Comparison of efficacy of oral and topical route of tranexamic acid in patients of melasma

Background: Melasma is a common pigmentary disorder which presents with brown coloured macules that occurs around the sun-exposed areas of the skin, particularly on the face. Many treatment modalities are present but often it is resistant to treatment. The aim of our study was to compare the therapeutic efficacy and safety of tranexamic acid administered by oral and topical route in patients of melasma. Methods: Our study was a prospective, randomised study which consisted of 40 new melasma patients. 20 patients were given Oral Tranexamic acid 250 mg twice daily, classified as Group 1, other 20 patients were given topical Tranexamic acid (3%) twice a day (fully covering the lesion), classified as Group 2 for a period of 8 weeks and both were given broad spectrum sunscreen (SPF 50). MASI was determined before starting treatment (baseline), 4 weeks and 8 weeks. Based on the reduction in the mean MASI, the therapeutic response is graded and subjective response and adverse effects were also recorded at each visit. Results: Mean percentage reduction in MASI scores was higher in oral (52.1%) as compared to topical (31.9%) group. In oral group, headache was the only adverse effect, however, in topical group, erythema, burning, acneiform eruptions were reported. At final assessment, fair improvement was seen in both groups. Conclusions: Both oral as well as topical tranexamic acid were efficacious for treatment of melasma, however, of the two oral tranexamic acid was safer and provided a better proportional response.