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Tranexamic Acid for Skin: What Trials Show for Melasma and Dark Spots

By · Published October 29, 2026 · 19 min read

Start with our pillar guide: What Is the Skin Barrier? The Science of Hydration, Ceramides and Occlusives, or browse all Skincare Fundamentals articles.

Tranexamic acid for skin is best studied in melasma, where meta-analyses of randomized trials find it lowers severity scores by every route tested. Oral tablets, a prescription option, act fastest; a tranexamic acid serum or cream works more slowly and modestly. Evidence for other dark spots is thinner.

Evidence: Moderate for melasma; Limited for other dark spots.

Key takeaways

  • A 2024 meta-analysis of 22 randomized trials with 1,280 patients found tranexamic acid reduced melasma severity, with oral use ahead of injections and topical use (Calacattawi et al., 2024).
  • In a 12-week randomized trial of 50 women, oral tranexamic acid cut melasma scores by 58.86% and a 5% cream by 50.88%, a non-significant difference (Heidary et al., 2025).
  • In a retrospective study of 561 patients on oral tranexamic acid, 89.7% improved, 27.2% of those relapsed, and 1 developed a deep vein thrombosis (Lee et al., 2016).
  • In a 20-person split-face trial, 3% tranexamic acid cream and 4% hydroquinone cream both improved melasma over 8 weeks, with no difference in patient ratings (Yasnova et al., 2024).
  • A 2024 review calls tranexamic acid off-label for most dark-spot conditions other than melasma (Chen et al., 2024), and we found no trial testing it alone on sun spots.

What does tranexamic acid for skin actually do?

Tranexamic acid (TXA) blocks plasmin, an enzyme involved in breaking down blood clots, and reviews report that it also dampens melanin production and inflammation. That second set of effects is why dermatologists use it for pigment problems.

TXA is a synthetic lysine analog, meaning a lab-made molecule modeled on the amino acid lysine. Its main medical use is controlling bleeding in trauma, surgery, dental procedures and hemophilia (Chen et al., 2024). It binds plasminogen and stops it from maturing into plasmin, and a 2022 review lists suppression of melanogenesis (melanin production) among its effects beyond clotting (Prudovsky et al., 2022). That review had US and non-US government support.

The 2024 review adds anti-inflammatory, anti-angiogenic (blocking new blood vessel growth) and barrier-recovery effects (Chen et al., 2024). A melasma trial describes TXA as interfering with signals between keratinocytes, the main skin cells, and melanocytes, the pigment cells (Saki et al., 2018). Separate in-vitro data suggest TXA may block melanocytes stimulated by PGE2, an inflammatory messenger (Desai et al., 2019).

For melasma, TXA is used off-label in many places (Konisky et al., 2023), though it "has achieved indications in some countries" (Chen et al., 2024). If you're placing a tranexamic acid skincare product into a routine, our skincare routine order guide covers where serums go. Evidence: Lab / animal only for mechanism; human results below.

Does tranexamic acid work for melasma?

Yes. Two meta-analyses of randomized trials found TXA lowers melasma severity scores, though the trials vary widely in dose, route and design.

Melasma is a pigment and blood-vessel disorder that often affects women aged 20 to 40, mostly on sun-exposed skin. Named risk factors include family history, higher estrogen or progesterone, certain medications and UV exposure (Konisky et al., 2023). Topical hormones are a separate subject, covered in estrogen cream for the face.

The largest pooled analysis included 22 randomized trials with 1,280 patients, with treatment lasting from 8 weeks to nearly 2 years (Calacattawi et al., 2024). TXA significantly reduced MASI, the Melasma Area and Severity Index used to score how much and how dark the patches are. Oral TXA showed the biggest drop, then injections, then topical use. The authors flagged high heterogeneity, meaning the studies disagreed more than chance would explain, and funding was not reported in the abstract.

A 2021 meta-analysis of 24 trials found TXA added to routine treatment beat routine treatment alone at 4, 8, 12 and 16 weeks (Feng et al., 2021). That advantage was not detected for topical or intradermal routes, and no serious adverse events occurred. A 2019 systematic review of 35 topical-treatment trials gave TXA a strong clinical recommendation for melasma (Austin et al., 2019).

