![]() Our main indicators of treatment for melasma by TA were the difference in MASI, MI, and EI scores before and after the treatment and the difference in MASI score between a routine treatment and that with TA as an adjuvant. The Review Manager Version 5.3 (the Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, Denmark) and STATA Version 15.1 software (StataCorp, TX, USA) were used for data analysis. Consequently, in this study, we conducted a systematic review to evaluate the therapeutic effect of TA for treating melasma. Although TA has emerged as a potential treatment for melasma, it has not been approved by Food and Drug Administration of the United States for melasma and treatment remains controversial. As a skin-lightening agent, TA has been used as a topical, intradermal microinjection, and oral agent. This was an accidental finding but prompted studies of TA on melasma patients. TA is a relatively new drug for melasma and was first reported in 1979 when Nijo Sadako tried to use it to treat a patient with chronic urticaria. ![]() It is a synthetic derivative of the amino acid lysine and exerts its effect by competitively inhibiting the activation of plasminogen activator (PA) through reversible interactions with its lysine-binding sites, thus inhibiting PA from converting plasminogen to plasmin. Tranexamic acid (trans-4-(Aminomethyl)cyclohexanecarboxylic acid, TA), a plasmin inhibitor, is used as a hemostatic agent to treat abnormal fibrinolysis to prevent excessive bleeding. However, the side effects and financial burden of these treatments limit their clinical application. Furthermore, physical treatments such as chemical peels and low-fluence Q-switched neodymium-doped yttrium aluminum garnet laser (QSNY) need multiple courses over several months. Some topical agents, such as hydroquinone, are limited by complications including irritant dermatitis, allergic contact dermatitis, postinflammatory hyperpigmentation, nail bleaching, and exogenous ochronosis. However, melasma is often difficult to treat and can be psychosocially detrimental to many patients. Moreover, various subsequent treatments of melasma include hypopigmenting agents, chemical peels, lasers, and dermabrasion. Because both UV and visible light can induce pigmentation, the therapy usually starts with the protection of UV sun, and topical lightening formulation. ![]() ![]() The treatments for melasma are generally aimed at inhibiting the pathways that synthesize melanin and decrease of melanosome transfer from melanocyte to keratinocytes. All these diverse factors trigger the increased synthesis of melanosomes in melanocytes and increased transfer of melanosomes to keratinocytes. ![]() Furthermore, there appears to be a genetic predisposition of melasma. Many factors are linked with the development of melasma, including UV radiation, pregnancy, hormonal activity, thyroid abnormalities, and medications. The prevalence of melasma reported in recent studies ranges from 8.8% to 40% based on ethnic makeup of the population. Melasma, also referred to as chloasma, is a common acquired condition of pigmentary disorder marked by irregular hyperpigmented macules or patches and most commonly occurs in females with dark skin types living in areas of intense ultraviolet (UV) light exposure. ![]()
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