Tranexamic Acid for Skin Lightening and Melasma

Tranexamic Acid Face Serum Minimalist.
Minimalist 3% tranexamic acid face serum for pigmentation and acne scars.

In recent years, Tranexamic Acid (TXA) has become increasingly popular for skin lightening and treating conditions such as melasma and dark spots. Tranexamic acid is a tyrosinase inhibitor and has anti-inflammatory properties that can even out skin tone. Note that TXA has not been officially licensed for use in dermatological conditions, so it is used off-label for skin applications.

Historically, tranexamic acid has been used to treat excessive blood loss (from surgery, postpartum bleeding, heavy menstruation and more) due to its blood clotting properties.

How does Tranexamic Acid Work?

According to DermNet NZ, the mechanism of action of tranexamic acid involves the shrinkage of dermal vasculature and reduced melanin synthesis. The latter is achieved via altering the interaction of keratinocytes and melanocytes, and via reduced tyrosinase activity. There are a number other products that reduce hyperpigmentation via tyrosinase inhibition.

Most topical products that contain tranexamic acid use 2% to 5% formulations. The oral dose used to treat melasma is 250 mg twice per day. A 2021 study found that a new topical tranexamic acid derivative improved overall facial skin tone and reduced the appearance of dark spots and redness.

Topical Skin Serums and Lotions

Tranexamic Acid Serum
Tranexamic acid 5% serum from Dearskin.

There a number of popular commercial lotions and serums that contain tranexamic acid. Among the most popular ones on Amazon is a 5% Tranex serum from Dearskin. It has an average rating of 4.3 out of 5 stars based on almost 1,000 reviews as of today. It is currently on sale for just $15 after a coupon discount.

Besides containing TXA, this product also includes other proven skin lightening and brightening ingredients such as kojic acid, niacinamide, vitamin C, hyaluronic acid and glycolic acid. Tranex has been tested by dermatologists and is cruelty free and vegan (not tested on animals). It is also formaldehyde- and paraben-free, and is made in the USA.

Another recommended product is The INKEY List’s tranexamic acid 2% hyperpigmentation treatment gel. The low concentration makes this a good option to start experimenting with TXA. It also contains acai berry extract and Vitamin C.

Using Tranexamic Acid in Skin of Color

Dr. Rattan has a great video titled: “Is Tranexamic Acid Suitable For Skin Of Color”. She is a fan of this ingredient since it is skin neutral. It works best on pH 5-7, which is approximately the same pH level as our skin. Dr. Rattan prefer to use tranexamic acid in combination cocktail products rather than via monotherapy, especially for stubborn melasma conditions.

Potential Side Effects

In general, Tranexamic acid is safe and well-tolerated by all skin types (assuming you use a reputable product and low dosage). Mild side effects include skin irritation, scaling or flaking, dryness and erythema. Most of these can be reduced with the use of moisturizer creams. Moreover, note that TXA can also reduce post-inflammatory erythema (PIE) and post-inflammatory hyperpigmentation (PIH) due to its anti-inflammatory effect.

Laser Hair Removal Burns on Dark Skin

As a dark skinned person, if you do not use an ideal laser type (usually Nd:YAG) for your hair removal, burn injuries and permanent skin damage are serious possibilities. This week, a number of dermatologists have discussed the sad and shocking burn scars on a brown skinned girl who had laser hair removal on her arms using an incorrect wavelength device.

Among doctors who specialize in ethnic skin treatments that mentioned this case on Instagram include:

1) Dr. Corey Hartman

Laser Hair Removal Burn Injury
A darker skinned patient suffered terrible burns on her arm after laser hair removal with an incorrect laser.

2) Dr. Alexis Stephens

3) Dr. Adeline Kikam

Laser Burn Injuries in Dark Skin

In all the above linked posts, there are hundreds of comments from readers. Some experienced similar burn injuries to this girl after getting laser treatments at inexperienced run-of-the-mill clinics. While most lasers will not cause dark permanent burn marks on people with lighter skin tones, the same is not true when treating darker skin tones.

Also adding to the confusion, if you are on the lighter end of brown skin complexion, you can be treated with other lasers (e.g., the Diode) besides the Nd:YAG. It is imperative to do thorough research on whichever laser your clinic will use for your hair removal. Also ask to see their before and after patient photos of customers with a similar skin type as yourself.

Laser light energy based treatments are not to be taken lightly. Skin damage is often permanent. Moreover, hyperpigmentation and burn mark side effects after incorrect treatment in people of color tend to be far more evident and longer-lasting.

