for a double-blind, randomised controlled trial. BMJ Open. 2023 Jul 21;13(7):e073568. doi: 10.1136/bmjopen-2023-073568. PMID: 37479524; PMCID: PMC10364183.
González-Molina V, Martí-Pineda A, González N. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. 2022 May;15(5):19-28. PMID: 35642229; PMCID: PMC9122278.
Sarkar R, Handog EB, Das A, Bansal A, Macarayo MJ, Keshavmurthy V, Narayan V, Jagadeesan S, Pipo E 3rd, Ibaviosa GM, Podder I, Bansal S. Topical and Systemic Therapies in Melasma: A Systematic Review. Indian Dermatol Online J. 2023 Oct 27;14(6):769-781. doi: 10.4103/idoj.idoj_490_22. PMID: 38099013; PMCID: PMC10718129.
Yasnova N, Sirait SP, Rahmayunita G. The effectiveness and safety of 3% tranexamic acid cream vs. 4% hydroquinone cream for mixed-type melasma in skin of color: a double-blind, split-face, randomized controlled trial. Acta Dermatovenerol Alp Pannonica Adriat. 2024 Jun;33(2):83-88. PMID: 38918942.
Kaikati J, El Bcherawi N, Khater JA, Dib SM, Kechichian E, Helou J. Combination Topical Tranexamic Acid and Vitamin C for the Treatment of Refractory Melasma. J Clin Aesthet Dermatol. 2023 Jul;16(7):63-65. PMID: 37560507; PMCID: PMC10409511.
Bala HR, Lee S, Wong C, Pandya AG, Rodrigues M. Oral Tranexamic Acid for the Treatment of Melasma: A Review. Dermatol Surg. 2018 Jun;44(6):814-825. doi: 10.1097/DSS.0000000000001518. PMID: 29677015.
Tian N, Sun Y, Liu Y, Jin J, Chen S, Han H, Zhang Y, Li Z. Safety assessment of tranexamic acid: real-world adverse event analysis from the FAERS database. Front Pharmacol. 2024 May 28;15:1388138. doi: 10.3389/fphar.2024.1388138. PMID: 38863974; PMCID: PMC11165083.
Meaidi A, Mørch L, Torp-Pedersen C, Lidegaard O. Oral tranexamic acid and thrombosis risk in women. EClinicalMedicine. 2021 May 6;35:100882. doi: 10.1016/j.eclinm.2021.100882. PMID: 34124632; PMCID: PMC8176123.
Memon RJ, Tiwari V. Angioedema. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30860724.
Hébert J, Boursiquot JN, Chapdelaine H, Laramée B, Desjardins M, Gagnon R, Payette N, Lepeshkina O, Vincent M. Bradykinin-induced angioedema in the emergency department. Int J Emerg Med. 2022 Mar 26;15(1):15. doi: 10.1186/s12245-022-00408-6. PMID: 35350995; PMCID: PMC8966254.
Hasara S, Wilson K, Amatea J, Anderson J. Tranexamic Acid for the Emergency Treatment of Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema. Cureus. 2021 Sep 20;13(9):e18116. doi: 10.7759/cureus.18116. PMID: 34692327; PMCID: PMC8525683.
Abdulkarim A, Craig TJ. Hereditary Angioedema. 2023 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29489144.
Caballero T. Treatment of Hereditary Angioedema. J Investig Allergol Clin Immunol. 2021 Feb;31(1):1-16. doi: 10.18176/jiaci.0653. PMID: 33602658.
Wintenberger C, Boccon-Gibod I, Launay D, Fain O, Kanny G, Jeandel PY, Martin L, Gompel A, Bouillet L. Tranexamic acid as maintenance treatment for non-histaminergic angioedema: analysis of efficacy and safety in 37 patients. Clin Exp Immunol. 2014
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