Why Tranexamic Acid Alone Hits a Wall
Tranexamic acid blocks the interaction between keratinocytes and melanocytes, essentially interrupting the signal that tells your skin to produce more pigment. In a 2020 study published in the Journal of the American Academy of Dermatology, oral tranexamic acid at 250 mg twice daily showed a 49% reduction in MASI (Melasma Area and Severity Index) scores over 12 weeks. Topical formulations at 3 to 5% concentrations show similar early promise. The problem is that melanin production has multiple triggers, UV exposure, hormonal fluctuation, inflammation, and tranexamic acid addresses only one pathway. Patients using it solo often see initial fading, then a plateau, because the other pathways keep feeding pigmentation back in.
