Melasma is a common, frequently relapsing acquired hypermelanosis of sunexposed areas. It is common in darker skin types and has a female preponderance. The exact etiopathogenesis of melasma remains elusive and various factors like genetic predisposition, sun-exposure, hormones, vascular factors influence its development. Presently, there is no universally effective procedure or agent for melasma treatment despite the availability of various therapeutic modalities. However, hydroquinone has shown some benefits in melasma since last five decades. Melasma responds relatively slow to treatment and tends to recur. In view of the adverse effects associated with hydroquinone, its long term use is not recommended. A multitude of alternatives ranging from natural extracts to LASERs have been extensively investigated for melasma. Preliminary trials with tranexamic acid are encouraging and its efficacy at various strengths, formulations and types of melasma are being explored.

Our study aimed at assessing the efficacy of topical 5% tranexamic acid solution versus 3% hydroquinone cream in melasma. After obtaining informed consent and randomization into two intervention groups, 100 eligible patients of melasma were provided with the above mentioned preparations for once daily application for 12 weeks. MASI and photographs at baseline, weeks 4, 8 and 12 were documented. Subjective improvement was assessed at the end of the study by patient satisfaction score.

Our study population consisted of 84 females and 16 males with 35.86+ 7.40 years in males and 36.18+ 7.52 years in females. Majority of the patients developed melasma in the fourth decade of their lives and only 12% had an onset during pregnancy and in 12% it was associated with hypothyroidism. About 50% of the patients in this study belonged to Fitzpatrick skin type IV, followed by type V(46%). Mixed melasma had the highest prevalence(63%) followed by epidermal type in 22% and dermal type in 15% of the study population.

The mean MASI scores in TA and HQ groups at baseline were 12.39±3.34 and 11.63 ± 3.72 respectively and after 12 weeks of study were 9.47±2.79 and 9.24±3.26 respectively. Percentage reduction of MASI in TA group was 27% and in HQ group was 26.7% and the difference in the reduction between the two groups was not significant (P> 0.05). Patient satisfaction score, a tool for subjective assessment of improvement showed significantly better results in TA group(P value-0.03).

TA appears to be a promising agent in the treatment of melasma. However, large scale studies are needed to establish its efficacy and safety in skin of color.