Innovative approaches in melasma management: unveiling the multifaceted potential of tranexamic acid

Tranexamic acid (TXA) has emerged as a promising therapeutic agent for melasma due to its multifaceted action on vascular, inflammatory, and melanogenic pathways. This review investigates the current evidence supporting the efficacy and safety of oral, topical, and intradermal routes of TXA administration. Oral TXA demonstrates notable effectiveness, achieving a 50–60% reduction in Melasma Area and Severity Index (MASI) scores, while topical formulations offer comparable benefits with an improved safety profile. Intradermal administration allows for rapid, localized effects, with MASI score improvements ranging from 55–65%. Moreover, combinatory regimens particularly with fractional CO₂ lasers or antioxidants like ascorbic acid have shown synergistic effects, offering new hope for recalcitrant cases. Despite these promising developments, challenges remain. The absence of comprehensive long-term safety data and the inadequate representation of varied communities in clinical studies necessitate immediate concern. Future research should emphasize longitudinal follow-up, genetic predispositions, and ethnic-specific responses. Ultimately, integrating advanced delivery systems with patient education and adherence strategies is vital for optimizing and sustaining TXA’s therapeutic benefits in melasma management.