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Adjunctive Tranexamic Acid May Reduce Burden of Inflammatory Acne


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

Study findings are supporting the use of 10% tranexamic acid, a treatment used for melasma, as adjunctive treatment for patients with mild to moderate acne, finding that the treatment was more effective than placebo in relieving the burden of the skin disease.

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

“One of the pathogeneses [of acne vulgaris] is inflammation caused by the innate immune response to P. acnes colonies in the follicles. Topical tranexamic acid affects melanogenesis; thus, is used in melasma,” explained the researchers. “Recently, several studies have shown its benefit against rosacea according to the anti- inflammatory effect of TXA. Some parts of the pathogeneses of rosacea are similar to acne. Currently, studies regarding TXA in acne have not been conducted before.”

In their study, the researchers observed significantly lower total inflammatory acne associated with tranexamic acid at 4 weeks, which continued through the 8 weeks.

On the tranexamic acid side, total inflammatory counts significantly dropped between baseline and 8 weeks, as well as between check-ins. Similar patterns were observed in papule counts among the tranexamic acid side, with counts continuing to drop significantly throughout the study period. There were no significant differences in inflammatory counts throughout the weeks and only a significant difference in papule counts at week 2 compared with week 6 for the placebo side.

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

“Apart from the anti-inflammatory effect of TXA, the physicians noted that the TXA side decreased the redness of the skin, corresponding to the imaging from VISIA® Skin Analysis. TXA reduced PIE(PIE) and hyperpigmentation (PIH). According to the VISIA® Skin Analysis user guide, red areas represented several conditions, such as acne, inflammation, rosacea or spider veins. Acne spots and inflammation were round and varied in size. Spider veins typically were short, thin and interconnected in a dense network,” wrote the researchers, noting that TXA led to corrected discoloration and improved 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 scaling, after using the treatment, although in both cases, the effects were resolved with moisturizer and did not reoccur.


CharoenwattanayothinA, Saiwichai T, Chaichalotornkul S. Adjunctive treatment for acne vulgaris by tranexamic acid. J Cosmet Dermatol. Published online April 7, 2022. doi:10.1111/jocd.14972

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