What is tranexamic acid?
Tranexamic acid (TXA for short) is a relatively new ingredient in skincare. It’s a synthetic derivative of the amino acid lysine:
You can take tranexamic acid orally as a tablet, apply it topically on your skin as a cream or serum, or have it injected into the lower layers of your skin (the dermis).
Oral tranexamic acid has been used for reducing bleeding for a long time, in situations like heavy menstrual periods, nosebleeds and surgery. In the last 5-10 years, dermatologists have also started using tranexamic acid for pigmentation disorders, especially melasma.
What is melasma?
Melasma is a skin condition where blotchy patches of brown pigment develop, mostly on the face. Both environmental and genetic factors can contribute to melasma, including hormonal changes (like pregnancy) and UV radiation. It’s more likely to happen in people of Asian, African, and Hispanic descent.
How melasma develops isn’t well understood. It seems to involve a complex interaction between various types of skin cells (including pigment-containing melanocytes), inflammation, hormones, sun damage and blood vessels.
How does tranexamic acid work?
Most of the studies on tranexamic acid and skin have been on taking it orally for melasma. It’s proposed that tranexamic acid tackles melasma in a number of different ways:
- It interferes with the interaction of pigment-producing melanocyte cells and regular keratinocyte skin cells
- It could decrease blood vessels in affected skin
- Tranexamic acid also decreases inflammatory mediators that stimulate pigment production after UV exposure
- It decreases the number of mast cells which release inflammatory mediators
- Since it’s structurally similar to tyrosine, it could also potentially slow down the production of melanin by tyrosinase (as a competitive antagonist)
(It does a lot of these by slowing down the production of plasmin, an enzyme in blood that breaks up clotting material – which is also why it’s used to slow down bleeding.)
Oral tranexamic acid
Oral tranexamic acid is effective for treating melasma. It’s generally taken at a dose of 250 to 1500 mg daily, for 8 to 12 weeks. It has few side effects (mostly digestive ones, but it could potentially increase the risk of blood clots).
Since it’s relatively new, oral tranexamic acid has mostly been studied on Asian patients and there’s limited data on other ethnicities. It’s generally used when topicals, peels and lasers don’t work well enough or aren’t suitable, or in combination with one of the other melasma treatments.
For other types of pigmentation
Interestingly, oral tranexamic acid doesn’t seem to be as effective for other types of hyperpigmentation – in one study, it had almost no effect on freckles and age spots even though it faded melasma well. In a study where oral and topical tranexamic acid were used together, the skin around melasma patches darkened during treatment, which was thought to be due to increased sun exposure.
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Topical tranexamic acid
Unfortunately, there’s a lot less evidence for tranexamic acid applied topically on the skin.
Like for oral tranexamic acid, most of the studies on topical tranexamic acid have been done on melasma. A few studies have found that tranexamic acid at 3-5% is as effective at fading melasma as 2-4% hydroquinone, with fewer side effects. Injections of tranexamic acid into the dermal layer of the skin has also been found to work for melasma.
In other types of pigmentation, there’s even less evidence. There are a few studies where tranexamic acid faded hyperpigmentation when combined with other ingredients known to fade pigment (kojic acid, niacinamide, alpha arbutin), but none where tranexamic acid was used alone.
Related post: What Is Niacinamide and What Does It Do in Skincare?
One area where I think tranexamic acid could be promising is for reducing skin redness. While there are a lot of other ingredients that can fade pigment, there’s a severe lack of skincare options for fading redness. Since tranexamic acid acts on blood vessels as well as pigment to fade melasma (this could partly explain its greater effectiveness compared to ingredients that solely act on pigment), it could potentially help fade redness. But again, there’s only very scant evidence available:
- There’s one report of nightly 5% tranexamic acid reducing post-inflammatory erythema (redness after acne) in 6-8 weeks
- A couple of preliminary studies have also been done using 10% tranexamic acid for erythematotelangiectatic rosacea
Have you tried tranexamic acid? What was your experience?
McKesey J et al., Melasma treatment: an evidence-based review, Am J Clin Dermatol 2020, 21, 173-225. DOI: 10.1007/s40257-019-00488-w
Bala HR et al., Oral tranexamic acid for the treatment of melasma: a review, Dermatol Surg 2018, 44, 814-825. DOI: 10.1097/DSS.0000000000001518
Perper M et al., Tranexamic acid in the treatment of melasma: a review of the literature, Am J Clin Dermatol 2017, 18, 373-381. DOI: 10.1007/s40257-017-0263-3
Forbat E et al., The emerging importance of tranexamic acid in dermatology, Clin Exp Dermatol 2019 DOI: 10.1111/ced.14115