Tranexamic acid for skin treatments

Tranexamic acid works differently from other skin lightening ingredients to treat skin hyperpigmentation.

It can be combined with other skin whitening products in your skin care routine.

But- the best products have at least 1% TXA in them. This blog is all about how tranexamic acid works, and the best products for different skin types.

Find your skin type for free with our quiz!

Used in skin care for evening skin pigment by interfering with melanin in various ways.

No particular dangers unless you are allergic to it.

Well studied and increasing in popularity.

Tranexamic acid products

These days, there are more and more tranexamic acid products entering the market. It can be challenging to figure out which ones are the best. For that reason, I’ve put a few of my favorite tranexamic acid products for you here:

How does tranexamic acid (TXA) work on hyperpigmentation?

TXA blocks melanin production through a 3 step process:

Inhibits plasmin

Decreases tyrosinase activity in melanocytes

Reduces prostaglandin synthesis

It only works well on hyperpigmentation caused by increased blood flow to the skin. (at least that is the current belief but studies are ongoing.)

Who should use tranexamic acid for skin?

Tranexamic acid is use to treat hyperpigmentation. When used orally and topically it can improve:

melasma

post inflammatory hyperpigmentation (PIH) (4)

hyperpigmentation

solar lentigos

Topical tranexamic does not prevent PIH, but has been shown to speed clearing of post inflammatory pigmentation. (1)

Injected intradermal tranexamic acid has been shown to prevent PIH. (4)

Is tranexamic acid an exfoliant?

No. Tranexamic is not an exfoliant.

Hydroquinone

Is tranexamic acid as good as hydroquinone?

Hydroquinone is usually much more effective than TXA topically.

This is because topical TXA is usually a very low dose in cosmeceuticals while hydroquinone is prescription and is usually 4-10%.

TXA does not absorb as well into the skin as hydroquinone does.

In research trials that use 3-5% of TXA, we see that TXA might work as well as hydroquinone.

Here are the research studies:

2014: A randomized, split-face trial compared 3% topical TXA versus 3% HQ and 0.01% dexamethasone used twice daily for 12 weeks. The improvement was better in the TXA group but the difference was not statistically significant. (9)

2015: A study compared 5% TXA versus 4% HQ cream for the treatment of melasma and did not find a statistically significant difference between the 2 groups. (10)

2017: Another study in 2017 compared 5% TXA with 2% hydroquinone and did not show a statistical difference. (11)

Is oral TXA as good as hydroquinone?

Oral tranexamic acid is much more effective than topical hydroquinone for treating melasma.

The topical formulations of TXA are not as effective as TXA orally or injected into the skin.

TXA pills and injections work much better than hydroquinone.

What can you layer tranexamic acid with?

TXA does not tend to react with other ingredients so it can be mixed with retinol, AHA, BHA, hydroquinone, vitamin C, kojic acid, arbutin and other skin lightening ingredients.

Niacinamide

Tranexamic acid and niacinamide together?

These are good skin lightening ingredients to use together because they work in 2 different ways.

Retinol

Tranexamic acid and retinol together?

These are great ingredients to use together but they should be used at different times in your skin care routine.

Hyaluronic acid

Tranexamic acid and hyaluronic acid together?

It is a good idea to use HA serums and TXA together because:

TXA absorbs poorly

HA increases absorption of TXA into the skin

Is TXA right for you? When is the best time to use it in your skin care routine?

We can help you build the best skin care routine for your Baumann Skin Type.

How is Tranexamic acid used?

TXA is used in 3 main ways:

topically in skin serums and creams

injected into dark spots

orally in a tablet pill form

Topical Tranexamic Acid Serums and Creams

Topical TXA is included in skin care products with formulations at a dose of up to 5% (8).

The most effective TXA skin care products have at least 1% of TXA.

TXA absorbs poorly so the products that you combine with it in your skin care routine matters a lot!

intradermal tranexamic acid injections

Intradermal Tranexamic Acid

TXA is injected into skin and after microneedling i to treat dyschromia.

It comes in a liquid form and most protocols use 4–100 mg/mL.

Several studies have looked at intradermal TXA or TXA applied after microneedling, however there is no consensus on dose and how often to inject.

At this time it is too early to say if TXA is an effective treatment when used in this manner. (12)

Oral tranexamic acid for skin

Oral tranexamic acid is not approved by the FDA but it is often used to treat melasma.

It works by decreasing blood flow to the skin.

This means that TXA will NOT work on dark spots that are not caused by an increased blood flow.

Dose of the tranexamic acid pill for hyperpigmentation

The most commonly used dose of TXA for melasma is350 mg two times a day. a 600mg tablet is broken in half to give a dose of 350 mg.

Studies that show oral tranexamic acid is good for melasma

Many studies show oral TXA works well to treat melasma.

In one study, 44 patients with melasma took 250mg of TXA by mouth two times a day for 3 months. (7)

They had a 49% improvement of melasma as assessed by the MASI score.

Many other studies have shown efficacy as well.

are the effects of tranexamic acid permanent?

Are the skin lightening effects of oral tranexamic acid permanent?

It is unknown how long the skin whitening effects of TXA will last, but they are not permanent.

Melasma tends to recur and relapse. This is seen after TXA treatment as with any other melasma treatments.

In one study (7), 26% of patients continued to show improvement at 3 months (49% had improvement at end of the study)- so only about half still showed improvement at 3 months.

