The emerging importance of tranexamic acid in dermatology

A split face study comparing intralesional tranexamic acid versus 1064 nm long pulsed Nd: YAG laser for acne vulgaris treatment

Acne is among most prevalent skin conditions that adversely impacts patients' quality of life and self-confidence. Conventional treatment methods face issues with high recurrence rates and unwanted side effects, prompting the need to explore new acceptable treatment options. Comparing the safety and clinical efficacy of intralesional tranexamic acid (TXA) versus 1064 nm long pulsed Nd:YAG laser in the treatment of facial inflammatory acne vulgaris. 30 patients with facial acne vulgaris were involved in a prospective randomized split-face comparative study. Each patient was treated with long-pulsed Nd: YAG laser on one side, and intralesional TXA on the other side at 2-week interval for 4 sessions. Cases were assessed through Investigator Global Assessment of acne (IGA) scale, lesions counting, and erythema score at baseline, after end of treatment, and after follow-up for 3 months. A statistically significant reduction in IGA, lesions count, and erythema score was found in both treated sides (p-value < 0.001). Improvement of IGA and non-inflammatory lesions count was better in laser side more than TXA side after end of treatment and follow-up (p-value < 0.05). Improvement of inflammatory lesions count was non-significant in both sides after end of treatment, while after follow-up it was better on laser side. Improvement of erythema score was non-significant between both therapy modalities after end of treatment and follow-up. 1064 nm long-pulsed Nd: YAG laser and intralesional TXA are effective, and safe treatment modalities for acne. However, Nd-YAG laser has prolonged therapeutic effect over intralesional TXA so, TXA can be considered a promising lunch-time procedure enhancing the outcome.

Treatment of Melasma With Q-Switched Laser in Combination With Tranexamic Acid

Melasma, a pigmentary disorder that particularly affects Asian women, has been clinically proven to respond effectively to combination therapy of Q-switched lasers and tranexamic acid (TXA), especially with the advancements in laser aesthetics in recent years. However, treatment outcomes can be influenced by factors such as the wavelength and spot size of the Q-switched laser, the route of administration for TXA (including injectable, oral, or topical), as well as the dosage and duration of treatment. This article presents 13 different combination approaches from six randomized controlled trials, indicating that oral administration of TXA in combination with a 1064 nm Q-switched laser is currently the most widely used and effective treatment approach.

Effectiveness of Inhalational Tranexamic Acid in Patients with Nonmassive Hemoptysis-A Systematic Review and Meta-Analysis

BACKGROUND

Hemoptysis, the expectoration of blood from the lower respiratory tract, varies in severity and necessitates effective management to mitigate morbidity. Traditional treatments include bronchial artery embolization and pharmacological approaches. Tranexamic acid (TXA), an antifibrinolytic agent known for its efficacy in reducing bleeding during surgery and trauma, is being explored for its efficacy in treating Hemoptysis via both intravenous and inhalational routes. Inhalational administration has garnered interest because of its targeted action and minimal systemic effects. This study aimed to assess the effectiveness of inhalational TXA in nonmassive hemoptysis.

METHODS

A systematic literature search encompassing PubMed Central, EMBASE, SCOPUS, and ProQuest was conducted. Randomized controlled trials (RCTs) and observational studies assessing the effectiveness of inhalational tranexamic acid for nonmassive hemoptysis were included. Comparative intervention effect estimates from meta-analyses are reported as pooled odds ratios and pooled mean differences with 95% confidence interval (CI).

FINDINGS

Analysis of three RCTs and two observational studies, comprising 351 patients (192 cases and 159 controls), revealed varying risk levels of bias across the studies. Nebulized tranexamic acid was 3.85 times more likely to achieve hemoptysis cessation than alternative treatments across all RCTs. Moreover, patients receiving nebulized tranexamic acid required fewer (43%) pulmonary interventional procedures than those receiving other treatments. Despite showing a trend towards reducing posttherapy bleeding (20 ml less), conclusive results were hindered by wide CI, necessitating further investigation.

