Effectiveness of Tranexamic acid in the treatment of Melasma - A randomized controlled clinical trial.

Melasma is a common pigment disorder that manifests as symmetric hyper-pigmented macules  on the face mostly on the malar areas of cheek and on forehead and chin and most commonly occurs in women of darker skin color.It typically affects women of reproductive age with skin type IV-VI . Current treatments using topical steroids such as superficial peels Lactic acid glycolic acid , trichlor acetic acid, kojic acid, Lasers and retinoids, demonstrate variable efficacy and side-effect profiles. Despite the plethora of treatment , melasma poses a great challenge as its treatment can be often unsatisfactory with high recurrence rate . The pathogenesis of melasma remains poorly understood and its treatment continues to be challenging with approximately 10% cases occurring in men. The disease prevalence among Asians is about 40% in females and about 20% in males. Melasma is the most common pigmentary disorder in India, with incidence of approximately 10%. It is also found to occur at a younger age among Indians.

Newer formulation that are being tried include tranexamic acid (TA), a well-known Anti-fibrinolytic agent, in the treatment of melasma, which is a plasmin inhibitor used to prevent abnormal fibrinolysis to reduce blood loss. Tranexamic acid is a pro-coagulant agent that is approved by the US Food and Drug Administration for treatment of Menorrhagia and to prevent hemorrhage, it also mitigates the UV radiation-induced pigmentation response. Challenges to the use of tranexamic acid for melasma treatment in a medico-legal environment, specifically the risks associated with using a pro-coagulant medication for a cosmetic indication. Melanocytes cultured in media were found to have decreased tyrosinase activity and reduced melanin content when treated with tranexamic acid.