You can help prevent recurrence of melasma after stopping tranexamic acid with:

Two skin care routines for melasma- a maintenance regimen and a treatment regimen

Habits to minimize pigmentation and help get rid of melasma

Treating melasma from the inside with anti-inflammatory diet and supplements

How long should I take tranexamic acid for melasma?

There is no consensus on how long TXA should be used. Most doctors have you take it until melasma clears or for 3 months.

We do not know many things about using TXA for melasma:

Should be a treatment holiday?

How long it is safe to take?

How common is relapse?

How long after stopping tranexamic acid does it recur?

TXA is a promising medication for the treatment of melasma, but more studies and clinical experience is needed to determine the most effective treatment and maintenance protocols.

Side effects of oral tranexamic acid

The most common side effects are GI complaints such as nausea and diarrhea.

Blood clots are a risk with TXA, but clots have not to my knowledge been reported in patients taking TXA for melasma treatment.

risks of tranexamic acid

Contraindications to oral tranexamic acid

Oral TXA Tranexamic acid can increase the risk of blood clots when used orally.

Do not take the tranexamic acid pills if you:

are on estrogen containing oral contraceptives

are taking estrogen for hormone replacement therapy

have a history of blood clots

have an increased risk of blood clots

are planning a very long flight or time period of inactivity such as bed rest

are pregnant

Do not take tranexamic acid pills if you have any of these medical issues:

Acute promyelocytic leukemia patients on oral tretinoin

History of blood clots,

History of deep vein thrombosis

History of pulmonary embolism

History of stroke

Stroke

Kidney disease—The effects may be increased because of slower removal of the medicine from the body.

Pregnancy

Breastfeeding

Discuss with your doctor before taking TXA if you are on any of these because of increased risk of blood clots:

Desogestrel

Dienogest

Drospirenone

Estradiol

Ethinyl Estradiol

Ethynodiol

Etonogestrel

Gestodene

Levonorgestrel

Medroxyprogesterone

Mestranol

Nomegestrol

Norelgestromin

Norethindrone

Norgestimate

Norgestrel

Segesterone

The best way to know if oral or injected TXA is a good option for you is to see one of our doctors or medical providers.

Other names for tranexamic acid

Trans-4-aminomethylcyclohexanecarboxylic acid

trans-AMCHA

TXA

Melasma pill

Melasma tablet

Wondering if topical TXA is good for your skin type?

Take our free quiz and find out today!

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For those times, this bareMinerals moisturizer is a great thing to have on hand. Vitamin C Serum “A great introduction to anti-aging is to start with a vitamin C serum in your morning skincare routine,” Ross says. “It’s a powerful antioxidant that will neutralize free radicals and brighten the skin.” He adds that it’s a great way to counteract the effects of the sun’s harmful rays, which, as previously mentioned, are among the biggest causes of premature aging. Drunk Elephant C-Firma™ Vitamin C Day Serum The Drunk Elephant C-Firma is a lightweight serum that promises to give skin a glow by combining the brightening powers of vitamin C with ferulic acid, l-ascorbic acid, and vitamin E. The included sodium hyaluronate is meant to replace hydration loss, so you shouldn’t have to deal with any irritation. Sunday Riley C.E.O. 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It is wise to use products that gently exfoliate, yet still remove oil and other impurities. Products that have Alpha Hydroxy Acids (AHA) or Beta Hydroxy Acids (BHA) are a good choice.” According to Somenek, you should only exfoliate two to three times a week. “People of all ages are guilty of over-exfoliating and that can be too much of a good thing,” he says. Dermadoctor Kakadu C Intensive Vitamin C Peel Pad A few swipes of this Derma Doctor powerful peel pad promise to leave your skin glowing and smooth, thanks to the seven (yes, seven) types of chemical exfoliants, including AHA and BHA. It also contains vitamin C via Kakadu plum extract for added brightening and antioxidant protection. KEY INGREDIENTS Kakadu plum extract is sourced from the Kakadu plum, a fruit grown in northern Australia. It contains vitamin C, which restores the skin’s natural barrier, increases collagen production, and soothes irritation. Dr. Dennis Gross Skincare Alpha Beta® Universal Daily Peel Pads These are the gold standard of peel pads, with a cult following and over 900 five-star reviews on Sephora. They’re easy to use and contain a blend of anti-aging exfoliating acids. Emollient Night Cream “In your 20s, you need to start upping the hydration in your skincare routine. You may have been cautious of over-moisturizing because of acne in your teens, but as you enter your 20s, your skin transitions and becomes drier,” Ross says. “I recommend an emollient night cream added into your evening skincare regimen.” “Twenty-somethings need to make sure that they are not using creams that will clog their pores and cause excess oil production,” says Somenek. Opt for non-comedogenic products. Cerave Skin Renewing Night Cream One great choice is the CeraVe Skin Renewing Night Cream, which is a non-comedogenic night cream that leaves skin soft and glowy. It combines the moisturizing powers of ceramides and hyaluronic acid. RoC Retinol Correxion Max Hydration Creme “The best night cream ingredients contain retinol, benzoyl peroxide, and/or salicylic acid or hyaluronic acid. The goal is to moisturize, yet remove excess oil,” says Somenek. This Roc Retinol Correxion cream fits the bill as it contains both hyaluronic acid and retinol so it promises to moisturize while also being non-comedogenic.

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