Tranexamic acid is one of the latest therapies for treating melasma, and one that’s most commonly prescribed for women. An editorial published in the April issue of the Journal of Drugs in Dermatology encourages dermatology clinicians to also consider the effect melasma has on men and to utilize tranexamic acid as a treatment option.
I interviewed the authors, dermatologist and Mohs surgeon Andrea Hui Austin, MD, and Nicole Chin, BS, to find out what dermatology clinicians should know about treating melasma in men.
This is the first dermatology study that I can remember that specifically addresses melasma in men. Why do you think male melasma is understudied?
Male melasma is likely understudied due to historical factors and societal norms. Traditionally, dermatology research has focused heavily on conditions more commonly associated with women, and melasma is no exception.
Tranexamic acid (TXA) is an antifibrinolytic medication largely known for its efficacy in managing menorrhagia (heavy periods), making it a medication predominantly used in women. It was first used in the 1960s, and by the 1970s, early studies revealed tranexamic acid’s effectiveness in reducing excessive menstrual bleeding. More recently, TXA has found a new dermatologic purpose for the improvement of melasma-related pigmentation. Given that melasma predominantly affects women, the diagnosis and treatment of melasma in men has not received adequate attention. We believe that this historical context of TXA and the populations that it has traditionally been used on has made it so the focus of TXA’s efficacy is largely on women, leaving male melasma patients in the minority. However, in our experience, TXA has been incredibly effective in treating melasma in both our female and male patients.
Have you noticed more men seeking treatment for melasma in recent years? If so, why do you think that’s the case?
There has been a noticeable increase in men seeking treatment for melasma in recent years. This trend could be attributed to several factors, including greater awareness of skincare and dermatologic procedures among men, shifting societal norms that encourage men to prioritize the health of their skin, and increased access to information about available treatments. There has been an increase in research on tranexamic acid’s effectiveness in treating melasma. And of course, we can’t forget about social media and the impact that has had on spreading information, even though it may not always be correct information!
Tranexamic acid is becoming a more popular treatment for melasma. Why is it important for dermatology clinicians to understand the long history of this medication’s use by women?
It is important for clinicians to recognize that just because TXA has historically been prescribed more often to females rather than males, there’s a historical reason behind this, and that this history doesn’t mean that male patients wouldn’t benefit from the use of TXA for their melasma. History should not preclude men from receiving TXA as a form of treatment for their melasma.
Is tranexamic acid as effective in treating melasma in men as it is in women?
While there is limited research specifically focusing on tranexamic acid’s effectiveness in treating melasma in men, within our own practice, with over 1500 prescriptions of TXA written (not including refills), we haven’t seen a significant difference in the effectiveness between men and women. Both populations respond well to TXA. However, larger studies with more diverse populations, including a significant representation of men, are needed to confirm these findings definitively. Nonetheless, based on available evidence and clinical experience, dermatology clinicians can reasonably consider tranexamic acid as a viable treatment option for male melasma patients.
What’s your current treatment protocol for melasma in men?
For treatment of melasma (in all of our patients, male and female), we like to start with a topical regimen of 10% tranexamic acid cream twice daily, topical tretinoin strength 0.05%-1% every evening, and daily physical sunblock. For patients with more severe forms of melasma (like in the cases we reported on), after thorough history that ensures we cover a history of blood clots and blood disorders, we recommend oral tranexamic acid 650 mg daily. We also like to supplement these at home regimens with in-office chemical peels and laser treatments at a time interval of every 4-6 weeks. These appointments also give us a good opportunity to check in with a patient’s progress and to make adjustments if needed. All in all, plan specifics differ from patient to patient depending on many factors.
What do we know about how tranexamic acid works, and what is still unknown?
The mechanism of action of tranexamic acid in treating melasma involves several pathways, although some aspects remain unknown. Tranexamic acid is believed to inhibit melanogenesis by interfering with plasmin activity, thereby reducing melanocyte stimulation and subsequent melanin synthesis. Additionally, its structural similarity to tyrosinase suggests a competitive antagonism of this enzyme’s function, further inhibiting melanin production. Furthermore, tranexamic acid’s anti-inflammatory properties may contribute to its efficacy by modulating cytokine levels and reducing inflammation associated with melasma.
What are some takeaways from your study?
Overall, TXA taken orally at 650 mg daily provides patients with a significant reduction of their melasma. Research on this subject heavily focuses on female subjects and most sample sizes make up females in these studies. While melasma predominantly affects women, it is important to acknowledge the impact that it has on men as well. Tranexamic acid has shown to be efficacious in our male melasma patients, and it is our hope that more men are offered this treatment method to target their melasma. As research continues to explore the applications of tranexamic acid, practitioners should consider the addition of oral TXA into the treatment plans for male melasma patients, as it has shown to be safe and seems effective based on our experience.
Do you plan to conduct any additional studies based on these results?
As more men are treated with TXA for treatment of their melasma, we will surely get a better picture of any significant differences in effects between females and males. In the future, we do hope to report on synergistic effects between TXA and other melasma treatments. We think that this research poses a wonderful opportunity for dermatologists, dermatology PAs and dermatology NPs to evaluate the treatments they are prescribing to certain populations more than others, and if we can expand inclusivity throughout dermatology treatments and suggestions we give to our patients.
Did you enjoy this JDD Buzz article? You can find more here.
