Oral tranexamic acid in the treatment of hyperpigmentation disorder beyond melasma: A review

Abstract Background Tranexamic acid, a synthetic derivative of the amino acid lysine, is an antifibrinolytic, procoagulant agent approved by the Food and Drug Administration for the treatment of cyclic heavy menstrual bleeding and prevention of bleeding in patients with hemophilia undergoing tooth extraction. Oral tranexamic acid has been used off‐label in dermatology in the treatment of melasma and other hyperpigmentation disorders. In a recent study, oral tranexamic acid was reviewed thoroughly in treating melasma, and its effectiveness was demonstrated. Their role in treating other hyperpigmentation disorders has also been tried in several studies. Aim To review the evidence regarding the use of tranexamic acid in treating different types of hyperpigmentation disorders other than melasma. Methodology A comprehensive literature review was searched using the electronic online database “PubMed” and “google scholar” using key words “Postinflammatory hyperpigmentation,” “lichen planus pigmentosus,” “ashy dermatosis,” “riehl melanosis”. After that, a full‐text review of the studies was performed. Result Oral tranexamic acid has been used in different types of hyperpigmentation disorder, including postinflammatory hyperpigmentation treatment and prevention, lichen planus pigmentosus, ashy dermatosis, and Riehl melanosis in a dose range from 250 mg per day to 1500 mg per day for a period range from 2 weeks to 6 months with variable efficacy and a good safety profile. Conclusion Oral tranexamic acid is a promising treatment option in a different type of hyperpigmentation disorders refractory to topical treatment. However, more evidence from blinded randomized controlled trials and case–control studies is needed to determine their efficacy in treating various hyperpigmentation disorders.