May 25, 2020 By Dr Chetna Singh

Use Of Tranexemic Acid(TXA) in treatment of Melasma

Hi guys this article is about use and efficacy of Tranexemic acid(TXA) in the treatment of Melasma. As I have discussed in my earlier blogs, Melasma is a skin condition where one gets brown batches on the skin(mainly face) like on bridge of nose, forehead, upper lip and chin. Women of reproductive age that is (30-45 years) are mostly affected, but in 10% of cases it also affects men.

The precipitating factors for this condition are sun(UV rays) exposure, pregnancy, oral contraceptive pills, hormonal imbalance, genetic predilection(like if your mother, grand mother or any of the aunts had it). This condition adversely affects the looks and the main concern is esthetics, because it is otherwise harmless(pathologically). Once it occurs it is very resistant to all the treatments and also the recurrence rate is quite high, that’s why its very frustrating for both the patient as well as the treating doctor.

Let me just briefly tell you what changes occur in the skin in melasma at the molecular level. Now there are a particular type of cells in the skin called as melanocytes which give colour to the skin, thus the larger number of melanocytes present in the skin, the darker the individual gets. In melasma there is an uncontrolled production of melanocytes in the skin, in the areas of discolouration.

 There are various modalities of treatments including certain topical creams, which are a combination of three creams namely Hydroquinone, Tretinoin and Mometasone. Basically these creams are bleaching agents. Other modalities of treatment include chemical peels like glycolic acid, kojic acid etc. Then there are lasers like ND-YAG laser, fraxel laser and IPL(intense pulse light). Most of these treatments show temporary improvement in the condition but there is high recurrence rate and also there are side effects like redness, irritation, post inflammatory hyperpigmentation(specially with lasers),that’s why in my clinic I don’t prefer these methods of treatments.

In my experience and a lot of studies have been done to back it, two method of treatments which have proven to give permanent results in treatment of Melasma are PRP(platelet rich plasma) therapy and use of Tranexemic acid. Now I have already discussed about use of PRP for melasma in my earlier blog, so I will discuss about the Tranexemic acid(TXA).

Tranexemic Acid is a fibrinolytic agent. To explain it in simpler terms, understand this, when bleeding occurs in our body, after 2-4 minutes, the bleeding stops, why? Because of the formation of blood clot. Our body makes a blood clot which stops the blood flow and bleeding stops. Tranexemic acid plays a role in making blood clot more stable and stronger and stops some chemicals(plasmin) in our body which can cause this blood clot to dissolve. So, basically TXA helps in stopping bleeding and that’s why it has been used for years in controlling heavy bleeding during menstruation in women, in surgeries to prevent excessive bleeding, after child birth to prevent excessive bleeding.

But recently it was discovered accidently that TXA was also seen to improve Melasma and then a lot of studies were done to prove it. It happens because when our skin is exposed to UV rays or undergo hormonal changes like in pregnancy or other above mentioned conditions there is an increased production of plasmin( the chemical which is responsible for breaking the clots), this plasmin increases the rate of melanogenesis and increased production of melanin and hence causes melasma. Now TXA is already known to prevent the formation of plasmin. So when it is given in patients having Melasma, it helps in reduction of the rate of melanogenesis and thus reduces melanin production and improves Melasma.

Now lets discuss the methods by which TXA can be given to the patients. First is oral formulation in a dose of 250mg/ BD, then are though topical creams , and lastly intralesional with the help of mironeedling or mesotherapy. Given in these forms, it has shown a drastic improvement in Melasma.

TXA given with the help of micronnedling
TXA given with the help of mesotherapy

In C&S clinic I generally prefer a combination of treatment with PRP and TXA(Tranexemic acid) for Melasma.

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