INTERPRETATION

Nebulized tranexamic acid may be a potential therapeutic option for nonmassive hemoptysis. While our analysis suggests its potential benefits in halting bleeding and reducing the need for invasive procedures, the quality of the available evidence is limited due to the risk of bias and study limitations. This underscores the necessity for additional randomized controlled trials with larger sample sizes and rigorous study designs to strengthen evidence and optimize clinical utility.

PROSPERO REGISTRATION

The registration for this systematic review and meta-analysis was completed through Prospero on January 30, 2024, with the registration number CRD42024501624.

The fibrinolysis renaissance

Fibrinolysis is the system primarily responsible for removal of fibrin deposits and blood clots in the vasculature. The terminal enzyme in the pathway, plasmin, is formed from its circulating precursor, plasminogen. Fibrin is by far the most legendary substrate, but plasmin is notoriously prolific and is known to cleave many other proteins and participate in the activation of other proteolytic systems. Fibrinolysis is often overshadowed by the coagulation system and viewed as a simplistic poorer relation. However, the primordial plasminogen activators evolved alongside the complement system, approximately 70 million years before coagulation saw the light of day. It is highly likely that the plasminogen activation system evolved with its roots in primordial immunity. Almost all immune cells harbor at least one of a dozen plasminogen receptors that allow plasmin formation on the cell surface that in turn modulates immune cell behavior. Similarly, numerous pathogens express their own plasminogen activators or contain surface proteins that provide binding sites for host plasminogen. The fibrinolytic system has been harnessed for clinical medicine for many decades with the development of thrombolytic drugs and antifibrinolytic agents. Our refined understanding and appreciation of the fibrinolytic system and its alliance with infection and immunity and beyond are paving the way for new developments and interest in novel therapeutics and applications. One must ponder as to whether the nomenclature of the system hampered our understanding, by focusing on fibrin, rather than the complex myriad of interactions and substrates of the plasminogen activation system.

Evaluating the effect of tranexamic acid as mesotherapy on persistent post-acne erythema: A before and after study

BACKGROUND

Acne vulgaris is a common skin disease that is more common in young population and it can be associated with some sequels after resolving the lesions. Post-inflammatory erythema is one of these complications that can be disturbing for patients and does not have any definite treatment. This study was aimed to evaluate the efficacy and safety of tranexamic acid (TA) as mesotherapy in treatment of post-acne erythema (PAE) treatment.

METHOD

This clinical trial study was performed in the dermatology clinic on 17 patients with persistent PAE (3 months after acne recovery). Two sessions of treatment were performed by a physician with 2-week intervals; TA was injected as mesotherapy into the right side of each patient's face as the case group, while the opposite side was used as the control group. A Visioface device was used to compare before and after treatment photographs of each side of the face in color mode with quantitative measures such as lesions count, area, and area percent.

RESULTS

Finally, 15 patients completed treatment sessions. There were statistically significant differences in right side lesions before and after treatment with p-values of 0.047, 0.002, and 0.035 for count, area, and area percent, respectively. There was no significant difference before and after treatment in terms of count, area. and area-percent on the left side.

CONCLUSION

According to the results of this study, TA injection as mesotherapy for resolving PAE can be effective. However, due to small sample size, further studies are needed.

Tranexamic acid for haemostasis and beyond: does dose matter?

Tranexamic acid (TXA) is a widely used antifibrinolytic agent that has been used since the 1960's to reduce blood loss in various conditions. TXA is a lysine analogue that competes for the lysine binding sites in plasminogen and tissue-type plasminogen activator impairing its interaction with the exposed lysine residues on the fibrin surface. The presence of TXA therefore, impairs the plasminogen and tPA engagement and subsequent plasmin generation on the fibrin surface, protecting fibrin clot from proteolytic degradation. However, critical lysine binding sites for plasmin(ogen) also exist on other proteins and on various cell-surface receptors allowing plasmin to exert potent effects on other targets that are unrelated to classical fibrinolysis, notably in relation to immunity and inflammation. Indeed, TXA was reported to significantly reduce post-surgical infection rates in patients after cardiac surgery unrelated to its haemostatic effects. This has provided an impetus to consider TXA in other indications beyond inhibition of fibrinolysis. While there is extensive literature on the optimal dosage of TXA to reduce bleeding rates and transfusion needs, it remains to be determined if these dosages also apply to blocking the non-canonical effects of plasmin.

