Abstract

Objectives: To assess the efficacy of tranexamic acid (TXA) in treating melasma and evaluate its associated adverse effects compared to other melasma treatments. Introduction: Melasma is a challenging condition to treat. Tranexamic acid (TXA) has emerged as a promising therapy, but its effectiveness and safety compared to other treatments need comprehensive evaluation. Materials / method: A systematic review and meta-analysis were conducted on 22 RCTs (n=1280 patients) following PROSPERO and PRISMA guidelines. Databases searched included PubMed, Scopus, Cochrane, and Embase. Inclusion criteria focused on full-text English RCTs with clear outcome measures on TXA in melasma. Data were analyzed using RevMan software, with heterogeneity assessed using I² statistics and forest plots. Results: TXA was administered orally, topically, or via injection. Significant reductions were observed in MASI (mean difference: -4.32) and mMASI scores. Oral TXA was most effective, followed by injections and topical treatments. Adverse effects included gastrointestinal issues and skin irritation. Conclusion: TXA is effective in reducing melasma severity, but further research is needed to optimize administration methods and address treatment heterogeneity.