Can You Combine Oral Tranexamic Acid And Prescription Topical Creams?

As you consider treatment options for your melasma or hyperpigmentation concerns, you may be wondering if combining oral tranexamic acid and prescription topical creams could help you get better results faster. Keep reading to learn if this is a treatment option that could work for you.

How do oral tranexamic acid and prescription topical creams work?

Oral tranexamic acid reduces the production of melanin by inhibiting tyrosinase activity and altering cell interactions. A 12-week study of oral tranexamic acid treatments for melasma showed an average improvement rate of 49% according to the MASI scale (Del Rosario).

Prescription-strength topical creams generally work by interfering with melanin production, typically by reducing melanocytes – cells that produce melanin to protect the skin from UV rays when exposed to the sun.

The “gold standard” topical treatment for melasma is hydroquinone, a lightening agent. It is frequently used in combination with steroids or retinols to prevent skin irritation and increase efficacy. Multiple studies suggest that combination creams including a 4% concentration of hydroquinone, a steroid, and tretinoin (a retinoid) are the most effective (Grimes).

Can you combine oral tranexamic acid with prescription topical creams?

Depending on your skin’s needs, your doctor may recommend a combination of both oral tranexamic acid and prescription topical creams to address your melasma or hyperpigmentation issues.

One study examined a treatment plan of oral tranexamic acid and a 2% hydroquinone triple combination cream. The study found that oral and topical treatments combined led to faster and sustained improvement in melasma patients (Padhi).

Another study found that oral tranexamic acid combined with a 4% hydroquinone cream led to significantly higher patient satisfaction with progress in treating their melasma than topical treatments on their own (Tehranchinia).

Treatment plans typically last 8-12 weeks, though sometimes treatment can last much longer depending on the nature of your skin concerns.

Read more:

• Types Of Acids Used In Hyperpigmentation Treatment And How To Pick The Right One
• What Is The Best Oral Tranexamic Acid Dosage For Hyperpigmentation?

Are there any side effects from combining oral tranexamic acid with prescription topical creams?

Tranexamic acid has coagulative properties, which is why it’s also used to treat heavy menstruation. If you have a heart condition or issues with blood clotting, you should be sure to let your doctor know.

Other mild side effects that may occur with oral tranexamic acid include:

• Mild gastrointestinal discomfort
• Allergic skin rash
• Hair loss

Hydroquinone and other topical treatments may cause some mild side effects that should subside once your skin adjusts to treatment, such as:

• Tenderness or swelling of treatment area
• UV light sensitivity
• Skin irritation, including stinging, dry skin, and redness

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
• Grimes PE, Ijaz S, Nashawati R, Kwak D. New oral and topical approaches for the treatment of melasma. Int J Womens Dermatol. 2018;5(1):30-36. Published 2018 Nov 20. doi:10.1016/j.ijwd.2018.09.004
• Padhi T, Pradhan S. Oral Tranexamic Acid with Fluocinolone-Based Triple Combination Cream Versus Fluocinolone-Based Triple Combination Cream Alone in Melasma: An Open Labeled Randomized Comparative Trial. Indian J Dermatol. 2015;60(5):520. doi:10.4103/0019-5154.164416
• Tehranchinia Z, Saghi B, Rahimi H. Evaluation of Therapeutic Efficacy and Safety of Tranexamic Acid Local Infiltration in Combination with Topical 4% Hydroquinone Cream Compared to Topical 4% Hydroquinone Cream Alone in Patients with Melasma: A Split-Face Study. Dermatol Res Pract. 2018;2018:8350317. Published 2018 Jul 2. doi:10.1155/2018/8350317

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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.