Box 1.
Expert consensus statements for use of oral TXA in melasma
| • Melasma is a recurrent, chronic, and often refractory skin condition.[6] |
| • Although there are several treatment options, because of poor results in many patients,[6] there is a need of an alternative for melasma. |
| • Considering the mechanism of action, TXA has an important role in melasma treatment.[6] |
| • Several investigators from different countries have documented the effectiveness of oral TXA in melasma through prospective[1,3,5,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28] and retrospective studies.[29,30,31] These studies have used oral TXA in different doses. |
| • TXA is not approved for the treatment of melasma. Clinicians should inform this to the patient, obtain full history to rule out complications, provide full information and document same in the case notes. |
| • Overall, oral TXA 250 mg twice daily seems to be promising treatment option for melasma. |
| • Oral TXA is also effective and well-tolerated treatment option for patients with refractory melasma.[33] |
| • Minimum of three-month treatment with oral TXA is required for the results. However, optimal duration of treatment is not known. |
| • Oral TX can be used as monotherapy or along with other modalities.[1,3,5,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31] |
| • According to the literature and experts, tranexamic acid may be given for up to six months. |
| • Patients with history hypersensitivity to TXA should not receive this treatment.[8] |
| • Females on combination hormonal contraception should not be treated with oral TXA.[8] |
| • Presence of active thromboembolic condition or history/risk of thrombosis or thromboembolism should be excluded before initiation of treatment with oral TXA.[8] |
| • Patients should be carefully selected before using oral TXA. Clinicians should rule out contraindications for use of oral TXA, before using it.[33] |
| • According to experts, in case of relapse, TXA may be repeated. However, for the duration of the gap, there is no specific recommendation. |