Tranexamic acid for skin treatments
Tranexamic acid works differently from other skin lightening ingredients to treat skin hyperpigmentation.
It can be combined with other skin whitening products in your skin care routine.
But- the best products have at least 1% TXA in them. This blog is all about how tranexamic acid works, and the best products for different skin types.
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Used in skin care for evening skin pigment by interfering with melanin in various ways.
No particular dangers unless you are allergic to it.
Well studied and increasing in popularity.
Tranexamic acid products
These days, there are more and more tranexamic acid products entering the market. It can be challenging to figure out which ones are the best. For that reason, I’ve put a few of my favorite tranexamic acid products for you here:
How does tranexamic acid (TXA) work on hyperpigmentation?
TXA blocks melanin production through a 3 step process:
Inhibits plasmin
Decreases tyrosinase activity in melanocytes
Reduces prostaglandin synthesis
It only works well on hyperpigmentation caused by increased blood flow to the skin. (at least that is the current belief but studies are ongoing.)
Who should use tranexamic acid for skin?
Tranexamic acid is use to treat hyperpigmentation. When used orally and topically it can improve:
melasma
post inflammatory hyperpigmentation (PIH) (4)
hyperpigmentation
solar lentigos
Topical tranexamic does not prevent PIH, but has been shown to speed clearing of post inflammatory pigmentation. (1)
Injected intradermal tranexamic acid has been shown to prevent PIH. (4)
Is tranexamic acid an exfoliant?
No. Tranexamic is not an exfoliant.
Hydroquinone
Is tranexamic acid as good as hydroquinone?
Hydroquinone is usually much more effective than TXA topically.
This is because topical TXA is usually a very low dose in cosmeceuticals while hydroquinone is prescription and is usually 4-10%.
TXA does not absorb as well into the skin as hydroquinone does.
In research trials that use 3-5% of TXA, we see that TXA might work as well as hydroquinone.
Here are the research studies:
2014: A randomized, split-face trial compared 3% topical TXA versus 3% HQ and 0.01% dexamethasone used twice daily for 12 weeks. The improvement was better in the TXA group but the difference was not statistically significant. (9)
2015: A study compared 5% TXA versus 4% HQ cream for the treatment of melasma and did not find a statistically significant difference between the 2 groups. (10)
2017: Another study in 2017 compared 5% TXA with 2% hydroquinone and did not show a statistical difference. (11)
Is oral TXA as good as hydroquinone?
Oral tranexamic acid is much more effective than topical hydroquinone for treating melasma.
The topical formulations of TXA are not as effective as TXA orally or injected into the skin.
TXA pills and injections work much better than hydroquinone.
What can you layer tranexamic acid with?
TXA does not tend to react with other ingredients so it can be mixed with retinol, AHA, BHA, hydroquinone, vitamin C, kojic acid, arbutin and other skin lightening ingredients.
Niacinamide
Tranexamic acid and niacinamide together?
These are good skin lightening ingredients to use together because they work in 2 different ways.
Retinol
Tranexamic acid and retinol together?
These are great ingredients to use together but they should be used at different times in your skin care routine.
Hyaluronic acid
Tranexamic acid and hyaluronic acid together?
It is a good idea to use HA serums and TXA together because:
TXA absorbs poorly
HA increases absorption of TXA into the skin
Is TXA right for you? When is the best time to use it in your skin care routine?
We can help you build the best skin care routine for your Baumann Skin Type.
How is Tranexamic acid used?
TXA is used in 3 main ways:
topically in skin serums and creams
injected into dark spots
orally in a tablet pill form
Topical Tranexamic Acid Serums and Creams
Topical TXA is included in skin care products with formulations at a dose of up to 5% (8).
The most effective TXA skin care products have at least 1% of TXA.
TXA absorbs poorly so the products that you combine with it in your skin care routine matters a lot!
intradermal tranexamic acid injections
Intradermal Tranexamic Acid
TXA is injected into skin and after microneedling i to treat dyschromia.
