Abstract

Objectives: Melasma, a chronic pigmentary skin condition mainly affecting the face remains a challenge despite availability of several options for treatment. Many melasma patients are not satisfied with treatment outcomes. Tranexamic acid (TXA), an anti-fibrinolytic drug has shown promising results in patients with melasma. Evidence from several clinical studies has surfaced on efficacy and tolerability of TXA in these patients. It can be used as monotherapy or adjuvant with other therapies. Introduction: Melasma, a chronic, acquired pigmentary disorder due to dysfunction in melanogenesis affecting exposed body parts, mainly the face is one of the common reasons of patients to consult dermatologists. Patients may develop localised hyperpigmentation of skin. The condition is associated with significant psychological disturbance resulting in impaired quality of life. Materials / method: A draft document was prepared based on the available published evidence retrieved through PubMed/Medline, Google Scholar and Cochrane Database. Search words included “melasma” “tranexamic acid” “trial” “study” words in the title. References of relevant articles were also included for review. Clinical trials, prospective studies, retrospective analysis, review articles, systematic reviews, meta-analysis, case series and case reports were considered for this review. Studies from India as well as other countries were included for analysis of evidence. Results: A total of 25 clinical studies published from 2012 to 2022 involving more than 2000 patients were retrieved. The details of these studies along with results are summarized . We have summarized the results in two sections; prospective studies and retrospective studies based on the years of publications of these articles. Conclusion: Clinical studies discussed in the previous section have not only showed clinical benefits, but also histological improvements in patients with melasma. Reduction of dermal blood flow in melasma affected areas has also been demonstrated. Evidence from Indian studies is also promising. Exact duration of therapy is not known. Recurrence has been reported after discontinuation of therapy. Results of retrospective studies are also in accordance with those from randomized clinical trials.29-31 Adverse event profile from different clinical studies does not raise serious concerns. Gastroint