Could this buzzy new skincare saviour banish your hyperpigmentation?

It sounds like something you would recite during enunciation exercises to improve your diction. How does something that was originally meant to stop heavy bleeding end up creating such tidal waves in the skincare world? We’re not suggesting you go the woo-woo route of smearing anything bloody on your face (unless micro-needling is involved). We’re talking about tranexamic acid, which became an unlikely hero for people who have been dealing with stubborn hyperpigmentation and melasma – AKA a large segment of the Indian population, according to dermatologists. A propensity for hyperpigmentation is the annoying flipside of having beautiful brown skin.

We say unlikely because when doctor couple Utako and her husband, Shosuke Okamoto, were trying to come up with a way to save the lives of women in 1950s Japan who were bleeding to death during childbirth, they probably never imagined their star discovery would end up plastered on serum bottles and face cream labels around the world.

Tranexamic acid is an antifibrinolytic agent, explains Dr Neha Dubey, consultant medical and cosmetic dermatologist and medical director at Meraki Skin Clinic, Gurugram. “It works by blocking the breakdown of blood clots, thus preventing bleeding.”

Four decades after the Okamotos, doctors who were using it to treat urticaria and noticed patients’ melasma had vanished too. That’s when they realised it could be used to treat pigmentary disorders.

Tranexamic acid has skincare benefits

According to the Fitzpatrick scale, developed by Thomas B Fitzpatrick to assess how different skin types respond to ultraviolet (UV) light, Type IV to VI (people on the browner side of things) have a high risk of hyperpigmentation and scarring.

When we talk about hyperpigmentation, we mean dark spots caused by sun damage, blemishes left behind by pimples, and large, stubborn patches of discolouration, also known as melasma. People with brown skin have more active melanocytes (pigment-producing cells), so when the skin is triggered, it produces melanin more easily (and abundantly) in the healing process.

Dubey explains that tranexamic acid works by reducing melanin synthesis as it alters the interaction between keratinocytes (normal skin cells) and melanocytes. “It also reduces the activity of an enzyme called tyrosinase, one of the key ingredients for melanin synthesis. It inhibits UV-induced plasmin activity, which aids in treating hyperpigmentation associated with UV radiation.”

Topical vs oral tranexamic acid – which is best for me?

Tranexamic acid can be used in two ways: in a topical serum or cream formula, or popping a pill. Oral treatment has a success rate of up to 89%, says Dubey.

Topical treatment sounds less daunting for those averse to adding more pills to their daily routine, but it can take a little longer to show results. It also depends on the extent of the discolouration, as not all melasma is the same. Dubey says that tranexamic acid, used as a step in your daily skincare routine, shows better results in epidermal or superficial pigmentation as compared to dermal or deep pigmentation.

Treating melasma is almost like trying to get rid of mould from your cupboard during the monsoon (we have some tips). Just when you think you’ve gotten rid of it, it makes a bigger comeback than Shah Rukh Khan in Pathaan. “Many times, patients with melasma face relapse and topical preparations like hydroquinone, which is the first line of defence in melasma treatment, cannot be used for a long time because of the risk of side effects. In such cases, tranexamic acid is quite useful,” says Dubey.

This ingredient is also used as an intradermal injection, she adds, along with in-clinic procedures like a “derma pen or micro-needling when we want a deeper drug delivery for treatment of deep pigmentation.” Consulting with a specialist is always a good idea when dealing with widespread pigmentation issues to create a plan that can make treatment feel less like trying to get to the top of Mount Everest on your first try.

Adding tranexamic acid to your skincare routine

Your palms might be itching now to hit ‘add to cart’ on your favourite shopping app for the latest tranexamic acid product drop, but Dubey advises that its use should be problem specific. Don’t get caught up in trends and hype.

Topical tranexamic acid is usually available in cream or serum form, says Dubey, paired with other brightening ingredients such as kojic acid, arbutin, vitamin C (not all vitamin C products are created equal) and other botanic extracts that aid in better skin penetration. She recommends twice-a-day application and a generous side of sunscreen during the daytime.

Orally, it takes about six weeks to show any noticeable reduction in pigmentation, while topical use (at a concentration of 5%) needs eight weeks.

Tranexamic acid FAQs with Dr Neha Dubey

Is tranexamic acid safe to use during pregnancy?

“Oral tranexamic acid, of course, cannot be used during pregnancy, while the topical formulation is not known to cause any problems.”

Is it an exfoliating acid?

“Tranexamic acid as a stand-alone ingredient does not work via exfoliation. Although when used in conjunction with other molecules like AHAs or BHAs, it will result in exfoliation.”

Does tranexamic acid dry out your skin?

“Generally, it does not dry out the skin. But every skin type is different, and people with sensitive skin might find the initial few days a bit challenging. In such cases, one can start slow with a once-a-day application on alternate days and gradually build on that.”

Can all skin types use it?

“I wouldn’t advise tranexamic acid for people suffering from atopic dermatitis.”

Does it bleach skin?

“No, it does not bleach the skin.”

Is tranexamic acid used for ‘skin whitening’?

“It is used as a treatment for hyperpigmentation which, in the process of clearing out blemishes, evens-out the skin.”

A note of caution: This story is for educational purposes with inputs from trained medical experts. Please consult your healthcare provider to know what suits your needs best.