Tranexamic Acid

 By Dr Davin Lim

What is the skin science behind Tranexamic Acid?

Tranexamic acid (T.Acid) provides a powerful and specific anti-inflammatory action, inhibiting pigment production in pigment cells known as melanocytes. At the same time it also blocks the transfer of pigment from melanocytes to cells in the upper layers of skin. While doing all this, tranexamic acid calms the skin and helps restore the skin barrier. 

Pigment production is far more complex than addressing the pigment cell, as research has shown that many other factors contribute to pigmentation, such as the interplay of blood vessels, epidermal cells, basement membrane factors and fibroblasts. The science of T.Acid is the biggest breakthrough in the management of melasma of the past decade. The most robust studies have involved oral administration of this compound with doses ranging from 250 to 1000 mg daily.

Does tranexamic acid lighten skin?

In recent times, T.Acid is claimed to have whitening & brightening effects especially for hyperpigmentation including melasma. To achieve this outcome, the ingredient is best combined with other pigment correctors, lasers & chemical peels. 

How often should I apply Tranexamic Acid?

Topical creams of this ingredient can be used up to twice a day. T.Acid can be combined with other topical pigment correctors including retinol, arbutin, azelaic acid, kojic acid, as well as ascorbic acid. In some cases I even combine T.acid with Hydroquinone in a compounded formulation. T. Acid can come in a variety of forms (serums, creams & tablets). Always use a similar forms together, so if you're using other pigment corrector creams, use a cream T.Acid.

As with layering any new formulation, always perform a test patch first, before full on application. You should gradually add new ingredients over a period of time to reduce the chances of skin irritation. 

What is the correct way to apply pigment correctors to skin?

One word: PRECISION. Whether you are using Tranexamic Acid, Kojic Acid, Arbutin or Hydroquinone for pigment, you have got to be PRECISE. Why? Because if you apply to the surrounding skin, you’re gonna get fading of normal skin and cause another colour to the mix. Apply your corrector of choice with the TIP of a cotton bud, only to the affected areas. 

Application should be in the evening, 2-4 hours BEFORE bedtime. Why? Because if you apply just before going to sleep, chances are you are going to smudge product on your pillowcase, resulting in, you guessed it, blotchy areas all over your face. Be precise, this will ensure your application is even.  

What are the side effects of Tranexamic Acid?

Although T.Acid is safe for most skin types, it's always important to consult with a skin specialist before incorporating a new ingredient into your skin care routine. Like any new ingredient in your skin care routine, a test patch is recommended. As always, start slowly with application every second night, & increase as tolerated. T.Acids are compatible with many other skin care ingredients, however it can be irritating to those with very sensitive skin. 

There are no systemic side effects of topical creams, however if prescribed orally, your dermatologist will discuss the risk benefit ratio of this tablet. Rare side effects include GIT upset and importantly, clotting issues. 

What is the best way to treat pigmentation?

Melasma pigmentation is best treated with a combination of sun protection, topical pigment inhibitors like hydroquinone, kojic acid, ascorbic acid, azelaic acid, and botanicals along with low dose lasers. For more information, go to @101.Skin Instagram!

Can Tranexamic Acid be combined with other skin care actives?

Yes, in most cases T.Acid plays well with other actives including pigment correctors, vitamin B3/niacinamide, hyaluronic acid & many others. 

How do I incorporate Tranexamic Acid in my daily skin care routine?

A sensible skin care routine that incorporates T.Acid goes something like this;

AM: Gentle cleanser, then antioxidants*,  SPF, make up. (*Tocopherol, ferulic acid, ascorbic acid)

PM: Cleanser, actives such as Niacinamide, Hyaluronic Acid, Pigment correctors & T.Acid (*Refer to below)

*There are many sensible options to combine skin care ingredients with endless combinations. A sensible starting point is to use a good formulation of T.Acid every other night and gradually incorporate it into your routine. If in doubt, dilute the active with a moisturiser, & conduct a test patch. Be guided by your skin care expert. 

** Most dermatologists including myself would opt for oral T.Acid over topical, as the former is more potent, especially when treating melasma. Do not use oral T.Acid if a you have personal or family history of pro coagulopathy. Prescription is specialist only. 

What other conditions can be treated with Tranexamic Acid?

Tranexamic acid (TXA) can also be used to treat or prevent excessive blood loss from major trauma, postpartum bleeding, surgery, tooth removal, hereditary angioedema, nosebleeds, and heavy menstruation. T.Acid has efficacy & safety data stretching back many decades and is best taken orally, followed by intradermal injections, and finally topical creams. 

Davin’s Skin Pro Tip 

This ingredient is probably the most beneficial compound for the treatment of melasma & post inflammatory hyperpigmentation. There is a plethora of excellent studies demonstrating the efficacy of this acid, along with many decades of safety data. The flipside is that it works best as a tablet & not a topical, however I do suspect that over the next few years better topical formulations will appear. Be guided by your skin expert as to the addition of this pigment corrector into your skin care regime.