Oral TXA / systemic tranexamic acid
A prescription antifibrinolytic drug — originally used to control heavy bleeding — taken off-label at low doses for stubborn melasma. It works from the inside by quieting the plasmin signalling that drives pigment cells to overproduce melanin, and it also calms the dilated vessels that sit under the brown patches of melasma. For an ingestible, the evidence is unusually strong: multiple randomised trials and meta-analyses show real, repeatable lightening, typically over 8–12 weeks. The important caveat is that this is a medication, not a supplement — it must be prescribed and monitored by a clinician who can screen for clotting risk. Reassuringly, a 2025 multicentre cohort found no rise in blood-clot events in appropriately screened melasma patients, but it remains off-limits for anyone with a clotting history, on oestrogen, pregnant, or who smokes. Not a whitening pill and no replacement for daily sunscreen — it dampens the signal that drives the pigment rather than bleaching it.
Prescription only — a clinician must prescribe and monitor it. Studied at 250mg twice daily (some low-dose regimens use 500mg/day), usually for 8–12 weeks and often capped at 3–6 months. Not for anyone with a history of blood clots, clotting disorders, oestrogen or contraceptive-pill use, pregnancy, or smoking. Always paired with daily sunscreen, which addresses the root trigger.
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