What it is
Symmetric brown/grey-brown facial patches
Oral TXA studied dose
250mg twice daily, ~89% respond by 8 weeks
Recurrence
Common if treatment stops — needs maintenance
Melasma is symmetric brown to grey-brown patches, usually across the cheeks, forehead, upper lip, or chin. It’s driven by a combination of UV exposure, heat, hormonal changes (including pregnancy and contraceptive use), and genetic predisposition to overactive melanocytes — and it’s especially common on Indian and other deeply pigmented skin types. It isn’t dangerous, but it’s genuinely stubborn: melasma tends to respond slowly to treatment and can recur even after it clears.
Heat, visible light (including from screens and indoor lighting near windows), and hormonal shifts can all trigger or worsen melasma — not just direct outdoor UV exposure. This is part of why melasma is often harder to fully control than other types of pigmentation.
Topical treatments that genuinely help
Oral tranexamic acid: what it actually involves
Oral tranexamic acid has become one of the better-studied systemic treatments for stubborn melasma, particularly when topical treatment alone isn’t enough. The dose most commonly studied is 250mg twice daily, with response rates reported as high as 89% within roughly 8 weeks in clinical research. But this is a genuine prescription medication, not a supplement, and it’s not a self-directed decision.
It should be avoided by anyone with a personal or family history of clotting disorders, venous thromboembolism, ischaemic heart disease, stroke, or other fibrinolytic conditions, as well as severe kidney impairment or a history of convulsions. While large studies haven’t shown a significantly increased clotting risk overall, the possibility of thrombotic complications can’t be entirely ruled out — this is strictly a dermatologist-supervised decision, involving a proper health history review first.
Why melasma tends to come back
One of the most frustrating aspects of melasma is that stopping treatment — topical or oral — often allows it to recur. This isn’t a sign that the treatment failed; it reflects how melasma works: the underlying melanocyte overactivity doesn’t fully switch off, it’s managed rather than cured. Many dermatologists recommend a maintenance phase (reduced-frequency topical use, continued strict sun protection) rather than stopping treatment abruptly once skin clears.
In-clinic procedures
Chemical peels and certain laser treatments can help, but they carry a genuinely higher risk of worsening pigmentation on deeper skin tones if done incorrectly or by an inexperienced provider — this is one area where the wrong in-clinic choice can set melasma back further than doing nothing. These should only be pursued with a dermatologist experienced in treating melasma on Indian and other richly pigmented skin.
Frequently asked questions
What causes melasma?
A combination of UV and visible light exposure, heat, hormonal changes (pregnancy, contraceptives), and a genetic tendency toward overactive melanocytes. It’s more common and often more stubborn on deeply pigmented skin.
Can melasma be cured permanently?
It’s generally considered manageable rather than curable — it responds well to consistent treatment but can recur, especially with sun exposure or hormonal changes, even after it clears.
How long does oral tranexamic acid take to work for melasma?
Clinical research on the commonly studied 250mg-twice-daily dose reports response within around 8 weeks for a majority of patients, though individual timelines vary.
Is oral tranexamic acid safe?
It can be, for the right candidate, under medical supervision — but it has genuine contraindications around clotting risk and other conditions. This requires a doctor’s evaluation of personal and family medical history before starting, not self-directed use.