It comes in a liquid form and most protocols use 4–100 mg/mL.
Several studies have looked at intradermal TXA or TXA applied after microneedling, however there is no consensus on dose and how often to inject.
At this time it is too early to say if TXA is an effective treatment when used in this manner. (12)
Oral tranexamic acid for skin
Oral tranexamic acid is not approved by the FDA but it is often used to treat melasma.
It works by decreasing blood flow to the skin.
This means that TXA will NOT work on dark spots that are not caused by an increased blood flow.
Dose of the tranexamic acid pill for hyperpigmentation
The most commonly used dose of TXA for melasma is350 mg two times a day. a 600mg tablet is broken in half to give a dose of 350 mg.
Studies that show oral tranexamic acid is good for melasma
Many studies show oral TXA works well to treat melasma.
In one study, 44 patients with melasma took 250mg of TXA by mouth two times a day for 3 months. (7)
They had a 49% improvement of melasma as assessed by the MASI score.
Many other studies have shown efficacy as well.
are the effects of tranexamic acid permanent?
Are the skin lightening effects of oral tranexamic acid permanent?
It is unknown how long the skin whitening effects of TXA will last, but they are not permanent.
Melasma tends to recur and relapse. This is seen after TXA treatment as with any other melasma treatments.
In one study (7), 26% of patients continued to show improvement at 3 months (49% had improvement at end of the study)- so only about half still showed improvement at 3 months.
You can help prevent recurrence of melasma after stopping tranexamic acid with:
Two skin care routines for melasma- a maintenance regimen and a treatment regimen
Habits to minimize pigmentation and help get rid of melasma
Treating melasma from the inside with anti-inflammatory diet and supplements
How long should I take tranexamic acid for melasma?
There is no consensus on how long TXA should be used. Most doctors have you take it until melasma clears or for 3 months.
We do not know many things about using TXA for melasma:
Should be a treatment holiday?
How long it is safe to take?
How common is relapse?
How long after stopping tranexamic acid does it recur?
TXA is a promising medication for the treatment of melasma, but more studies and clinical experience is needed to determine the most effective treatment and maintenance protocols.
Side effects of oral tranexamic acid
The most common side effects are GI complaints such as nausea and diarrhea.
Blood clots are a risk with TXA, but clots have not to my knowledge been reported in patients taking TXA for melasma treatment.
risks of tranexamic acid
Contraindications to oral tranexamic acid
Oral TXA Tranexamic acid can increase the risk of blood clots when used orally.
Do not take the tranexamic acid pills if you:
are on estrogen containing oral contraceptives
are taking estrogen for hormone replacement therapy
have a history of blood clots
have an increased risk of blood clots
are planning a very long flight or time period of inactivity such as bed rest
are pregnant
Do not take tranexamic acid pills if you have any of these medical issues:
Acute promyelocytic leukemia patients on oral tretinoin
History of blood clots,
History of deep vein thrombosis
History of pulmonary embolism
History of stroke
Stroke
Kidney disease—The effects may be increased because of slower removal of the medicine from the body.
Pregnancy
Breastfeeding
Discuss with your doctor before taking TXA if you are on any of these because of increased risk of blood clots:
Desogestrel
Dienogest
Drospirenone
Estradiol
Ethinyl Estradiol
Ethynodiol
Etonogestrel
Gestodene
Levonorgestrel
Medroxyprogesterone
Mestranol
Nomegestrol
Norelgestromin
Norethindrone
Norgestimate
Norgestrel
Segesterone
The best way to know if oral or injected TXA is a good option for you is to see one of our doctors or medical providers.
Other names for tranexamic acid
Trans-4-aminomethylcyclohexanecarboxylic acid
trans-AMCHA
TXA
Melasma pill
Melasma tablet
Wondering if topical TXA is good for your skin type?
Take our free quiz and find out today!
