Tranexamic Acid for Adults with Melasma: A Systematic Review and Meta-Analysis

Table 1

The characteristics of included studies.

Study; (first author, year)	Country	Completed/Participants	Age, y	Delivery mode	TA treatment	Primary outcome^§	Side effects (patients)
Shin 2013[11]	Korea	44/48	48^†(28-56)	Oral	750mg (Qd, 8W); + QSNY (2 rounds, 4W intervals)	mMASI	Heartburn (1); Nausea (1)
Budamakuntla 2013[12]	India	52/60	- (18-50)	Injection	MI: 8mg (Qm, 8W); MN: 2-4mg (Qm, 8W)	mMASI	Itching (4); Burning (3); Erythema (8)
Lajevardi 2016[13]	Iran	88/100	- (18-65)	Oral	250mg (Tid, 12W); + Topical 4% HQ (Qn, 12W)	MASI	Therapy-related complications (3); Abdominal pain (2)
Banihashemi 2015[14]	Iran	23/30	- (25-47)	Topical	5% TA (Qn, 12W)	MASI	None
Na 2012[15]	Korea	22/25	- (20-55)	Oral+; Topical	Oral TA 250mg (Tid, 8W) +; Topical 2% TA (Bid, 8W)	MI; EI	None
Kim 2016[16]	Korea	23/23	- (34-60)	Topical	Emulsion 2% TA (Bid, 12W) +; Fabric mask 2% TA (Tiw, 12W)	mMASI	None
Lee 2006[17]	Korea	85/100	38^‡ (29-46)	Injection	0.2mg/cm^2 (Qw, 12W)	MASI	None
Padhi 2015[18]	India	40/40	36^‡ (24-55)	Oral	250mg (Bid, 8W) +; Topical 4% HQ (Qd, 8W)	MSAI	Erythema (2); Burning (2); Hypopigmentation/Depigmentation (2); Oligomenorrhoea (1)
Karn 2012[19]	Nepal	260/260	30^‡ (17-55)	Oral	250mg (Bid, 12W) + Topical HQ	MASI	Oligomenorrhoea (19); Belching (12); Abdominal cramps (9); Palpitation (1); Urticarial rash with angioedema (1)
Tan 2016[20]	Singapore	25/25	47^‡ (32-63)	Oral	250mg (Bid, 12W)	MASI	None
Rosario 2017[21]	USA	39/44	44^‡ (-)	Oral	250mg (Bid, 12W)	mMASI	Moderate myalgias (1)
Cho 2013[22]	Korea	51/51	41^‡ (-)	Oral	500mg (Qd, 8W) + IPL + QSNY (3-4 rounds, 1-2W intervals)	mMASI	Transient headache (4)
Atefi 2017[23]	Iran	60/60	39^‡ (-)	Topical	5% TA (Bid, 12W)	MASI	None
Sharma 2016[24]	India	80/100	37^‡ (18-55)	Oral; Injection	Oral TA 250mg (Bid, 12W); TA Injection 4mg (3 rounds, 4W intervals)	MASI	Oral: Hypomenorrhea (6); Epigastric discomfort (2); Injection: Injection site pain and transient oedema (13)
Ebrahimi 2014[25]	Iran	39/50	40^‡ (29-51)	Topical	3% TA (Bid, 12W)	MASI	Erythema, skin irritation, xerosis, and scaling (Total: 9)
Chung 2015[26]	Korea	13/15	41^‡ (-)	Topical	2% TA (12W) + IPL (4 rounds, 4W intervals)	mMASI	None
Thillaikkarasi 2017[27]	India	48/60	40^‡ (-)	Oral; Injection	Oral TA 250mg (Bid, 12W); TA Injection 4mg (3 rounds, 4W intervals)	MASI	Hypothyroidism (5); Irregular menstrual cycle (7 females); Depression and anxiety (38)
Saki 2017[28]	Iran	31/37	36^‡ (25-49)	Injection	3 rounds, 4W intervals	MI; EI	Unknown
Steiner 2009[29]	Brazil	17/18	41^‡ (23-52)	Topical; Injection	Topical 3% TA (Bid, 12W); TA Injection 0.2mg/cm^2 (Qw, 12W)	MASI	Side effects were minimal.
Lu 2017[30]	China	81/84	43^†(23-58)	Topical	2.5% TA (7h/d, 8W)	MASI	None
Xu 2017[31]	China	28/30	39^‡ (20-50)	Topical	0.5% TA (Qw, 12W)	MI; EI	None

Median age. ^‡Mean age.
TA: tranexamic acid, HQ: hydroquinone, Qd: once a day, Qn: once a night, Bid: twice a day, Tid: thrice a day, Qm: once a month, Qw: once a week, Tiw: thrice a week, QSNY: low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet, MI: microinjection, MN: microneedling, IPL: intense pulsed light.
^§MASI: Melasma Area and Severity Index, mMASI: modified Melasma Area and Severity Index, MI: Melanin Index, EI: Erythema Index.