Oral tranexamic acid for melasma in 561 patients

Improved
89.7%
503 of 561; median treatment 4 months
Relapse rate among those who improved
27.2%
Retrospective data
Had an adverse event
7.1%
40 patients; most transient
Deep vein thrombosis
1
Later diagnosed with familial protein S deficiency

Lee et al., J Am Acad Dermatol, 2016 PubMed record

That 2016 study reviewed patients at one tertiary dermatology center from 2010 to 2014, and 91.4% were women (Lee et al., 2016). People without a family history of melasma responded more often than those with one (90.6% vs 60.0%). It was retrospective, so there was no comparison group.

On dose, a 2018 review found oral TXA effective in Asian skin even at low doses such as 500 mg daily for 8 to 12 weeks (Bala et al., 2018). A network meta-analysis of 6 randomized trials with 599 patients estimated 250 mg three times daily for 12 weeks as the optimal regimen (Wang et al., 2023). These are study estimates, not dosing instructions; oral TXA is a prescription decision for a doctor. Evidence: Moderate.

Which route of tranexamic acid for skin works best?

Oral TXA works fastest and shows the largest short-term effect, but over longer follow-up the route may matter less. Topical TXA alone is the weakest route in reviews.

A network meta-analysis found oral TXA plus routine topical treatment beat intradermal, topical and microneedling TXA at weeks 4, 8 and 12 and at last follow-up (Liang et al., 2024). Oral TXA beat placebo from week 4; the other routes did so from week 8. In the long run, the authors concluded that the effect of TXA alone "has nothing to do with the mode of administration." The number of trials was not given in the abstract.

Route What it involves What the evidence shows Main cautions
Topical (serum or cream) Applied to skin at home Least effective route alone (Konisky); no added benefit over routine care in pooled trials (Feng 2021) Skin irritation (Calacattawi)
Oral Prescription tablets Largest drop in severity scores (Calacattawi); fastest onset (Liang) Stomach upset, menstrual changes, clot screening (Konisky)
Injected (intradermal microinjection) Small injections into the patches in a clinic Second-largest effect (Calacattawi); matched oral at 8 weeks in 45 women (El Hadidi) Clinic procedure; long-term data limited
Microneedling + topical Tiny needle punctures, then TXA applied Beat routine treatment only at 4 weeks across 16 trials (Feng 2024) Safety results not given in the abstract

The most direct comparison is a single-center randomized trial of 50 women (mean age about 39.9) given oral TXA 250 mg twice daily or a 5% TXA cream twice daily for 12 weeks (Heidary et al., 2025). Both groups improved significantly, and the gap between them wasn't significant. One person on the cream stopped because of skin sensitivity. The authors declared no conflicts.

MASI reduction after 12 weeks: oral vs topical tranexamic acid (n=50) Source: Heidary et al., J Cosmet Dermatol, 2025 (randomized, single center; difference between groups not significant; no conflicts declared)
Oral 250 mg twice daily58.86%5% cream twice daily50.88%
Show data table
RouteMASI reduction (%)
Oral 250 mg twice daily58.86%
5% cream twice daily50.88%

A 2021 randomized trial assigned 45 women with melasma to oral TXA 250 mg twice daily or intradermal TXA at 100 mg/mL or 4 mg/mL every 2 weeks, for 8 weeks (El Hadidi et al., 2021). All 3 groups improved, with no significant difference between them. Funding was not reported in the abstract.

For microneedling, a 2024 meta-analysis of 16 trials found severity scores fell from baseline at every time point from 4 to 20 weeks (Feng et al., 2024). Compared with routine treatment, it was better only at 4 weeks. For aftercare, see skincare after microneedling.

