11/29/2025
When I die, I want my tombstone to say: “he cured melasma”.
Until our specialty figures this out, melasma is best treated with strict sun avoidance, sun protection, topicals and sometimes a bit of help from carefully delivered lasers. Oral tranexamic acid tablets are a newer option – this is an old medication used commonly by gynecologists to help women who suffer from excess menstrual bleeding. It was discovered, at very low doses, to suppress melasma. This patient with difficult-to-treat, refractory melasma had slow and steady progress over 3 and 6 months. Though I do love lasers and devices, I love the treatment that provides the best outcome more.
Because tranexamic acid stabilizes blood clots, we avoid using it in patients at higher risk of clotting: personal history of clotting, family history of clotting, smoking, concurrent estrogen-containing oral contraceptive or hormone replacement, and of course pregnancy.
