Can Oral Tranexamic Acid And Topical Retinols Be Combined?

Tranexamic acid is a prescription-only drug taken orally or applied topically to treat melasma and other hyperpigmentation conditions. Oral tranexamic acid has shown great promise as a long-term melasma treatment that has few side effects. Combining treatments for melasma can be more effective at clearing dark patches of skin than a single treatment on its own. Today, we take a look at whether you can safely use oral tranexamic acid and topical retinols.

How does oral tranexamic acid work and what are its possible side effects?

Oral tranexamic acid treats hyperpigmentation by inhibiting the melanin production process. Melasma and hyperpigmentation show significant improvement after taking low doses of between 500mg and 1500mg per day for eight to twelve weeks.

Current research has not encountered any significant side effects of taking low doses of oral tranexamic acid for extended periods (Del Rosario). However, the risk of blood clotting disorders like embolisms remains (oral tranexamic acid also treats bleeding disorders), so it is vital to speak with a healthcare professional before starting use.

How do topical retinols work and what are possible side effects?

Retinol derives from retinoids/retinoic acid/vitamin A and treats various skin conditions. Topical retinol penetrates the outer skin layer (epidermis) through to the dermis. There, its tiny molecules neutralize free radicals and promote collagen and elastin production. The result is a fuller, plumper skin appearance that reduces the visibility of wrinkles, fine lines, and enlarged pores.

Retinol can treat:

• Acne
• Fine lines
• Wrinkles
• Sunspots
• Freckles
• Photoaging
• Uneven skin texture
• Melasma
• Large pores

Unlike prescription-only retinoids, retinol is available in over-the-counter (OTC) formulations because it is relatively weaker than retinoids.

The primary side effects of topical retinol are skin dryness, irritation, redness, itching, and skin peeling. In addition, retinol can make the skin more sensitive to UV rays, heightening the risk of sunspots, post-inflammatory hyperpigmentation, and wrinkles.

Should you combine oral tranexamic acid and topical retinols?

As a rule of thumb, doctors do not recommend combining treatments yourself (self-medicating) as there might be factors overlooked that could make your melasma or hyperpigmentation worse.

Since oral tranexamic acid and retinol are both acids, they might have the same drying effect on the skin, increasing the risk of UV skin damage. Another factor that might affect using this combination treatment is the skin type and condition.

References

• Del Rosario E, Florez-Pollack S, Zapata L Jr, et al. Randomized, placebo-controlled, double-blind study of oral tranexamic acid in the treatment of moderate-to-severe melasma. J Am Acad Dermatol. 2018;78(2):363-369. doi:10.1016/j.jaad.2017.09.053

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Brandon Kirsch, MD

Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the Naples Community Hospital.