Key human trials of tranexamic acid for skin
Heidary et al., J Cosmet Dermatol, 202550 women12 weeksOral 250 mg twice daily vs 5% cream twice dailyMASI -58.86% vs -50.88%; difference not significant
El Hadidi et al., Dermatol Ther, 202145 women8 weeksOral 250 mg twice daily vs intradermal 100 mg/mL or 4 mg/mL every 2 weeksAll improved; no difference between groups
Lee et al., Skin Res Technol, 201442 Korean women8 weeks2% niacinamide + 2% TXA cream vs vehicle, plus sunscreenCombination better than vehicle (P<0.05)
Yasnova et al., Acta Dermatovenerol APA, 2024208 weeks3% TXA cream vs 4% hydroquinone cream, split-faceBoth improved; no difference in patient ratings
Ghasemiyeh et al., Sci Rep, 2025993 monthsNiosomal 2% TXA/2% niacinamide vs 5% TXA/4% niacinamide vs 4% hydroquinoneAll comparable; adverse reactions and relapse in hydroquinone group
Rocio et al., J Cosmet Dermatol, 202560 women5 monthsSerum with 1% TXA, 5% niacinamide, vitamin C derivative vs 4% hydroquinone then serumSimilar efficacy; serum better tolerated
Saki et al., J Dermatolog Treat, 20183720 weeks follow-up3 monthly intradermal TXA sessions vs 2% hydroquinone nightly, split-faceTXA better at 4 weeks; no difference at 20 weeks
Heidary et al., J Cosmet Dermatol, 2025Sample size: 50 women · Length: 12 weeks · Dose: Oral 250 mg twice daily vs 5% cream twice daily

Result: MASI -58.86% vs -50.88%; difference not significant

Single-center RCT. 1 topical dropout for sensitivity. No conflicts declared. Evidence: Limited.

El Hadidi et al., Dermatol Ther, 2021Sample size: 45 women · Length: 8 weeks · Dose: Oral 250 mg twice daily vs intradermal 100 mg/mL or 4 mg/mL every 2 weeks

Result: All improved; no difference between groups

RCT. Funding not reported in abstract. Evidence: Limited.

Lee et al., Skin Res Technol, 2014Sample size: 42 Korean women · Length: 8 weeks · Dose: 2% niacinamide + 2% TXA cream vs vehicle, plus sunscreen

Result: Combination better than vehicle (P<0.05)

Double-blind, vehicle-controlled RCT. First author affiliated with a company R&D center. Evidence: Limited.

Yasnova et al., Acta Dermatovenerol APA, 2024Sample size: 20 · Length: 8 weeks · Dose: 3% TXA cream vs 4% hydroquinone cream, split-face

Result: Both improved; no difference in patient ratings

Double-blind split-face RCT in Indonesian patients. Funding not reported in abstract. Evidence: Early / preliminary.

Ghasemiyeh et al., Sci Rep, 2025Sample size: 99 · Length: 3 months · Dose: Niosomal 2% TXA/2% niacinamide vs 5% TXA/4% niacinamide vs 4% hydroquinone

Result: All comparable; adverse reactions and relapse in hydroquinone group

Double-blind RCT. University-funded; no competing interests. Evidence: Limited.

Rocio et al., J Cosmet Dermatol, 2025Sample size: 60 women · Length: 5 months · Dose: Serum with 1% TXA, 5% niacinamide, vitamin C derivative vs 4% hydroquinone then serum

Result: Similar efficacy; serum better tolerated

Investigator-blind RCT. Vichy-funded; 2 authors L'Oréal employees. Evidence: Limited.

Saki et al., J Dermatolog Treat, 2018Sample size: 37 · Length: 20 weeks follow-up · Dose: 3 monthly intradermal TXA sessions vs 2% hydroquinone nightly, split-face

Result: TXA better at 4 weeks; no difference at 20 weeks

Split-face randomized trial. Funding not reported in abstract. Evidence: Early / preliminary.

MASI and mMASI are standard melasma severity scores. Most trials are small and short.

Evidence: Moderate (meta-analyses with high heterogeneity).

Does a tranexamic acid serum or tranexamic acid cream work on its own?

A tranexamic acid serum or cream can fade melasma in trials, but it works best as part of a combination and is weaker than oral TXA. Most topical trials tested TXA mixed with other brighteners, so the effect of TXA alone is hard to isolate.

A 2023 review of 46 articles found topical TXA alone the least effective route, though it can be combined with other cosmeceuticals to improve outcomes (Konisky et al., 2023). A 2022 review of 80 papers called topical TXA a newer option for adjuvant and maintenance treatment, with no known severe adverse effects (González-Molina et al., 2022). The authors reported no conflicts.

Combination products have the most data. In a double-blind trial of 42 Korean women aged 30 to 60, a cream with 2% niacinamide and 2% TXA used twice daily for 8 weeks beat a plain cream, with both groups using sunscreen (Lee et al., 2014). The first author was affiliated with a company research center. A 12-week study of a serum with 3% TXA, 1% kojic acid and 5% niacinamide in Brazilian women (Fitzpatrick skin types I to IV) reported improvement from week 2 (Desai et al., 2019); the abstract gives neither sample size nor funding.

