Assessment the efficacy of tranexamic acid for reduce melasma using MASI/mMASI score: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background Melasma is a commonly acquired pigmentary disorder, appearing as brown macules and patches on sun-exposed areas of the face and neck. Many treatments have been attempted to reduce melasma, however there has been no universally impactful procedure to show promising results. In recent studies, tranexamic acid (TXA) oral, injection, or topical has been used for treating/ reducing melasma with promising results. Tranexamic acid’s main effect on skin is a whitening effect either systematically or topically preparation. We aim to provide the latest evidence on the clinical efficacy of TXA in the treatment of melasma by pooling data from cohort studies.   Methods We performed a comprehensive search on topics that assesses tranexamic acid to reduce melasma from inception up until May 2023.   Results There were 21 studies out of a total of 1167 patients reported the changes of MASI/mMASI score after using oral, topical, and injection TXA at 4 weeks, 8 weeks, and 12 weeks. The pooled analysis showed the significance of reduction in melasma area severity index/modified melasma area severity index (MASI/mMasi) scores at 4 weeks (MD: 3.58; 95% CI, 2.15-5.01;I2 = 92%), 8 weeks (MD: 5.08; 95% CI, 3.34–6.81;I2=96%) and 12 weeks (MD: 4.89; 95% CI, 3.80–5.97;I2=91%) after treatment were all less than the baseline scores, regardless of the delivery route.   Conclusion The objective of this thorough examination and analysis is to present the available information regarding the application of TXA as a treatment option for individuals with melasma. Additional extensive randomized controlled trials (RCTs) are required to determine the most effective dosage and treatment plan for TXA.