Tranexamic Acid
Also known as TXA
One of the more effective options for stubborn melasma, available topically and — under supervision — orally.
Topical serums $20–60. Oral is inexpensive but requires a prescription and screening.
How it works
Inhibits the plasminogen–plasmin pathway in keratinocytes, reducing the UV-triggered inflammatory signalling that stimulates melanocytes. It addresses pigmentation upstream rather than bleaching existing melanin.
How it's used
Topical 2–5% daily as a first step. Oral low-dose tranexamic acid for melasma is prescribed off-label by dermatologists and requires screening for clotting risk — it is not a self-prescribing situation.
Trade-offs
In favour
- Effective for melasma, which resists most other treatments
- Topical form is well tolerated
- Does not carry hydroquinone-style ochronosis risk
Against
- Oral form requires medical screening and supervision
- Melasma recurs without strict sun protection
- Slower than hydroquinone
Risks and side effects
- Oral use carries thromboembolic risk — contraindicated with clotting disorders, smoking plus oestrogen contraception, or a personal history of clots
- Mild GI upset with oral use
- Topical irritation is uncommon
How good is the evidence?
Good randomised evidence for oral use in melasma and growing evidence for topical formulations.
Sources
Sources point to guideline bodies and literature searches rather than single papers, so they stay accurate as the evidence moves.