Ask the Nurse

I am an OB/GYN physician and am curious if you have any experience using Tranexemic Acid/Lysteda® pills, one daily orally to treat melasma? I am considering prescribing a non-hormonal IUD for my patient who can’t tolerate hormone contraceptive pills.

Melasma is a common skin condition that presents clinically as dark spots on the skin, most commonly seen on the face. It is often referred to as the "mask of pregnancy" because it is often triggered by hormones of pregnancy and/or hormonal contraceptives. It can also be exacerbated by sunlight, so women are often cautioned to:

  • Be liberal with sunscreen year-round on the face and exposed skin
  • Use at least SPF 30 or greater with an agent containing meroxyl, available in Antheliosis® and Neutrogena®
  • Wear a hat to protect the face from UVA and UVB light

Dermatologists may prescribe intermittent Tri-luma® cream which contains tretinoin, hydroxyquinone (bleaching agent) and fluocinolone (steroid agent). Laser therapy and other cosmetic options by experts might be considered. There are several over the counter skin brightening products available that usually contain 2% of hydroxyquinone. Vitamin C serums may also help brighten and clarify skin tone.

The use of Tranexamic acid/Lysteda®, which is FDA approved to treat heavy menstrual bleeding, has been shown in several small studies to be a safe and effective treatment for melasma at various doses, but is not FDA approved for this purpose to date. Results can be seen as early as 4 weeks, however patients on oral long term tranexamic acid should be followed closely by their OD/GYN and their dermatologist as this medication carries an increased risk of clot and CAN NOT be used in conjunction with hormones.

Since there are local and topical therapies for this cosmetic condition and systemic tranexamic acid can be associated with serious side effects like blood clots and more studies are still needed to assess long term effects of this medication in patients with melasma BEFORE we would endorse this as a first line therapy and would instead recommend a referral to a cosmetic dermatologist first.

It may be safer to use TOPICAL tranexemic acid (TA) in melasma. Our cosmetic dermatologist reserves this therapy and oral therapy for women who fail other therapies. It is recommended to check protein C, S and factor 5 levels before prescription or oral TA for a cosmetic use. Most of the literature supporting ORAL tranexamic acid are from other countries with lower oral doses than available in the USA.

All my best,
Speaking of Women's Health nurse

June 7, 2019 at 8:26pm