Aesthetic considerations for treating the Middle Eastern patient: Thriving in Diversity international roundtable series

BACKGROUND

The Middle East has a significant influence on the global aesthetic market. Within the United States and globally, patients with Middle Eastern heritage have a wide range of ethnic and cultural backgrounds that affect their perceptions of beauty and motivations to seek cosmetic treatment.

AIMS

The aim of this roundtable was to discuss similarities and differences in anatomy and treatment preferences of Middle Eastern patients and explore how these differences may influence aesthetic practices.

PATIENTS/METHODS

In support of clinicians who wish to serve a diverse patient population, a 6-part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021, to May 16, 2022.

RESULTS

The results of the fourth roundtable in the series, the Middle Eastern Patient, are described here. A discussion of treatment preferences is included, and specific procedural information is provided for  commonly treated areas in this population (forehead, infraorbital area, and jawline).

CONCLUSIONS

Middle Eastern patients have a variety of aesthetic preferences, which are influenced by a wide range of cultural backgrounds, making it difficult to develop general statements about this demographic. There is an unmet need for research into this diverse group of patients to help physicians understand and incorporate their unique needs and desires into clinical practice.

Effectiveness of combination therapy of broadband light and intradermal injection of tranexamic acid in the treatment of chloasma

OBJECTIVE

To investigate the efficacy and safety of broadband light (BBL) combined with intradermal injection of tranexamic acid for treating melasma.

METHODS

120 women with melasma admitted to our hospital from January 2021 to April 2022 were randomly categorized into the following groups: control group, treated with 250 mg tranexamic acid given orally twice daily, except during menstruation; group I, treated with BBL (Sciton, Inc., USA) monthly; group II, received intradermal injections of tranexamic acid monthly; and group III, treated with BBL with intradermal injection of tranexamic acid monthly. Treatment in each group lasted three months. The MASI (Melasma Area Severity Index) and VISIA (Canfield VISIA Complexion Analysis) were used for evaluation.

RESULTS

After treatment course, MASI scores and VISIA brown spot and red zone ranking improved in all four groups (p < 0.05). The decrease in MASI scores and improvement rates of VISIA brown spot and red zone rankings were not significantly different among the control group, group I, and group II; however, the decreased MASI scores and improvement rates of VISIA brown spot and red zone rankings were significantly higher in group III than in the other three groups (p < 0.05).

CONCLUSION

The effect of BBL combined with the intradermal injection of TA in the treatment of melasma is remarkable. This combination therapy can be an alternative and effective treatment for managing melasma.

Tranexamic acid: Beyond antifibrinolysis

Tranexamic acid (TXA) is a popular antifibrinolytic drug widely used in hemorrhagic trauma patients and cardiovascular, orthopedic, and gynecological surgical patients. TXA binds plasminogen and prevents its maturation to the fibrinolytic enzyme plasmin. A number of studies have demonstrated the broad life-saving effects of TXA in trauma, superior to those of other antifibrinolytic agents. Besides preventing fibrinolysis and blood loss, TXA has been reported to suppress posttraumatic inflammation and edema. Although the efficiency of TXA transcends simple inhibition of fibrinolysis, little is known about its mechanisms of action besides the suppression of plasmin maturation. Understanding the broader effects of TXA at the cell, organ, and organism levels are required to elucidate its potential mechanisms of action transcending antifibrinolytic activity. In this article, we provide a brief review of the current clinical use of TXA and then focus on the effects of TXA beyond antifibrinolytics such as its anti-inflammatory activity, protection of the endothelial and epithelial monolayers, stimulation of mitochondrial respiration, and suppression of melanogenesis.

Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

Tranexamic acid (TXA) is an antifibrinolytic drug primarily used for reducing blood loss in patients with major bleedings. Animal and cell studies have shown that TXA might modulate the inflammatory response by either enhancing or inhibiting cytokine levels. Furthermore, recent human studies have found altered inflammatory biomarkers in patients receiving TXA when compared with patients who did not receive TXA. In this systematic review we investigated the effect of TXA on inflammatory biomarkers in different patient groups. A systematic literature search was conducted on the databases PubMed and Embase to identify all original articles that investigated inflammatory biomarkers in patients receiving TXA and compared them to a relevant control group. The review was performed according to the PRISMA guidelines, and the literature search was performed on November 29, 2021. Thirty-three studies were included, among which 14 studies compared patients receiving TXA with patients getting no medication, another 14 studies investigated different dosing regimens of TXA, and finally five studies examined the administration form of TXA. The present review suggests that TXA has an anti-inflammatory effect in patients undergoing orthopaedic surgery illustrated by decreased levels of C-reactive protein and interleukin-6 in patients receiving TXA compared with patients receiving no or lower doses of TXA. However, the anti-inflammatory effect was not found in patients undergoing cardiac surgery, pediatric craniosynostosis patients, or in rheumatoid arthritis patients. The inflammatory response was not affected by administration form of TXA (oral, intravenous, or topical). In conclusion, an anti-inflammatory effect of TXA was consistently found among orthopaedic patients only.

Facelift Patients Receiving Intraoperative Administration of a Self-assembling Hemostat Agent Experienced Minimal Bruising and No Acute Hematomas: A Pilot Study

Background

Hematomas are consistently cited as the most common complication of facelift surgery, with reported incidence rates ranging from 1% to 9% despite preventative measures. A self-assembling RADA16 peptide solution (PuraSinus, 3-D Matrix, Newton, MA) designed to aid in wound healing, adhesion prevention, and bleeding control has demonstrated hemostatic control of intra- and postoperative bleeding associated with various surgical procedures, including nasal and sinus surgery.

Objectives

To report surgical experience using novel application of RADA16 hemostatic agent in facelift procedures.

Methods

Through exploring incorporation of RADA16 hemostatic agent into standard of care, 15 higher-risk facelift patients were treated intraoperatively between December 2020 and July 2021. Postoperative follow-up was on post-procedure day 1 and 3 and at approximately one week. During follow-up, potential complications were assessed subjectively, including hematoma, swelling, and bruising; postoperative observations recorded; and photographs taken.

Results

Among facelift patients receiving intraoperative RADA16 hemostatic agent there were no hematomas or protracted ecchymosis events. The only significant complication was one patient admitted for intravenous hydration due to post-operative nausea and vomiting. All patients had minimal bruising or a dramatic absence of bruising and experienced no hemorrhage or hematoma. Through surgical experience, technique for RADA16 hemostatic agent placement was optimized and procedural details are provided.

Conclusions

Intraoperative administration of topical RADA16 hemostatic agent appears to deter acute hematoma and hemorrhage formation and early experience suggests that RADA16 hemostatic agent may also attenuate post-operative bruising in facelift patients. These observations warrant further investigation in a larger randomized controlled study.

Level of Evidence: 4

Collagenase Clostridium histolyticum for the Treatment of Cellulite in the Buttocks and Thigh: Early Insights From Clinical Practice

Background

Collagenase Clostridium histolyticum (CCH-aaes; QWO [Endo Aesthetics, Malvern, PA]) is an injectable, enzyme-based treatment indicated for the treatment of moderate to severe cellulite on the buttocks of adult women. The minimally invasive nature of the treatment makes it an attractive option for targeted disruption of the fibrous septae which give rise to the dimples characteristic of cellulite in buttocks and thighs.

Objectives

The article provides an overview of cellulite treatment with CCH-aaes, including patient identification and education, treatment planning, CCH-aaes dilution, injection technique, safety, and early experience with mitigation of adverse events, including bruising.

