Context: Melasma is a chronic, acquired hyperpigmentary disorder. Plethora of treatment options are available but none is promising and recurrence is common. Treatment of melasma using oral tranexamic acid is a novel concept.

Aims: To compare the efficacy of oral tranexamic acid with conventional topical therapy for the treatment of melasma.

Design: Prospective, parallel, randomized, comparative, clinical study.

Methods and Material: It was a prospective, randomized controlled trial conducted among 104 melasma patients. Patients were assigned into two groups (group A and group B) consisting of 52 patients each. Group A was given routine treatment measures along with oral Tranexamic Acid and photoprotection while Group B was treated only with routine topical measures and photoprotection. Oral Tranexamic Acid was prescribed at a dose of 250 mg BD for three months and patients were followed for three months. Clinical response was evaluated on the basis of Melasma Assessment Severity Index (MASI). Mean scores between the two groups were then compared.

Results: The MASI scores at baseline, 8 weeks and 12 weeks in group A were 18.24 + 1.05,6.13 + 4.9 and 2.19 + 2.3 respectively and in group B were 15.42 + 1.09,11.07 + 9.16 and 7.99 + 6.05. MASI score reduction percentage at the end of 12 weeks was 88% and 54.6% respectively indicating a greater decrease in the group taking Tranexamic acid and was statistically significant for both the groups with P< 0.05

Conclusion: Addition of oral tranexamic acid with the triple combination results in rapid and sustained response with less chances of relapse. So tranexamic acid is a great boon for the melasma patient as well as for the clinicians.

Prateek Jain