The strengths tested range from 1% to 5%. No study in our sources compares concentrations head to head or compares a serum with a cream, so we can't say which strength or texture works best. A recurring reader question is whether a drugstore serum can match prescription tablets; the 50-woman Heidary trial above is the closest test, and it used a 5% cream. Because many TXA products also contain niacinamide or vitamin C, see whether you can use niacinamide with vitamin C. Evidence: Limited.

Does tranexamic acid for dark spots work beyond melasma?

Possibly for post-inflammatory hyperpigmentation, but the evidence is mostly narrative reviews. We found no trial in our sources that tests TXA alone on sun spots.

Post-inflammatory hyperpigmentation (PIH) is darkening left behind after acne, a rash or skin injury. A 2024 review describes TXA as still off-label for most pigment conditions other than melasma, including PIH (Chen et al., 2024). A 2026 narrative review reported that oral, topical and intradermal TXA reduced pigmentation in melasma and PIH (AlJabr et al., 2026). Both declared no conflicts, but narrative reviews don't pool data systematically.

The only trial-level PIH data in our sources come from the Desai serum study, which mixed TXA with kojic acid and niacinamide and reported improvement in PIH from week 2 (Desai et al., 2019). The Lee 2014 trial targeted "irregular facial pigmentation," not a specific diagnosis (Lee et al., 2014).

So claims that tranexamic acid for dark spots fades sun spots or age spots have no direct support in our sources. For darkening on the lips specifically, see lip hyperpigmentation. For other brightening options, compare vitamin C for hyperpigmentation, kojic acid for skin and glutathione for skin. No trial tests TXA on lips either; for that, see lip hyperpigmentation treatment. Evidence: Early / preliminary.

Tranexamic acid vs hydroquinone: which is better?

In small head-to-head trials, topical TXA matched hydroquinone (HQ) for melasma with fewer side effects. Review and consensus papers still rank HQ-based triple combination cream (HQ, tretinoin and a corticosteroid) as the top treatment.

Tranexamic acid vs hydroquinone for melasma
FeatureTranexamic acidHydroquinone
Standing in reviewsTopical TXA a newer adjuvant or maintenance option (2022); oral TXA an alternative (2026 consensus)HQ and triple combination most effective and best studied (2020); supervised triple combination the gold standard (2026 consensus)
3% TXA vs 4% HQ cream, 20 people, 8 weeksSeverity improvedSeverity improved; no difference in patient ratings
TXA/niacinamide creams vs 4% HQ, 99 people, 3 monthsAs effective as HQAs effective; adverse reactions and relapse seen
Monthly TXA injections vs nightly 2% HQ, 37 peopleBetter at 4 weeksCaught up; no difference at 20 weeks
TolerabilityTopical TXA better tolerated than HQ (2023 review)Higher redness score in a 60-woman trial
Theoretical risk named in a 2019 reviewThrombosis (clotting)Ochronosis, a skin discoloration (triple combination)

Bottom line: Topical TXA held its own against HQ in small trials, but expert consensus still places supervised HQ-based triple combination first.

The trials behind the table are Yasnova et al., 2024, Ghasemiyeh et al., 2025, Saki et al., 2018 and Rocio et al., 2025; the last was Vichy-funded with 2 L'Oréal-employed authors. The standing row comes from a 2020 review of 113 studies with 6,897 participants (McKesey et al., 2020), a 2022 review (González-Molina et al., 2022) and a 2026 Delphi consensus of 38 dermatologists from 11 countries, funded by Galderma India (Sarkar et al., 2026). The risk row is from Austin et al., 2019. Evidence: Limited.

Is tranexamic acid for skin safe?

Topical TXA is generally well tolerated, with skin irritation the main reported problem. Oral and injected TXA are prescription or clinic treatments with stomach, menstrual and clotting considerations that need a doctor's input.

For topical products, reviews list skin irritation as a side effect (Calacattawi et al., 2024), and 1 cream user stopped for skin sensitivity in the Heidary trial (Heidary et al., 2025). The 2022 review found no known severe adverse effects for topical TXA (González-Molina et al., 2022).

