My dermatologist recommended tranexamic acid orally for melasma

if transexamic acid was very successful it would be a regular treatment offered by everyone and be a more regular treatment in the community.
Hyperpigmentation from any type needs a combination approach of peels like cosmelan,  lasers like clear and brilliant and aerolase or laser genesis, radiofrequency like venus viva, and constant skin care and sun protection.  Bimontly facials with silk peel dermalinfusion is essential to hydrate, exfoliate and infuse vitamins and antioxidants into the skin.  If you have acne you can do additional treatments and peels to get more improvement.  I suggest a formal consultation with an expert in lasers and peels. Best, Dr. Emer.

The short answer to your question is that both topical and oral tranexamic acid have relatively recently been found useful for fading melasma. Tranexamic acid, an FDA approved medication, has been used safely for quite some time to reduce excessive bleeding from a variety of causes.  Its successful use, both via topical and oral routes, for the treatment of melasma is more recent. Individuals with a higher risk for the developing of blood clots, such as smokers and those on birth control pills, need to be monitored carefully when taking this medication orally. Make sure you consult with a board certified aesthetic dermatologist. Best of luck to you. 

Dear ver212,
I would have to examine you but Melasma can be treated with a comprehensive approach.  Stopping or changing the birth control medication, avoidance of UV and direct light, and also retinol and hydroquinone treatment. You should always use sunscreen.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I have had patients who have had some success with oral tranexamic acid for melasma. However, I have had much greater success for treating melasma with Cosmelan. Cosmelan is the best treatment to reduce and eliminate melasma. Through the use of hydroquinone and retain-a the pigmentation will be resolved.  Careful sun exposure is necessary to stop the recurrence of your melasma.  Best, Dr. Green

T. acid can help with the vascular component of melasma, another option is Cosmelan - Dermamelan peel. Dr Michelle Green in NYC is an expert. 
Melasma can not be completely cured, however effective treatment are possible. Melasma patients have skin that is very sensitive to UV light. Even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. 
I prefer to use a combination of creams and laser for melasma. My most frequently prescribed topicals include hydroquinone, along with vitamin A creams and botanical extracts. The exact percentages will depend on your skin sensitivity, clinical presentation and your current skin care routine. 
I usually start my patients on a series of lasers (low dose Q switch or Picosure), along with medical therapy. Another laser I use is the Clear and Brilliant in the Permea setting. In some cases I combine glycolic AHAs, TCA low strength single coat peels, and in other cases I use a tablet called Tranexamic acid to help modulate the blood vessels that are associated with melanocytes (pigment cells). Melasma treatments should be tailored to each patient. 
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia. Cutis International 

Hi there,Melasma needs to be tackled from different angles such as topical medications, chem peels, lasers and sun avoidance. See a certified dermatologist to get you started on your treatment program. Best of luck...