Tranexamic Acid for Melasma: How It Works and Precautions

This is an English adaptation of a clinical article Dr. SangYoul Yun: board-certified dermatologist and Medical Director of Delight Dermatology in Gangnam, Seoul, originally published in Korean. Read the Korean original on Naver. It has been restructured and translated for international readers; dosing details were removed from this version on October 14, 2026.

Melasma is a common concern. It develops from a range of causes (hormonal changes, oral contraceptives, sun exposure) and because the causes are varied, it is not easy to treat. One of the medications used for melasma is tranexamic acid (known in Korea by the brand Doransamin).

Tranexamic acid comes as an orange-and-yellow capsule. It has long been used as a hemostatic (bleeding-control) agent, but after its effect on melasma became clear, it has been available over the counter in Japan since 2007.

How it works

In melasma lesions, the number of mast cells is increased. These mast cells produce vascular endothelial growth factor (VEGF), transforming growth factor-beta and fibroblast growth factor, all of which contribute to the development of melasma. However, using an antihistamine alone to reduce mast cells did not prove effective for melasma.

Separately, a factor called plasmin stimulates melanocytes and promotes melanin production. Tranexamic acid is an anti-plasmin agent: it suppresses melanin production, which is how it treats melasma and pigmentary conditions.

What the trials actually show

A 2024 meta-analysis of randomized controlled trials found that adding oral tranexamic acid to standard triple-combination cream improved MASI scores significantly more than the cream alone (mean difference −3.10) and was associated with a roughly 72% lower relative risk of melasma recurrence (risk ratio 0.28, 95% CI 0.16–0.49) (PMID 38848545). Korean clinical data indicates similar results for combination care: patients who took oral tranexamic acid alongside IPL and low-fluence laser treatment improved more than those treated with light and laser alone, with the difference most visible during periods of higher sun exposure (PMID 22103770).

Precautions

Tranexamic acid should be used with caution in patients who have a clot (such as cerebral thrombosis, myocardial infarction or thrombophlebitis) or who are at risk of thrombosis.

Side effects

Possible side effects include reduced menstrual flow, headache, skin rash and abdominal pain. If any of these occur, talk to the dermatologist who prescribed it.

Tranexamic acid is one part of melasma care

Because melasma is genuinely difficult to treat, it often requires more than tranexamic acid alone: laser treatment, radiofrequency, chemical peels and other approaches are frequently combined. You can read more about our combined approach to melasma treatment and broader pigmentation treatment.

Medical disclaimer. This article is general information and does not replace individual consultation. Tranexamic acid is a prescription medication with contraindications (for example, thrombotic disease), so whether to take it must be decided only after consulting a dermatologist.