Methods

As part of a continuing medical education (CME; xMedica, Alpharetta, GA) event on developments in cellulite treatment, a panel of experts developed a course and roundtable, which included lectures on cellulite physiology, new developments in the field of cellulite treatment, demonstrations of injection technique for CCH-aaes, and a review of considerations for the use of CCH-aaes in real-world clinical practice.

Results

The practical guidance presented here is based upon real-world experience with CCH-aaes. The discussion includes strategies based on early experience for how to obtain the best results as well as suggestions on how to mitigate bruising.

Conclusions

CCH-aaes has been a welcome addition to the armamentarium for the treatment of cellulite. With knowledge of proper patient evaluation and injection technique, thorough patient education, diligent photography, and developing research on bruising mitigation, CCH-aaes shows great promise as an effective and safe modality for the management of cellulite.

Level of Evidence 5

Laser-Assisted Drug Delivery of Tranexamic Acid by Picosecond Laser in Postinflammatory Hyperpigmentation: A Split-Area Double Blind Randomized Prospective Study

Background: Tranexamic acid has been reported to benefit the treatment of postinflammatory hyperpigmentation (PIH). Laser-assisted drug delivery (LADD) could facilitate the efficacy of topically applied drugs into the dermis. This split-area randomized prospective study aims to assess whether early utilization of the LADD procedure with tranexamic acid delivery followed by picosecond lasers can attenuate the PIH better than the utilization of picosecond lasers alone. Patients and methods: Ten post-traumatic cases of PIH in 10 patients (8 female and 2 male) with an average age of 34.2 ± 11.2 years were included in this clinical trial. Using block randomization to determine the treatment side, one side of each area of the PIH was separated from the midline into two halves belonging to the control and tranexamic acid groups. The half area of the tranexamic acid group was further topically applied with 10% tranexamic acid solution. This procedure was repeated every 6 weeks, four times in total. Results: The self-assessment of the hyperpigmentation and overall satisfaction of the treatment outcome were not significantly different between the treatment and control sides. Conclusions: This split-area study revealed that, compared with picosecond alone, there was no significant difference adopting tranexamic acid in LADD after nonablative fractional picosecond laser for PIH.

A prospective randomized controlled trial of Q-switched Nd:YAG laser with topical 3% tranexamic acid (TA) versus microneedling with topical 3% tranexamic acid (TA) in treatment of melasma

INTRODUCTION

Treatment of melasma is challenging. Topical TA has shown promising results as an adjuvant, when combined with microneedling or QS Nd:YAG laser. The efficacy of both combinations has been demonstrated but the efficacy between these two combinations has never been compared.

AIM AND OBJECTIVES

To compare the efficacy and side effects of microneedling and QS Nd:YAG laser when combined with topical 3% TA gel.

MATERIALS AND METHODS

60 patients were randomized into 2 groups. Group A received Nd:YAG laser sessions monthly with daily 3% TA gel while Group B underwent microneedling monthly with daily 3% TA gel. A total of 5 sessions were given with follow-up after 2 months. Evaluation using modified Melasma Area and Severity Index (mMASI), Patient satisfaction score, and photography was done at baseline, 3rd session, 5th session, and final follow-up.

RESULTS

Mean fall in mMASI at follow-up in Group A was 5.12 ± 2.66 to 2.33 ± 1.33 and Group B was 4.60 ± 2.38 to 1.88 ± 1.08 (p < 0.001). Patient satisfaction score was not significantly different. Side effects of both interventions included erythema, pain, and burning sensation.

CONCLUSION

Our study shows equal efficacy of microneedling and QS Nd:YAG laser when combined with topical 3% TA gel in treating melasma without serious side effects. Microneedling has more downtime and maybe less preferable as a lunchtime procedure.

