The Magic of Tranexamic Acid, a Prescription Powerhouse Fighting Melasma and Dark Spots
Let’s skip the poetic preamble and get straight to the point: tranexamic acid in pill form, available only by prescription, works wonders for melasma and dark spots. Unlike harsher topicals such as hydroquinone and tretinoin—which have somehow become the established norm—tranexamic acid taken orally doesn’t leave your skin sun-sensitive, and it doesn’t compromise your skin barrier either.
For years, my dermatologist Dr. Jessica Wu has been urging me to consider tranexamic acid in pill form to help with dark spots and melasma. I was hesitant (not because I don’t trust her; on the contrary, I often hang on to her every word. She’s a respected Harvard grad with impeccable Dior ensembles, and she communicates clearly.). I was reluctant to listen to her because I wasn’t interested in taking an oral prescription that didn’t seem necessary. It’s important to note here that I’m 50, and at age 39, after having my third child, I went straight into menopause. I’ve been on hormone replacement therapy ever since, so I am extremely cautious about adding anything extra to my regimen. However, after this very hot summer, which gifted me melasma galore, I reflected on the harsh topicals I’ve tested in the past—hydroquinone, tretinoin, and vitamin C (which just doesn’t always vibe with me, sorry)—as well as various other actives containing mercury and peroxide that were absorbed into my bloodstream. While these may not be inherently dangerous, I questioned whether my skin—the largest organ in the body—really needed to absorb such ingredients for the sake of achieving an even complexion.
So why not test this out? I went for it. I got the prescription, and for the past three weeks, I’ve been taking half a pill in the morning and half at night. During this time, I faced several potential melasma triggers, including a massive heatwave in L.A. and a recent trip to humid Mexico. Remarkably, I noticed my skin was looking really great and melasma was not triggered—not even once. I felt confident enough to forgo makeup, and my skin appears even and fantastic. Did all of my spots disappear? No, but they were greatly minimized.
Dr. Wu generally prescribes this pill for 3 to 6 months, followed by a break. After that, pigmentation may slowly return, necessitating another round. I want to point out that you need to consult with your doctor, as this treatment isn’t for everyone. You must be the right candidate. As Dr. Wu explains, “Taking these pills for melasma is an 'off-label' use. This means it’s FDA-approved for a different condition—heavy menstrual periods—but physicians may prescribe it for other uses when deemed medically appropriate.” She also notes that there may be an increased risk of blood clots for some patients, so a consultation with your internist is essential. While a few patients might experience nausea or diarrhea, I can’t imagine that’s worse than the side effects of Ozempic, the "Splenda" of my beloved L.A. community.
My goal is to be honest about what works for me, and this pill has been incredibly effective for managing a skin condition exacerbated by hormones. If you're grappling with similar issues, it may be worth discussing with your dermatologist.