Supplemental tranexamic acid may reduce the burden of inflammatory acne

Within 4 weeks of starting treatment, patients saw an improvement in their condition, indicating an anti-inflammatory effect of the treatment.

The study results support the use of 10% tranexamic acid, a treatment used for melasma, as an adjunct treatment for patients with mild to moderate acne, finding that the treatment was more effective than the placebo to relieve the burden of skin disease.

The small study of 18 patients had patients using tranexamic acid serum on one side of the face and a placebo on the other. At baseline, characteristics were comparable and patients were followed for 8 weeks, with additional checks at 2 weeks, 4 weeks, and 6 weeks. Within 4 weeks of starting treatment, patients experienced improvements in their condition on the side of tranexamic acid, indicating an anti-inflammatory effect of treatment.

One of the pathogenesis [of acne vulgaris] is an inflammation caused by the innate immune response to P.acnes colonies in the follicles. Topical tranexamic acid affects melanogenesis; thus, is used in melasma,” the researchers explained. “Recently, several studies have shown its benefit against rosacea according to the anti-inflammatory effect of TXA. Parts of the pathogenesis of rosacea are similar to acne. Currently, no studies regarding TXA in acne have been conducted before.

In their study, the researchers observed a significant decrease in total inflammatory acne associated with tranexamic acid at 4 weeks, which continued for the 8 weeks.

On the tranexamic acid side, the total number of inflammatories fell significantly between baseline and 8 weeks, as well as between controls. Similar patterns were observed in the number of papules on the tranexamic acid side, with the number continuing to decline significantly throughout the study period. There was no significant difference in the number of inflammations over the weeks and only a significant difference in the number of papules at week 2 compared to week 6 for the placebo side.

Significant differences in the number of wheals between the tranexamic acid and placebo sides were observed at 6 and 8 weeks. There were no notable differences in pustules, nodules, and cysts between treatments, but there was a significant difference in the number of pustules between baseline and week 8 on the tranexamic acid side.

“In addition to the anti-inflammatory effect of TXA, physicians noted that the TXA side decreased skin redness, consistent with VISIA® Skin Analysis imaging. TXA reduced PIE (PIE) and hyperpigmentation (PIH). According to the VISIA® Skin Analysis user guide, the red areas represented several conditions, such as acne, inflammation, rosacea or spider veins. Acne spots and inflammation were round and variable in size. The spider veins were typically short, thin, and interconnected in a dense network,” the researchers wrote, noting that TXA resulted in corrected discoloration and improvement in uneven skin tones.

According to the researchers, adverse reactions to tranexamic acid were mild and transient throughout the study. Two (11%) patients reported side effects, including minimal flaking, after using the treatment, although in both cases the effects resolved with moisturizer and did not recur.


Charoenwattanayothin A, Saiwichai T, Chaichalotornkul S. Adjunctive treatment of acne vulgaris with tranexamic acid. J Cosmet Dermatol. Published online April 7, 2022. doi:10.1111/jocd.14972

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