INTRODUCTION
Tranexamic acid (TXA) is an antifibrinolytic medication largely known for its efficacy in managing menorrhagia, or heavy periods, making it a medication predominantly used by women. It was first used in the 1960s, and by the 1970s, early studies revealed tranexamic acid's effectiveness in reducing excessive menstrual bleeding.1 TXA is now a standard for treating menorrhagia.
More recently, TXA has found a new dermatologic purpose for the improvement of any melasma-related pigmentation. Melasma is a skin condition commonly characterized by dark patches or irregularities in pigmentation in the skin, particularly in sun-exposed areas.2,3 Subsequent studies have shown promising results in TXA's effectiveness in reducing melanogenesis, the process by which pigment in the skin and hair is produced.4 Although, many of these studies largely focus on female populations, leaving male melasma patients in the minority. The historical background of the drug's initial use could largely be the reason why there are so few male patients included in current studies. Melasma can negatively impact an individual's self-esteem and confidence thereby reducing the quality of life of an individual.5 We hope to shine a light on the efficacious nature of oral TXA on male melasma patients. We now consider oral TXA for all melasma patients, male and female, before undergoing any additional treatments with lasers or chemical peels.
CASES
Case 1:
This is a 45-year-old male with moderate melasma on his face and neck. He was started on a regimen of oral tranexamic acid 650 mg daily, along with topical tretinoin 0.05% gel every evening and topical tranexamic acid 3% serum (Discoloration Defense by Skinceuticals, New York, NY) twice daily, along with daily physical sunblock. He received four treatments of KTP vascular laser (ExcelV by Cutera, Brisbane, CA). Almost complete resolution was achieved about 14 months from the first appointment. He has maintained his results with the same oral and topical regimen as of publication.
Case 2:
This is a 55-year-old man with moderate melasma and also a self-described outdoorsman and surfer. He was often tanned and not a candidate for laser. He was started on a regimen of oral tranexamic acid 650 mg daily and topical compounded tretinoin 0.025%/hydroquinone 4%/hydrocortisone 0.5%/kojic acid 6% by Sincerus Pharmaceuticals, Pompano Beach, FL) every evening. He received a series of 6 chemical peels (Vitalize peel by Allergan, Irvine, CA) with complete resolution of his melasma.
