Recently, some melasma patients who came to the clinic through the website or cell phone WeChat will continue to ask some questions after the first consultation, which is reasonable because it is not realistic to communicate all the questions in just a few minutes of face-to-face consultation time. However, there are some questions that people are eager to solve, so I would like to share them with you here. First of all, for some patients with melasma, I will prescribe an oral medication: tranexamic acid (I usually use imported torsemide). Some careful friends will have a big doubt after reading the instruction of this drug: This is a medicine to stop bleeding, but the instruction does not say it is for treating melasma, did Dr. Zhang prescribe the wrong medicine? Can I take this medicine? Does it have any side effects? In fact, tranexamic acid has been used for the treatment of melasma for more than 30 years. It was first announced to the medical community by a Japanese doctor in 1979, who accidentally found that some patients with melasma had reduced their pigmentation in the treatment of adult women with internal diseases, so he did a lot of case studies and found that it was no accident. In the following decades, as the research became more and more advanced, many mysteries were slowly uncovered. For example, what is the mechanism by which tranexamic acid is effective in treating some patients with melasma? It is now believed that it is also related to its original action – preventing more than one bleeding, by inhibiting the stimulation of melanocytes by some cytokines to improve melasma. Are there any side effects of tranexamic acid when taken orally for a long time? Especially the side effect of hemostasis which is a concern? In fact, the mechanism of tranexamic acid hemostasis is not to promote coagulation, but to inhibit fibrinolysis, so the parameters of coagulation function are not affected, which has been studied very maturely abroad, and some experts in China have also conducted a one-year follow-up observation on patients who took tranexamic acid orally and came to the same conclusion, so we do not need to worry. What’s more, the dosage used to stop bleeding (two capsules three times a day) is much larger than the dosage used to treat melasma (one capsule twice a day at the beginning). The most common side effects of tranexamic acid are gastrointestinal reactions, including nausea and regurgitation, diarrhea, abdominal pain, etc. (the incidence is 1~5.4%, which is much smaller than the incidence of 3~9% of another common drug that needs to be taken for a long time, aspirin), if this happens, you can choose to take it half an hour after meals. The other is that about 8.1% of people experience a temporary decrease in menstrual flow, so most people can recover on their own if they stop taking it during menstruation. Who should not be treated with tranexamic acid? Tranexamic acid is not effective in patients with a history of blood clots (cerebral thrombosis, myocardial infarction, thrombophlebitis, etc.), in patients with wasting coagulation disorders (with heparin, etc.), and in some types of melasma. Can it be used in pregnant or lactating patients? A small amount of data on the use of tranexamic acid during pregnancy showed no harm to the fetus, but we do not feel it is necessary to take this risk, so use with caution in pregnant women. However, because the concentration of tranexamic acid in breast milk is very low (only one percent of that in the blood) and the infant absorbs very little of the drug from breast milk each day, tranexamic acid can be used by nursing women. How long do I really need to use tranexamic acid? This question varies greatly for different people, but generally speaking at least three months, and it is not recommended to stop the medication immediately after it becomes effective, otherwise there will be a greater chance of recurrence, and the exact method of taking it will be decided by your doctor according to how well you are doing. Of course, not every melasma patient needs to be treated with tranexamic acid, and tranexamic acid can only solve part of the problem. At present, the best solution for melasma treatment is still personalized and multiple methods combined treatment, so as to get more improvement and faster improvement.