Oral TXA caused stomach upset and menstrual irregularities in many patients, and a 2023 review says its "pro-thrombotic nature" must be considered before prescribing (Konisky et al., 2023). The 561-patient study had 1 deep vein thrombosis, in a woman later found to have familial protein S deficiency, an inherited clotting disorder (Lee et al., 2016). Its authors and a 2018 review both advise screening for personal and family clot risk factors first (Bala et al., 2018).

Newer reports are reassuring but incomplete. A 2025 systematic review is titled "No thromboembolic events observed in randomized controlled trials of oral tranexamic acid" (Kuceki et al., 2025). A 2026 multicenter health-record cohort is titled "Oral tranexamic acid use for melasma is not associated with thromboembolism" (Hernandez et al., 2026). Neither record has an abstract, so we can't report their numbers.

If you have a personal or family history of clots, use hormonal contraception or take other medicines, talk to a doctor before any oral or injected TXA. Never start, stop or change a medication on your own. We found no pregnancy or breastfeeding safety data in our sources. Evidence: Moderate for short-term safety; long-term safety unknown.

How long does tranexamic acid for skin take to show results?

Oral TXA showed effects from about 4 weeks in pooled trials, while topical, injected and microneedling routes took about 8 weeks. Relapse after stopping is common.

When tranexamic acid studies saw changes

  1. Week 2
    Earliest topical report

    A 3% TXA combination serum showed improvement starting at week 2 (Desai).

  2. Week 4
    Oral beats placebo

    Oral TXA differed from placebo from week 4 (Liang); monthly injections led 2% HQ at 4 weeks (Saki).

  3. Week 8
    Other routes beat placebo

    Topical, intradermal and microneedling TXA differed from placebo from week 8 (Liang).

  4. Within 2 months
    Oral responders improve

    Patients who improved on oral TXA did so within 2 months (Lee 2016).

  5. Week 12
    Main trial endpoint

    Oral and 5% topical TXA both cut MASI by about half or more (Heidary).

  6. Week 20
    Routes converge

    Injected TXA and 2% HQ no longer differed (Saki).

Relapse is the catch. In the 561-patient study, 27.2% of people who improved later relapsed (Lee et al., 2016). The 2026 consensus calls broad-spectrum sunscreen essential for everyone with melasma (Sarkar et al., 2026); for choosing one, see whether SPF 50 beats SPF 30. Evidence: Moderate.

Where the evidence stops

  • Trials are small and short. Most last 8 to 12 weeks, and the main meta-analysis reported high heterogeneity.
  • No head-to-head test of concentrations or of serum vs cream textures.
  • Most topical trials used combinations, so the effect of TXA alone in a serum is unclear.
  • No trial in our sources isolates TXA for sun spots, and PIH evidence comes mainly from narrative reviews.
  • Long-term safety and relapse prevention are unstudied beyond a few months.
  • Clot-safety reassurance rests partly on title-only records whose data we can't report.
  • No pregnancy or breastfeeding data in our sources.
  • Several comparison trials had industry ties, including the Vichy-funded serum trial.

FAQ

What does tranexamic acid do for skin?

Tranexamic acid binds plasminogen and blocks its conversion to plasmin, and reviews report that it also suppresses melanin production and inflammation. In skin, it is mainly studied as a treatment for melasma, where randomized trials show lower severity scores.

Does tranexamic acid work for melasma?

Yes. A 2024 meta-analysis of 22 randomized trials with 1,280 patients found that tranexamic acid significantly reduced melasma severity scores, with oral use showing the largest drop, followed by injections and then topical products. The included studies varied a lot, so the size of the effect is uncertain.

Is a tranexamic acid serum as good as oral tranexamic acid?

In one 12-week trial of 50 women, a 5% tranexamic acid cream cut melasma scores by 50.88% and 250 mg oral tablets twice daily cut them by 58.86%, a difference that was not statistically significant. Larger meta-analyses rank oral use above topical use, and a 2023 review called topical tranexamic acid alone the least effective route.

Does tranexamic acid help dark spots that aren't melasma?

Narrative reviews from 2024 and 2026 describe tranexamic acid as an off-label option for post-inflammatory hyperpigmentation, the dark marks left after acne or irritation. We found no trial in our sources that tests tranexamic acid alone on sun spots.

