title: Oral tranexamic acid (TA) in the treatment of melasma: A retrospective analysis.
abstract: BACKGROUND
  Melasma is a common pigmentary disorder among Asians and treatment is challenging. Oral tranexamic acid (TA) has emerged as a potential treatment for refractory melasma. Large-scale studies on its use, outcomes, and safety are limited.
  
  
  OBJECTIVE
  We sought to evaluate treatment outcomes and adverse effects of oral TA in melasma in an Asian population.
  
  
  METHODS
  We conducted a retrospective analysis of patients who received oral TA for melasma in a tertiary dermatologic center from January 2010 to June 2014.
  
  
  RESULTS
  In all, 561 patients (91.4% female, 8.6% male) were enrolled. Median duration of treatment was 4 months. The majority (503 [89.7%]) improved, 56 (10.0%) had no improvement, and 2 (0.4%) worsened. Patients without family history of melasma had better response rates than those with family history (90.6% vs 60.0%, P = .01). Of the 503 who improved, response was seen within 2 months of TA initiation, with a relapse rate of 27.2%. Adverse events occurred in 40 (7.1%). Most were transient, but 1 developed deep vein thrombosis requiring prompt discontinuation. She was later given the diagnosis of familial protein S deficiency.
  
  
  CONCLUSIONS
  This was a retrospective study.
  
  
  CONCLUSIONS
  Oral TA may be an effective adjunct for refractory melasma. Careful screening for personal and familial risk factors for thromboembolism should be done before initiation.
authors.affiliation: National Skin Center, Singapore. Electronic address: hclee@nsc.gov.sg.
authors.forename: Hwee Chyen
authors.initials: HC
authors.lastname: Lee
authors.affiliation: National Skin Center, Singapore.
authors.forename: Tien Guan Steven
authors.initials: TG
authors.lastname: Thng
authors.affiliation: National Skin Center, Singapore.
authors.forename: Chee Leok
authors.initials: CL
authors.lastname: Goh
mesh_terms: D000284:Administration, Oral; D000328:Adult; D044466:Asian People; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005148:Facial Dermatoses / Q000188:drug therapy* / Q000208:ethnology; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006261:Headache / Q000139:chemically induced; D006801:Humans; D008297:Male; D008548:Melanosis / Q000188:drug therapy* / Q000208:ethnology; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore; D014148:Tranexamic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000139:chemically induced
chemical_list: D003879:Dermatologic Agents; D014148:Tranexamic Acid
keywords: angiogenesis; chloasma; facial pigmentation; melanogenesis; melasma; tranexamic acid