Derms May Have Found The Best Ingredient for Treating Melasma

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I have melasma on my cheeks and a smattering of dark spots of my chin and jawline from old breakouts, so I’m constantly asking dermatologists about the best brightening ingredients to help fade them both. The one ingredient I'm hearing about the most? That would be tranexamic acid. It's is the latest obsession among skincare experts and beauty brands thanks to its ability to reduce the appearance of sun spots, post-inflammatory hyperpigmentation, and melasma. And unlike many other brightening ingredients (like hydroquinone and retinol), it’s safe for all skin types and tones and doesn’t come with a long list of annoying side effects, like chronic dryness or irritation.

To learn more about the hero ingredient that’s taking over the skincare space, I reached out to dermatologists Amelia Hausauer, MD, Macrene Alexiades, MD, and David Kim, MD, for all the important intel. Ahead, everything you need to know about tranexamic acid for skin, its benefits, how to use it, and more. I've even included my favorite tranexamic products for you to check out too.

What is tranexamic acid?

Tranexamic acid is a synthetic derivative of lysine, an amino acid. And although it's featured as a popular ingredient in tons of skincare products, it was initially used orally as a hemostatic agent. “It’s an antifibrinolytic medication, meaning that it stabilizes and preserves blood clots to help stop bleeding from major trauma or injuries, after giving birth, with some surgeries, nosebleeds, or heavy periods,” says Dr. Hausauer.

The use of tranexamic acid for skin was discovered only by accident when a patient using the medication off-label noticed the lightening of skin discoloration. Now we know that when used in skincare or taken orally, tranexamic acid decreases melanin production by inhibiting melanocytes, the pigment-making cells responsible for hyperpigmentation and melasma, says Dr. Alexiades. In topical form, 5 percent tranexamic acid is to said to be as effective at treating melasma as 3 percent hydroquinone, says Dr. Alexiades.

Tranexamic Acid Serum

Tranexamic Acid Serum

Dark Spot Lifting Serum with 5% Tranexamic Acid

Dark Spot Lifting Serum with 5% Tranexamic Acid

Tranexamic Topical Acid 5%

Dark Spots Serum

What are the benefits of using tranexamic acid for skin?

The biggest benefits of tranexamic acid are the lightening and brightening effects it has on the skin thanks to its ability to stop irregular melanin production, says Dr. Hausauer. That means it's an excellent ingredient for fading existing dark spots, acne scars and marks, and melasma—as well as preventing new discoloration from forming in the future.

Tranexamic acid also has anti-inflammatory benefits and can help prevent the formation of blood vessels, which can help reduce redness and barrier compromise among rosacea patients, as well as acne flares and their associated redness.

And. JSYK, even though the word "acid" is in it's name, tranexamic acid doesn't actually exfoliate the skin like glycolic acid or salicylic acid, says Dr. Kim.

How long does it take tranexamic acid to work on skin?

How long it takes for tranexamic acid to work really depends on the formulation and strength being used. In general, brightening agents work gradually, so results will get better and better the longer you consistently use it. That said, Dr. Alexiades explains, by four weeks of regular use, the effects will begin to manifest. One study even found that 90 percent of participants taking 250mg of tranexamic acid twice daily saw improvement in their melasma within two months. Even so, it’s important not to stop treatment at the first sign of progress; instead, continue to use it for at least 12 weeks.

Is it okay to use tranexamic acid every day?

How frequently you should use tranexamic acid will vary depending on its form. “Pill forms of tranexamic acid need to be stopped intermittently,” Dr. Hausauer says. “In my practice at Aesthetx, I cycle people on and off of it, along with other maintenance therapies, including sunscreen with SPF 30 or more, lightening creams, and in-office treatments, like light lasers or microneedling.” As a topical, tranexamic acid is safe to use everyday provided your skin isn't irritated by the ingredient.

Is tranexamic acid or vitamin C better?

When it comes to tranexamic acid and vitamin C, one isn't better than the other. Tranexamic acid is an excellent skin brightening ingredients, while vitamin C is more of a multitasking ingredient that has antioxidant properties and collagen boosting benefits in addition to skin brightening. The good news is that topical tranexamic plays nice with vitamin C, so in most cases it's totally safe to use the two together. In fact, doubling up on brighteners may help fade your dark spots and hyperpigmentation even fast. As a rule, Dr. Alexiades suggests that anyone with sensitive or reactive skin start with tranexamic acid on its own first and then gradually introduce other actives to avoid any unwanted irritation.

