Addressing Long Standing Dermal PIH: Can Tranexamic Acid Help?

Question

I have a light brown Indian skin. A Glycolic acid peel done 20 years ago caused severe PIH on my forehead, which hasn’t gone despite using all sorts of topical creams. The PIH has gone into the Dermis is what I have been told. Can Tranexamic Acid help in this case? Will it be more effective orally or topically? If it is applied topically after a procedure like Micro-Needling, will absorption be better?

Anna Chacon, MD, FAAD · Answer

Post-inflammatory hyperpigmentation (PIH) can be particularly challenging to treat, especially when it has persisted for many years and has affected the dermal layer. Tranexamic acid has emerged as a promising treatment for PIH due to its ability to inhibit the plasminogen/plasmin pathway, which plays a role in melanogenesis.

Efficacy of Tranexamic Acid:

Oral Tranexamic Acid: This form has been studied and shown effectiveness in reducing melanin production and improving PIH. It is generally considered when topical treatments have not been successful. However, it should be used under the guidance of a healthcare provider due to potential side effects and contraindications.

Topical Tranexamic Acid: This is often used as a first-line treatment due to its safety profile. While it may not be as potent as the oral form, it can still be effective, particularly when used in conjunction with other treatments.

Topical Application Post-Procedure: Applying tranexamic acid topically after procedures like microneedling can enhance its absorption and effectiveness. Microneedling creates micro-channels in the skin, potentially allowing for better penetration of topical agents.

Considerations:

Combination Therapy: Tranexamic acid is often more effective when combined with other treatments such as hydroquinone, retinoids, or chemical peels. Discuss with your dermatologist about an integrated approach.

Professional Guidance: Due to the complexity of treating dermal PIH and the risk of side effects, it is important to work closely with a dermatologist who can tailor a treatment plan specific to your skin type and condition.

Monitoring and Follow-Up: Regular follow-up is crucial to monitor progress and adjust treatment as necessary.

Each case of PIH is unique, and what works for one individual may not be as effective for another. It is essential to have a thorough discussion with your dermatologist to explore the best treatment options for your specific situation.

Addressing Long Standing Dermal PIH: Can Tranexamic Acid Help?

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Addressing Long Standing Dermal PIH: Can Tranexamic Acid Help?

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