Plasminogen: an enigmatic zymogen

Plasminogen is an abundant plasma protein that exists in various zymogenic forms. Plasmin, the proteolytically active form of plasminogen, is known for its essential role in fibrinolysis. To date, therapeutic targeting of the fibrinolytic system has been for 2 purposes: to promote plasmin generation for thromboembolic conditions or to stop plasmin to reduce bleeding. However, plasmin and plasminogen serve other important functions, some of which are unrelated to fibrin removal. Indeed, for >40 years, the antifibrinolytic agent tranexamic acid has been administered for its serendipitously discovered skin-whitening properties. Plasmin also plays an important role in the removal of misfolded/aggregated proteins and can trigger other enzymatic cascades, including complement. In addition, plasminogen, via binding to one of its dozen cell surface receptors, can modulate cell behavior and further influence immune and inflammatory processes. Plasminogen administration itself has been reported to improve thrombolysis and to accelerate wound repair. Although many of these more recent findings have been derived from in vitro or animal studies, the use of antifibrinolytic agents to reduce bleeding in humans has revealed additional clinically relevant consequences, particularly in relation to reducing infection risk that is independent of its hemostatic effects. The finding that many viruses harness the host plasminogen to aid infectivity has suggested that antifibrinolytic agents may have antiviral benefits. Here, we review the broadening role of the plasminogen-activating system in physiology and pathophysiology and how manipulation of this system may be harnessed for benefits unrelated to its conventional application in thrombosis and hemostasis.

Efficacy and safety of tranexamic acid in the treatment of adult melasma: An updated meta-analysis of randomized controlled trials

WHAT IS KNOWN AND OBJECTIVE

Tranexamic acid (TXA) is a novel treatment option for melasma; however, no consensus exists on its use. This study evaluates the efficacy and safety of TXA for melasma.

METHODS

A comprehensive literature review was conducted to search for randomized controlled trials comparing TXA alone, TXA as adjuvant to routine treatment and placebo. Changes in the Melasma Area Severity Index (MASI)/modified MASI (mMASI) between pre- and post-treatment and between a certain melasma treatment and TXA were the primary outcomes. Twenty-four trials comparing oral, topical or intradermal TXA with routine treatment were included in the meta-analysis.

RESULTS AND DISCUSSION

The change in MASI/mMASI scores at 4 (MD, 3.58; 95% confidence interval (CI), 2.15-5.01), 8 (MD, 5.08; 95% CI, 3.34-6.81), 12 (MD, 4.89; 95% CI, 3.80-5.97) and 16 (MD, 6.55; 95% CI, 2.62-10.48) weeks after treatment was all less than the baseline scores, regardless of the delivery route. The reduction in the MASI/mMASI scores between TXA adjuvant and routine treatment at 4 (MD, -0.43; 95% CI, -0.79 to -0.08), 8 (MD, -0.81; 95% CI, -1.09 to -0.54), 12 (MD, -1.10; 95% CI, -1.78 to -0.43) and 16 (MD, -1.12; 95% CI, -1.51 to -0.74) weeks was significant. However, the superiority of TXA was not detected when the topical or intradermal route was adopted. No serious adverse events occurred with the use of TXA.

WHAT IS NEW AND CONCLUSION

These results suggest that oral TXA is an available, effective and safe alternative treatment for melasma.

Clinical observation and dermoscopy evaluation of fractional CO2 laser combined with topical tranexamic acid in melasma treatments

BACKGROUND

Melasma is an acquired refractory pigmentary disorder, which is a skin disease that predominantly affects females. This investigation aims to assess the efficacy of a low-power fractional CO₂ laser combined with tranexamic acid (TXA) for melasma topical treatment with MASI and dermoscopy.

MATERIALS AND METHODS

A randomized comparative split-face study was performed. Each treatment interval was 3 weeks with four times in total. At the same time, we applied TXA solution twice a day. Assessments were made by the MASI score of the melasma area severity index, and the dermoscopy performance was collected and analyzed.

RESULTS

After treatments, the patient MASI score decreased significantly. Compared with the baseline, the MASI score was significantly lower than that of control group (P < .05), and the decrease ratio was higher than that of controls. Dermoscopy examination results verified that all lesions performed reticuloglobular pattern, granular, or punctate, with no structural pigmentation and obvious capillary dilation. After comprehensive treatments, the pigmentation area displayed lighter chroma, the follicle pore uniformity was completely improved, and the capillary dilation was significantly reduced.