Super C Ferulic

35% Vitamin C+ Perfecting Serum

Skin Renewing Vitamin C Serum

TULA Skincare Brightening Treatment Drops Triple Vitamin C Serum at Nordstrom

Is tranexamic acid or niacinamide better?

Just like with tranexamic acid and vitamin C, tranexamic acid isn't better or worse than niacinamide. Both ingredients can help brighten your skin tone and fade dark spots, but if your skin is sensitive and/or oily, niacinamide may be a better choice since it has anti-inflammatory properties, can help minimize pore size, and can even help reduce excess oil production. The good news is that it's easy to find great serums that combine tranexamic acid and niacinamide, like four below.

SkinCeuticals Discoloration Defense

SkinCeuticals Discoloration Defense

Alastin Skincare A-Luminate Brightening Serum

Alastin Skincare A-Luminate Brightening Serum

Faded Brightening and Clearing Serum

Paula's Choice ClinicaL Discoloration Repair Serum

CLINICAL Discoloration Repair Serum

Can you use tranexamic acid with retinol?

Yes, you can definitely use tranexamic acid with retinol. I personally use the duo to help keep breakouts in check and fade post-inflammation hyperpigmentation at the same time. Dr. Kim recommends using a serum with tranexamic acid in the morning and then an OTC or Rx retinoid in the evening.

Effaclar Adapalene Gel 0.1% Acne Treatment

Retinol 1.0 Complex

Clinical Solutions Retinol 0.5

Clinical Solutions Retinol 0.5

Retinol+ Emulsion 0.3

What are the side effects of tranexamic acid?

Although tranexamic acid is notably safer and more tolerable than many other brightening ingredients, it’s not without potential side effects. “When used topically, tranexamic may cause dryness, irritation, and flaking of the skin,” Dr. Alexiades explains.

It also carries the risk of other, non-skin-related side effects, especially when taken orally. These include abdominal pain, bloating, nausea and vomiting, headache, muscle cramps, and fatigue, as well as others that should be discussed with your doctor. “By far, the most worrisome, albeit uncommon, is development of blood clots, which can be extremely serious,” Dr. Hausauer says. “Those with personal or family history of clots, blood disorders, and certain heart, kidney, or other conditions should not take tranexamic acid orally.”

She is also careful about prescribing oral tranexamic acid to patients on birth control pills or who smoke, since these both further increase the possibility of clotting. “Importantly, this risk is dose dependent, meaning that higher amounts are more likely to cause problems, and we use relatively low doses for skin conditions,” she adds.

The takeaway:

Tranexamic acid is, without a doubt, a worthwhile tool in the fight against hyperpigmentation and melasma. Known to be safer and often more effective than other brightening agents, like hydroquinone, retinol, and even vitamin C, it is generally safe for all skin types and tones and can even be used topically during pregnancy.

Tranexamic acid is available as both an oral and topical medication and is currently used in a wide variety of over-the-counter skincare products, but it’s a good idea to always consult your board-certified dermatologist before adding it or any other active ingredient to your regimen.

Meet the experts:

• Amelia Hausauer, MD, is a board-certified dermatologist at Aesthetx in Campbell, California. Dr. Hausauer was a pioneer in the early uses of PRP and microneedling and specializes in the treatment and management of signs of aging.

• Macrene Alexiades, MD, PhD, is a board-certified dermatologist at the Dermatology and Laser Surgery Center of New York and is the founder of Macrene Actives. An expert in dermatology and genetics, Dr. Alexiades treats a full range of skincare concerns and regularly conducts clinical and skincare research.

• David Kim, MD, is a board-certified dermatologist at Idriss Dermatology in New York, New York and the founder of Lightsaver, a sunscreen brand.

Why trust Cosmopolitan?

Lauren Balsamo is deputy beauty director at Cosmopolitan with a decade of experience researching, writing, and editing skincare stories that range from the best retinol eye creams to the best lasers for acne scars. She regularly works with the industry’s top dermatologists and aestheticians to assess new skincare treatments, products, and trends.

Gabby Shacknai is a New York City-based journalist with years of experience researching, writing, and editing beauty and wellness stories. Gabby is an authority in all skincare categories, but is an expert when it skincare ingredients like tranexamic acid. She regularly works with the industry’s top dermatologists and plastic surgeons to assess new skincare treatments, trends, products, and technologies.

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