During the winter months, our warm weather–induced melasma and dark spots need some extra TLC. Enter spot-saving tranexamic acid (TXA): a hard-hitting acid used in dermatology for the treatment of dark spots and a skin condition known as melasma, which causes patchy discoloration on the face.
2-5 percent: The amount of TXA needed in skin-care products in order to help keep new discoloration from forming.
—Deborah Kilgore
Originally prescribed in the early 1960s to women with heavy menstrual periods, tranexamic acid is known as an antifibrinolytic agent, meaning it blocks the breakdown of blood clots and prevents bleeding. “When TXA was first prescribed orally for heavy periods, women with hyperpigmentation on their face were seeing the condition fade throughout treatment,” New York dermatologist Orit Markowitz, MD says, adding that the oral version, which should not be used if you have a clotting disorder, is effective at treating the skin from the inside-out. While the acid can still be taken orally, cosmetic chemist Stephen Alain Ko says it has “found its way into skin-care products as a topical,” and Dr. Markowitz adds that this mechanism works just as well as the internal method if a high percentage—about 12 percent TXA—is used.
It works in its own way.
popular skin-care acids, it’s evident that it’s in a category of its own. “While ‘acid’ is part of the ingredient name, tranexamic acid does not exfoliate the way ingredients like AHAs (alphahydroxy acids) or BHAs (betahydroxy acids) do,” explains Deborah Kilgore, director of skin-care education programs at Paula’s Choice.
The big difference, besides the fact that TXA is one of the few acids that can be taken orally, is that it “shrinks blood vessels in the dermis and reduces the amount of tyrosinase—a rate-limiting enzyme that controls the production of melanin—therefore eliminating dark patches on the face,” says Dr. Markowitz. Ko adds that “there’s also some evidence showing that tranexamic acid may be useful as an anti-inflammatory.”
It pairs well with other treatments.
One of TXA’s most praised traits is its ability to work alongside other ingredients and treatments. “In studies where TXA is combined with an in-office treatment like lasers, the ingredient has performed quite nicely, whether it’s used orally or topically,” Dr. Markowitz explains. “When TXA is simultaneously applied on the face during microneedling, it can work even better because the microchannels help the ingredient further sink into the skin.” While the combination of the two is extremely effective, Ko says that solely using the oral or topical form of TXA may be helpful on its own. “It’s a much more affordable option compared to some treatments like lasers.”
According to Greenwich, CT dermatologist Lynne Haven, MD, TXA is less irritating than alternative topicals, making it suitable to mix with other brighteners like kojic acid, vitamin C or retinoids in order to maximize results. “Another advantage of topical tranexamic acid is that, unlike hydroquinone, it does not cause paradoxical skin darkening, which is when the affected area has an adverse reaction and turns darker instead of lighter,” she adds. Another way to contradict skin darkening: SPF. “Any ingredient targeted toward reducing melasma is best paired with the consistent use of a broad-spectrum sunscreen,” says Ko.
It prevents future discoloration.
Although effective, the oral treatment should be monitored by a dermatologist.
—Stephen Alain Ko
It’s evident that TXA can backtrack damage and zap away discoloration, but daily use can also prevent future discoloration from occurring. “Products powered with concentrations of 2 to 5 percent tranexamic acid can work as a targeted treatment to help new discoloration from forming,” says Kilgore. Dr. Markowitz puts extra emphasis on the prevention of post-acne marks: “Using TXA daily topically or orally in combination with acne treatments can prevent post-inflammatory hyperpigmentation the same way it helps manage melasma,” she explains. However, Ko notes there has been far more research done on tranexamic acid’s ability to help clear up melasma versus other forms of hyperpigmentation.
The Bright Side