Is tranexamic acid better than hydroquinone?

In small head-to-head trials, topical tranexamic acid matched hydroquinone for melasma and was better tolerated. Review and consensus papers from 2020 to 2026 still name hydroquinone-based triple combination cream as the most effective or gold-standard treatment.

Can oral tranexamic acid cause blood clots?

In a retrospective study of 561 patients on oral tranexamic acid for melasma, 1 person developed a deep vein thrombosis and was later diagnosed with an inherited clotting disorder. A 2025 systematic review reported no clot events in randomized trials of oral tranexamic acid, but reviews still advise screening for clot risk factors, so anyone with a clotting history or taking hormonal contraception or other medicines should talk to a doctor.

How long does tranexamic acid take to work?

In a network meta-analysis, oral tranexamic acid beat placebo from week 4, while topical, injected and microneedling routes beat placebo from week 8. In a 561-patient study, people who improved on oral tranexamic acid did so within 2 months.

Can you use tranexamic acid with niacinamide or vitamin C?

Several trials tested tranexamic acid already combined with niacinamide, and one tested a serum that also contained a vitamin C derivative, with good tolerance. No study in our sources tests layering separate tranexamic acid, niacinamide and vitamin C products, so any layering order is clinic convention.

References

  1. Prudovsky I, et al. Tranexamic acid: Beyond antifibrinolysis. Transfusion. 2022. Narrative review; US and non-US government support. https://pubmed.ncbi.nlm.nih.gov/35834488/
  2. Konisky H, et al. Tranexamic acid in melasma: A focused review on drug administration routes. J Cosmet Dermatol. 2023. Review of 46 articles; funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/36606378/
  3. Chen T, et al. Tranexamic Acid for the Treatment of Hyperpigmentation and Telangiectatic Disorders Other Than Melasma: An Update. Clin Cosmet Investig Dermatol. 2024. Narrative review; no conflicts declared. https://pubmed.ncbi.nlm.nih.gov/39350932/
  4. AlJabr A, et al. Tranexamic Acid for Hyperpigmentation Disorders: A Literature Review on Efficacy and Safety in Melasma and PIH. J Cosmet Dermatol. 2026. Narrative review; no conflicts declared. https://pubmed.ncbi.nlm.nih.gov/41601401/
  5. Calacattawi R, et al. Tranexamic acid as a therapeutic option for melasma management: meta-analysis and systematic review of randomized controlled trials. J Dermatolog Treat. 2024. Meta-analysis, 22 RCTs, 1,280 patients; funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/38843906/
  6. Feng X, et al. Efficacy and safety of tranexamic acid in the treatment of adult melasma: An updated meta-analysis of randomized controlled trials. J Clin Pharm Ther. 2021. Meta-analysis, 24 trials; funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/33959984/
  7. Liang R, et al. Comparative efficacy and safety of tranexamic acid for melasma by different administration methods: A systematic review and network meta-analysis. J Cosmet Dermatol. 2024. Network meta-analysis, number of trials not stated in abstract; funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/38059683/
  8. Wang WJ, et al. The optimal dose of oral tranexamic acid in melasma: A network meta-analysis. Indian J Dermatol Venereol Leprol. 2023. Network meta-analysis, 6 RCTs, 599 patients, 8-12 weeks; funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/36332095/
  9. Heidary B, et al. Randomized Clinical Trial on the Efficacy of Oral Tranexamic Acid Versus Topical Tranexamic Acid in Treatment of Melasma. J Cosmet Dermatol. 2025. Single-center RCT, n=50 women, 12 weeks; no conflicts declared. https://pubmed.ncbi.nlm.nih.gov/40923777/
  10. El Hadidi H, et al. The efficacy of oral vs different dilutions of intradermal tranexamic acid microinjections in melasma-A randomized clinical trial. Dermatol Ther. 2021. RCT, n=45 women, 8 weeks; funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/33651442/
  11. Feng X, et al. The efficacy and safety of microneedling with topical tranexamic acid for melasma treatment: A systematic review and meta-analysis. J Cosmet Dermatol. 2024. Meta-analysis, 16 trials; funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/37584240/
