Title : Tranexamic acid as a therapeutic option for melasma management: meta-analysis and systematic review of randomized controlled trials
Abstract:
Introduction: Melasma is a prevalent acquired pigmentary disorder characterized by hyperpigmented macules or patches with irregular borders. This study aimed to evaluate the efficacy of tranexamic acid (TXA) in treating melasma through a meta-analysis and systematic review of randomized controlled trials (RCTs), focusing on identifying associated adverse effects and comparing TXA’s effectiveness with other melasma treatments.
Materials and Methods: Following PROSPERO and PRISMA guidelines, an extensive electronic search was conducted across four databases for RCTs on TXA use in melasma. Inclusion criteria encompassed full-text English articles with specific outcome measures, while studies with high bias risk or non-English publications were excluded. Data from 22 relevant studies were analyzed using RevMan software, with heterogeneity identified using I² statistics and forest plots.
Results: A total of 22 studies including 1280 patients were reviewed. TXA was administered orally, topically, or via injection, with treatment durations ranging from 8 weeks to nearly 2 years. TXA significantly reduced melasma severity, evidenced by reductions in MASI, mMASI, MI, and hemi-MASI scores. Oral TXA demonstrated the greatest decrease in MASI scores, followed by injections and topical applications. However, studies exhibited high heterogeneity, particularly among combined treatments. Reported adverse effects included gastrointestinal discomfort, skin irritation, and menstrual irregularities.
Conclusions: TXA is effective in treating melasma, either alone or combined with other modalities. Despite significant reductions in melasma severity, further research is warranted to standardize TXA administration methods and assess long-term safety outcomes. The observed heterogeneity underscores the need for consistent treatment protocols across future trials.
