What should you know about oral TXA for melasma?

Melasma causes uneven brown or grey-brown colour, often on the face, and can become more noticeable with ultraviolet or visible light, heat, and hormonal changes. Oral tranexamic acid is a medicine that affects pathways involved in pigment-related inflammation and clot breakdown. It is not suitable for everyone and is generally considered only after a clinician reviews the diagnosis and medical history.

A history of blood clots, clotting disorders, stroke, certain heart or blood-vessel conditions, or medicines that raise clotting risk may change the decision. Pregnancy, breastfeeding, menstrual history, smoking, migraines, and hormonal contraception also deserve discussion. Improvement can fade after treatment ends, and sun protection remains part of controlling recurrence.

Arrange an assessment with a qualified clinician before taking tablets for pigmentation. Bring a complete medicine list and mention previous clots, leg swelling, chest symptoms, headaches with neurological features, and planned surgery or long travel. Do not share tablets or use a leftover prescription. Daily broad-spectrum sun protection, shade, and gentle skin care can support the plan.

For background, see [Melasma](/conditions/melasma/), [Sun-Damaged Skin](/conditions/photoaging/), [Dark Patches On Skin](/symptoms/dark-patches-on-skin/), and [Uneven Skin Tone](/symptoms/uneven-skin-tone/). Other clinician-guided options include [Skin Brightening Treatment](/treatments/aesthetic-procedures/skin-brightening-treatment/), [Chemical Peel](/treatments/aesthetic-procedures/chemical-peel/), [Microneedling](/treatments/aesthetic-procedures/microneedling/), or [Laser Toning](/treatments/laser-and-energy/laser-toning/).

Stop the medicine and seek urgent help for sudden shortness of breath, chest pain, coughing blood, one-sided leg swelling or pain, sudden weakness, trouble speaking, or a new severe vision problem. Contact the prescribing clinician about severe headache, unusual bleeding, or a concerning new symptom. A rapid change in pigmentation, a bleeding spot, or a lesion that differs from surrounding melasma also needs a skin assessment.

Ask how confident the clinician is in the melasma diagnosis, why oral treatment is being considered, how clotting risk will be assessed, and how long monitoring will continue. Discuss contraception, pregnancy plans, migraine history, other pigment treatments, and what to do if the colour returns.