Dual Benefits of Oral Tranexamic Acid: Reducing Melasma Severity and Inflammation

ABSTRACT Background Melasma is a chronic hyperpigmentation disorder influenced by hormonal factors, ultraviolet exposure, and inflammation. While oral tranexamic acid ( TXA ) is an established treatment, its effects on systemic inflammation remain unclear. Aims This study aimed to evaluate the impact of TXA on melasma severity and inflammatory markers. Methods This retrospective study included 80 melasma patients and 80 healthy controls. Patients received oral TXA (500 mg/day) for 3 months. Melasma severity was assessed using the Melasma Area and Severity Index ( MASI ), and inflammatory markers (monocyte, neutrophil, lymphocyte, HDL , MHR , MLR , NLR ) were measured at baseline, Month 1, and Month 3. Changes within the melasma group and comparisons with controls were analyzed. Results At 3 months, melasma severity significantly improved, with a 65.1% reduction in MASI (from 12.9 to 4.5, p  < 0.001). Monocyte, neutrophil, MHR , MLR , and NLR levels significantly decreased, while HDL and lymphocyte levels increased ( p  < 0.001). Compared to controls, baseline inflammatory marker levels differed significantly; however, at month 3, only monocyte, MHR , and HDL remained significantly different ( p  < 0.05). Regression analysis identified NLR and HDL as significant predictors of melasma severity reduction ( p  = 0.045 and p  = 0.011, respectively). Conclusion Oral TXA not only improved melasma severity but also modulated systemic inflammation. The association between NLR , HDL , and treatment response suggests their potential as biomarkers for monitoring therapeutic efficacy.