Dark spots
Strong evidenceIndependent trials and meta-analyses agree on melasma
Multiple independent randomized trials — and 2024 meta-analyses pooling 22 of them — agree: 3–5% topical tranexamic acid improves melasma comparably to 3–4% hydroquinone over 12 weeks, with better tolerability. Individual trials are small, and oral doses (a prescription matter) show larger effects than topical.
The receipts
90 trials/reviews indexed · showing most cited- Randomized trialJ Cosmet Laser Ther· 2012· cited 73×
Topical 5% tranexamic acid for the treatment of melasma in Asians: a double-blind randomized controlled clinical trial.
- Meta-analysisActa Derm Venereol· 2017· cited 66×
Efficacy and Safety of Tranexamic Acid in Melasma: A Meta-analysis and Systematic Review.
- Randomized trialJ Am Acad Dermatol· 2018· cited 65×
Randomized, placebo-controlled, double-blind study of oral tranexamic acid in the treatment of moderate-to-severe melasma.
- Randomized trialDermatol Surg· 2013· cited 63×
Oral tranexamic acid enhances the efficacy of low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet laser treatment for melasma in Koreans: a randomized, prospective trial.
- Meta-analysisJAMA Otolaryngol Head Neck Surg· 2018· cited 58×
Preoperative Tranexamic Acid for Treatment of Bleeding, Edema, and Ecchymosis in Patients Undergoing Rhinoplasty: A Systematic Review and Meta-analysis.
- Randomized trialMedicine (Baltimore)· 2017· cited 45×
Efficacy of functional microarray of microneedles combined with topical tranexamic acid for melasma: A randomized, self-controlled, split-face study.