Topical Tranexamic Acid for Post-Inflammatory Hyperpigmentation
Keywords:
Tranexamic acid; post-inflammatory hyperpigmentation; hyperpigmentation; dark skin; hydroquinone alternative.Abstract
Introduction: Post-inflammatory hyperpigmentation (PIH) is common in darker skin types. Tranexamic acid (TXA) inhibits plasminogen activation and melanocyte tyrosinase. This review evaluates topical TXA. Methods: Ten studies (5 RCTs, 5 split-face; n=448) using TXA 2-5% creams or lotions for 12 weeks. Outcome: Melasma Area Severity Index (MASI) adapted for PIH. Results: TXA reduced PIH area by 48% vs 18% for vehicle (p<0.001). Combination with 4% hydroquinone was additive (67% reduction). Irritation was mild (4%) and no hypopigmentation occurred. Discussion: TXA’s dual anti-inflammatory and anti-melanogenic action is unique. Lack of long-term (>6 months) safety data is a gap. Conclusions: Topical TXA 2-5% is an effective and safe treatment for PIH, especially in patients intolerant of hydroquinone.
