Tranexamic acid

By Dr. Doaa Al Rawad, Dermatologist
Updated 13 Oct 2026 · 3 min read

What it is

DermNet describes tranexamic acid as an antifibrinolytic agent: it reduces the breakdown of blood clots, and it is commonly prescribed for heavy menstrual bleeding. In dermatology it has been used off-label to improve melasma. How it works on pigment is not fully understood.

Topical tranexamic acid

Creams and serums containing tranexamic acid are a different thing from tablets. DermNet notes that topical tranexamic acid is under investigation for melasma and has shown promising results, particularly in the more superficial type. The evidence is still mixed, products vary widely, and it is not established that it consistently works better than other well-chosen topical options.

Introduce one new active at a time and stop if it burns, stings or causes a rash. Topical does not automatically mean suitable for everyone, and no serum replaces daily broad-spectrum sunscreen.

Oral tranexamic acid

Tablets are a prescription decision. Because the medicine affects clotting, a clinician needs to review your personal and family history of clots, stroke, heart disease, migraine, smoking, hormonal contraception and other medicines before it is considered. Never start it from social media advice, buy it online for pigmentation or use someone else's tablets.

Seek urgent care for symptoms such as sudden chest pain, breathlessness, coughing blood, or one-sided leg pain and swelling. During pregnancy or breastfeeding, ask your clinician before using any pigmentation treatment.

Where it fits

Tranexamic acid, in either form, is one possible part of a melasma plan, not the whole of it. Diagnosis comes first, because not every dark mark is melasma, and protection from ultraviolet and visible light remains the foundation. Pigmentation can return after treatment stops, so a dermatologist will usually plan maintenance care.