Potential Role of Tranexamic Acid and Nonablative Fractional Resurfacing in Managing Facial Hyperpigmentation

To the Editor In reading the recent article by Kundu et al regarding the management of facial hyperpigmentation due to melasma and postinflammatory hyperpigmentation (PIH), we have additional perspectives regarding medical and procedural management given recent advancements described in the literature and our own clinical experience. Regarding medical management, several recent studies have supported the effectiveness and safety of oral tranexamic acid (TA) in treating various pigmentary disorders, such as melasma and PIH. Despite its historical hemostatic indications at higher doses, multiple studies have demonstrated low clotting risk when TA is used at dosages used for dermatologic indications. For example, the largest retrospective review of oral TA for melasma found that among 561 included patients, only 1 (who was later found to have protein S deficiency) developed a deep vein thrombosis. Likewise, in a 5-year single-institution cross-sectional study of 206 patients with 451 prescriptions of TA, 650 mg, once daily, we found no documented adverse events that were associated with clotting risk. This included durations of therapy of up to 6 months without follow-up study. We routinely prescribe this dosage and have found it to be well tolerated with clinical improvement, even for recalcitrant melasma.
Source: JAMA Dermatology - Category: Dermatology Source Type: research