  12. Lee HC, et al. Oral tranexamic acid (TA) in the treatment of melasma: A retrospective analysis. J Am Acad Dermatol. 2016. Retrospective study, n=561, median 4 months; funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/27206758/
  13. Bala HR, et al. Oral Tranexamic Acid for the Treatment of Melasma: A Review. Dermatol Surg. 2018. Narrative review; funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/29677015/
  14. Kuceki G, et al. No thromboembolic events observed in randomized controlled trials of oral tranexamic acid: A systematic review and descriptive synthesis. J Am Acad Dermatol. 2025. Systematic review; no abstract available; no conflicts disclosed. https://pubmed.ncbi.nlm.nih.gov/40480374/
  15. Hernandez T, et al. Oral tranexamic acid use for melasma is not associated with thromboembolism: Findings from a multicenter propensity score-matched electronic health record cohort. JAAD Int. 2026. Retrospective cohort; no abstract available; no conflicts disclosed. https://pubmed.ncbi.nlm.nih.gov/41256337/
  16. Austin E, et al. Topical Treatments for Melasma: A Systematic Review of Randomized Controlled Trials. J Drugs Dermatol. 2019. Systematic review, 35 RCTs; funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/31741361/
  17. McKesey J, et al. Melasma Treatment: An Evidence-Based Review. Am J Clin Dermatol. 2020. Systematic review, 113 studies, 6,897 participants; funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/31802394/
  18. González-Molina V, et al. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. 2022. Systematic review, 80 papers; no conflicts reported. https://pubmed.ncbi.nlm.nih.gov/35642229/
  19. Sarkar R, et al. Delphi consensus on melasma management by international experts and pigmentary disorders society. J Eur Acad Dermatol Venereol. 2026. Delphi consensus, 38 dermatologists from 11 countries; Galderma India funding. https://pubmed.ncbi.nlm.nih.gov/40996222/
  20. Lee DH, et al. Reduction in facial hyperpigmentation after treatment with a combination of topical niacinamide and tranexamic acid: a randomized, double-blind, vehicle-controlled trial. Skin Res Technol. 2014. RCT, n=42 Korean women, 8 weeks; non-US government support; first author affiliated with a company R&D center. https://pubmed.ncbi.nlm.nih.gov/24033822/
  21. Desai S, et al. Effect of a Tranexamic Acid, Kojic Acid, and Niacinamide Containing Serum on Facial Dyschromia: A Clinical Evaluation. J Drugs Dermatol. 2019. Clinical evaluation, 12 weeks, plus in-vitro data; n and funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/31141852/
  22. Yasnova N, et al. The effectiveness and safety of 3% tranexamic acid cream vs. 4% hydroquinone cream for mixed-type melasma in skin of color: a double-blind, split-face, randomized controlled trial. Acta Dermatovenerol Alp Pannonica Adriat. 2024. Split-face RCT, n=20, 8 weeks; funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/38918942/
  23. Ghasemiyeh P, et al. Safety and efficacy of niosomal and conventional tranexamic acid/niacinamide vs. hydroquinone creams in melasma: A randomized, double-blind, case-controlled clinical trial. Sci Rep. 2025. RCT, n=99, 3 months; university-funded; no competing interests. https://pubmed.ncbi.nlm.nih.gov/41315336/
  24. Rocio J, et al. Evaluation of the Efficacy of a Serum Containing Niacinamide, Tranexamic Acid, Vitamin C, and Hydroxy Acid Compared to 4% Hydroquinone in the Management of Melasma. J Cosmet Dermatol. 2025. Investigator-blind RCT, n=60 women, 5 months; Vichy-funded, 2 authors L'Oréal employees. https://pubmed.ncbi.nlm.nih.gov/40062688/
  25. Saki N, et al. Comparing the efficacy of topical hydroquinone 2% versus intradermal tranexamic acid microinjections in treating melasma: a split-face controlled trial. J Dermatolog Treat. 2018. Split-face randomized trial, n=37, 20 weeks; funding not reported in abstract. https://pubmed.ncbi.nlm.nih.gov/29027510/

Disclosure: This article is for general information only. It is not medical advice. Peptide Skincare has no affiliate links in this article and received no payment from any manufacturer mentioned. Oral and injected tranexamic acid are prescription treatments with bleeding and clotting considerations; talk to a doctor, and never start, stop or change a medication on your own.

For educational purposes only; not medical advice. See our disclaimer and research method.