How to Reduce Hyperpigmentation on Dark Skin

Perhaps the most common dermatological complaint of people with darker skin tones is hyperpigmentation due to excess melanin production. Even the slightest injury, acne, insect bite, rash, scratching or burn in a person with dark skin often leads to long lasting post-inflammatory hyperpigmentation (PIH).

Even worse are major injuries that cause thick dark lines, scars and marks. In people of color, such marks take years to fade, and sometimes never go away completely. Some scars and stitch marks even turn into raised keloids or hypertrophic scars, especially in people of African American heritage. My own slightly raised and darker shade scar from a childhood chin injury is still visible decades later.

Dark skinned people also tend to suffer from hormone driven melasma and its associated dark patches in large areas of their face and forehead. Undereye dark circles are also more common in people of color, especially in people from South Asia.

Fairer skinned people tend to see less pigmented skin reactions and scarring due to the lack of significant melanin production by melanocytes. In darker skinned people, the melanocyte cells are easily triggered by the smallest of injuries.

It should be noted that some people with dark skin want to lighten their entire face or even whole body. Their first method of choice is usually via the use of skin lightening and bleaching creams. On this page, I focus on reducing small areas of skin darkening rather than overall skin bleaching. However, some of the ingredients and methods use to accomplish the latter are the same when it comes to targeting smaller areas of hyperpigmentation.

How to Treat Hyperpigmentation in Darker Skin

One of the most instructive videos on treating hyperpigmentation in dark skin is courtesy of Dr. Vanita Rattan. Make sure to also check out her bestselling book and her Instagram page.

Among her warnings include:

  • To never ever use TCA chemical peels on skin of color.
  • She does not like glycolic acid peels, since they can often cause inflammation and further skin darkening.
  • Avoid lasers if possible. She is not a fan of using any form of light energy (other than Nd:YAG later per a later e-mail to me) on skin of color. She feels that most lasers can damage the lower dermal layer of the skin and cause burns. I think that some newer lasers might be more effective and safer, but I am glad that Dr. Rattan is not promoting them left and right.
  • She says that hydroquinone gives fantastic results when you are on it due to its powerful tyrosinase inhibition. It just stops melanin from being formed. However, when you come off of it after three months, you get rebound hyperpigmentation that is often even worse then before as melanocyte cells rebound. Hydroquinone is just too aggressive in skin of color. I wish that someone had warned me as such before I damaged my skin by using a high-strength dose of this product.

Her favorite pigment reducing ingredients (which she uses in her own products too) include:

  • Octadecanoic acid.
  • Phytic acid.
  • Ferulic acid.
  • Vitamin A.
  • Vitamin C.
  • Licorice extract.
  • Mulberry extract.
  • Niacinamide.
  • Azelaic acid.
  • Antioxidants.
  • Kojic acid dipalmitate (KAD — which she prefers to kojic acid, which can cause irritation in darker skin tones).

In another video, Dr. Rattan also praises tranexamic acid as a very good ingredient to reduce melasma and hyperpigmentation.

Another great video on treating hyperpigmentation is from Dr. Dray. However, her advice pertains to all skin tones and is not focused on people of color. In her opinion, the top 10 ingredients to fade hyperpigmentation are as follows:

  1. Topical Vitamin C.
  2. Hydroquinone.
  3. Kojic Acid.
  4. Soy.
  5. Azelaic Acid.
  6. Topical Vitamin A.
  7. Salicylic Acid.
  8. Licorice Root.
  9. Niacinamide.
  10. Sunscreen.

Hyperpigmentation Resources

Below I list some great resources in relation to treating hyperpigmentation and skin darkening in people of color. It is much harder to tackle hyperpigmentation in darker skin (Fitzpatrick 4-6) types. Some of the resources below often include testimonials, reviews and videos from people with much fairer skin, so please keep that in mind. Try to find results from people with a similar skin type to yourself to get the best idea of which products and treatments work. And which procedures causes side effects most frequently.

For example, liquid nitrogen cryotherapy on a lower leg scar on my skin type 4 caused significant skin darkening that remains even over five years later. Recently, one doctor on Instagram said that she no longer treats her darker skin patients with cryotherapy. Of course this does not mean that such a treatment will never work on your ethnic skin, but it is best to be cautious.

  • Reddit’s r/SkincareAddiction has a great hyperpigmentation wiki. But do note that the page is not broken out by lighter versus darker skin types.
  • The Bombay Skin Clinic has a very thorough page on pigmentation treatments.
  • Dr. Seemal Desai wrote a good review on hyperpigmentation therapy options in 2014.