EFFECTIVENESS AND SAFETY OF TRANEXAMIC ACID IN THE TREATMENT OF MELASMA: A SYSTEMATIC REVIEW

• DOI: https://doi.org/10.22533/at.ed.159522503014

• Palavras-chave: "Tranexamic Acid," "Melasma Treatment," "Hyperpigmentation," "Safety Profile," "Efficacy"

• Keywords: "Tranexamic Acid," "Melasma Treatment," "Hyperpigmentation," "Safety Profile," "Efficacy"

• Abstract:

  This systematic review confirmed the significant efficacy of tranexamic acid (TXA) in reducing pigmentation in patients with melasma, demonstrated by improvements in the severity indices of the condition, such as the Melasma Area and Severity Index (MASI) and the Melanin Index (MI). The results indicated benefits in both monotherapy and combination treatments, with noticeable clinical responses often observed in 8 to 12 weeks, regardless of the route of administration. A comparative analysis of the routes of administration revealed that oral TXA promotes a faster reduction in pigmentation indices and is indicated for moderate to severe cases, although it is associated with mild adverse effects, such as gastrointestinal symptoms. Topical application stood out for its safety and tolerability, making it a choice for mild cases or patients with systemic contraindications. Intradermal administration, on the other hand, has shown localized efficacy and is useful in refractory cases.
  Adverse events related to the use of TXA were generally mild and self-limiting, with a higher prevalence of skin irritation in the topical route and gastrointestinal discomfort in the oral route. The intradermal route presented an even more favorable profile. Despite the promising results, the review identified important limitations, such as methodological heterogeneity, small sample sizes and the absence of standardized protocols, which make it difficult to generalize the findings. Future clinical trials should prioritize the standardization of evaluation methods, studies with greater methodological rigour and prolonged follow-up to assess the durability of the benefits and long-term safety.
  The growing recognition of TXA in the management of melasma reflects its positive impact on even skin tone and patients' quality of life. The exploration of therapeutic combinations and predictive biomarkers could consolidate TXA as a first-line approach in the treatment of melasma, especially in high-prevalence populations.