CONCLUSIONS

Low-power fractional CO₂ laser combined with topical TXA solution is a comparatively effective and safe method for melasma treatment. TXA could reduce the dilation of blood vessels.

Lessons Learned from the First Decade of Laser-Assisted Drug Delivery

Laser-assisted drug delivery augments the distribution and penetration of topically applied treatments, leading to enhanced delivery and bioavailability. We discuss the therapeutic application of laser-assisted drug delivery in clinical practice in cases of non-melanoma skin cancer, vitiligo, melasma, scarring, and alopecia (female pattern hair loss, male pattern hair loss, alopecia areata) as well as for vaccination, local anaesthesia, analgesia, viral warts, infantile haemangiomas and cosmetic uses, and we review clinical studies that have used this technique over the last decade. Our review shows that the application of laser-assisted drug delivery enhances topical agent efficacy, potentially reducing the agent concentration and duration of topical treatment required. Future research into the use of laser-assisted drug delivery before topical therapies is needed to establish the optimal techniques to enhance drug delivery and thus improve patient outcomes.

The influence of topical 5% tranexamic acid at pH 2.38 with and without corundum microdermabrasion on pigmentation and skin surface lipids

Tranexamic acid (TA) has anti-hemorrhagic effects; however, oral administration has been found to decrease hyperpigmentation. The aim of the work was to compare the effects of treatment with 5% tranexamic acid in combination with corundum microdermabrasion on skin pigmentation, redness, pH, transepidermal water loss (TEWL), sebum level and hydration of back surface and dorsal surface of the hand skin. Six treatments were performed every week on the back surface and both dorsal surfaces of the hands of 12 subjects. The entire back/both hands were treated with 5% tranexamic acid at pH 2.38; left side of the back or left hand were also subjected to corundum microdermabrasion. Skin parameters were measured using the Courage & Khazaka 580 Multi Probe Adapter. Clinical photos were taken using the Fotomedicus system. Significant differences between treatment methods were observed for melanin, erythema and pH. In addition, the two methods differed significantly with regard to the amount of sebum, TEWL and the level of moisture in the skin. Both methods gave similar acidic pH. Summing up tranexamic acid causes a significant reduction in epidermal melanogenesis, has a significant impact on the level of skin hydration, lipids of the epidermis and maintaining the proper TEWL. TA has a significant effect on reducing skin redness.

[Oral tranexamic acid in the treatment of lichen planus pigmentosus: A prospective study of 20 cases]

INTRODUCTION

Lichen planus pigmentosus is a variant of lichen planus that is particularly difficult to treat. The aim of this study was to evaluate the efficacy and safety of tranexamic acid in lichen planus pigmentosus.

PATIENTS AND METHODS

This prospective study, conducted at the University Hospital of Casablanca from August 2017 to June 2019, included 20 patients with histologically confirmed lichen planus pigmentosus. The exclusion criteria were pregnancy, breastfeeding, known hypersensitivity to tranexamic acid, and thromboembolic disease. Evaluation was carried out by means of clinical examination and measurement of the affected area using the Visioface® RD hardware package at 6 and 12 months (M6 and M12).

RESULTS

Eighteen women and 2 men with an average age of 49 years (range: 26-65 years) were included. All patients were phototype 3 or 4. The average disease duration was 2.9 years (range: 2 months-15 years). Pigmented, slate-grey, well-delineated macules were observed in all patients on the face (n=19), neck (n=14) or arms (n=2). Pruritus was present in 9 patients. All patients received oral tranexamic acid 250mg/d for 4 to 6 months with external photoprotection that was prolonged beyond 6 months. At M6, partial improvement was noted in 10 patients, 3 patients showed no improvement, and 7 patients were lost to follow-up. Pruritus disappeared in all patients and no relapse was seen at M12.

DISCUSSION

Our study suggests that tranexamic acid could be an effective treatment for lichen planus pigmentosus with a good safety profile. However, the limitations of the study are the limited population and the high number of patients lost to follow-up at M6. Larger-scale studies are needed to provide more detailed results.