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Tranexamic acid vs. azelaic acid for melasma: What to know

Which of these ingredients works best for hyperpigmentation? Curology’s dermatology providers explain.

Curology Team Avatar
Curology Team Avatar
by Curology Team
featuring Curology Team
Updated on Jul 26, 2023 • 9 min read
Medically reviewed by Laura Phelan, NP-C
Woman Applying Cream to Melasma
Curology Team Avatar
Curology Team Avatar
by Curology Team
featuring Curology Team
Updated on Jul 26, 2023 • 9 min read
Medically reviewed by Laura Phelan, NP-C
We’re here to share what we know — but don’t take it as medical advice. Talk to your medical provider if you have questions.

Our skin’s needs are as unique as we are, and that is particularly true when dealing with hyperpigmentation disorders. 

Today, we’ll dive into a comprehensive comparison of two popular ingredients that help fight against melasma: tranexamic acid and azelaic acid. So, what are they? Which one should you recruit for your skincare team? We’ll tell you everything you need to know, so you can make the best choice for your skin. Spoiler alert: We'll also explore how these seemingly rival ingredients can actually team up for a more powerful impact. 

What is tranexamic acid?

Tranexamic acid (TXA) is a versatile medical compound with a long history. It’s particularly well-known for its role in managing bleeding. Initially, oral tranexamic acid was used to control excessive bleeding during surgeries or in individuals suffering from certain blood clotting disorders.¹

Tranexamic acid has recently emerged as a promising solution for melasma, a common skin condition characterized by brown patches of skin on the face that are often symmetrical. The mechanism of TXA's action is twofold: First, it curbs several factors that induce skin pigmentation. Second, it inhibits the activity of an enzyme called tyrosinase, which is crucial for the production of melanin, the pigment that gives color to our skin.²

There are three forms of tranexamic acid that have been studied for melasma: oral, topical, and intradermal (injected into the skin). Oral TXA is beginning to show more promise with recent studies.³ It’s worth noting, though, that while topical TXA has demonstrated no reported adverse effects in studies, oral TXA does carry risks including gastrointestinal side effects.⁴

As with any medication, it’s crucial to follow the advice of a healthcare provider when using tranexamic acid. 

What is azelaic acid?

Azelaic acid (AA) is a unique compound that comes from an unusual source: a fungus called Pityrosporum ovale found in grains like rye, wheat, and barley. Over time, this naturally derived acid has gained a reputation for its skincare benefits.⁵

AA is particularly recognized for its ability to combat acne, with studies showing that it can help reduce acne and post-inflammatory hyperpigmentation. But azelaic acid’s abilities don’t end there. It’s also used to address other hyperpigmentation issues, such as melasma.⁶ 

AA’s mechanism for lightening dark spots involves inhibiting the activity of an enzyme called tyrosinase.⁷ This enzyme is key to melanin production, the pigment responsible for the color of our skin. By interfering with this process, AA can help fade dark patches and restore a more even skin tone.

In terms of safety, most patients tolerate azelaic acid well. The most commonly reported side effects are typically localized and include itching, redness, or irritation.⁸ It’s always important to follow package instructions when using products containing azelaic acid. This can help minimize potential side effects. When in doubt, reach out to a licensed dermatology provider for personalized advice.

Tranexamic acid vs. azelaic acid: Which works better? 

Tranexamic acid and azelaic acid are both proven treatments for melasma.⁹ However, even though both treatments are effective individually, there’s not a substantial amount of research comparing the two head-to-head. 

One small study did reveal that a combination of oral and topical 3% tranexamic acid had a significantly better outcome than a combination of oral tranexamic acid and 20% azelaic acid.¹⁰ This might suggest a stronger impact of TXA on melasma, but it’s important to remember that research in this area is still limited.

Other studies suggest that combination treatments often yield the best results for managing skin conditions like melasma.¹¹ This means using more than one type of treatment can be beneficial, so it’s not always a matter of choosing one treatment over the other. The concept of using multiple treatments together reflects the complicated nature of our skin, the variety of factors causing melasma, and the necessity of a multi-faceted approach to counter them. 

Ultimately, the choice between TXA and AA—or potentially using them in combination—should be made on an individual basis. Skin is as unique as the person it belongs to, and what works wonders for one might not for another. To make the best decision for your skin, consult with a licensed dermatology provider, such as those at Curology. We can provide personalized recommendations based on your specific skin condition and health history, helping you achieve the best possible results.

It’s worth noting that Curology offers personalized formulas with one or both of these proven-effective ingredients. So, our providers are ready and able to share all they know about tranexamic acid and azelaic acid.

Other melasma treatments to consider

Tranexamic acid and azelaic acid are both effective melasma treatments, but they aren’t your only options. Here are some other ingredients proven to fight hyperpigmentation that you can consider for your skin care team. 

Keep melasma from getting worse

The first step in treating melasma is to keep it from getting worse. Sun exposure is well-known to make skin hyperpigmentation darker. So it’s time to make sunscreen your new best friend if you haven’t already.¹² If you need a recommendation, we’re partial to our Everyday Sunscreen, which is great for acne-prone or sensitive skin types. 

Retinoids

Vitamin A derivatives such as tretinoin, retinol, and adapalene help treat melasma by inhibiting tyrosinase and encouraging cell turnover. They’re mostly well-tolerated but can cause some temporary redness, drying, or peeling.¹³ 

Niacinamide

This form of vitamin B3 is the biologically active form of niacin (maybe you’ve seen it in your multivitamin?). It works on melasma by decreasing the amount of melanin that accumulates in the skin. It’s also known to reduce inflammation and sun damage to the skin. The possible side effects of topical niacinamide are generally mild but include mild burning, redness, or itching.¹⁴

Other topical melasma treatments

There are quite a few other treatments to look at for melasma. So if these first steps don’t give you the results you’re looking for, don’t lose heart. Other topical treatments that have been shown to be effective at treating melasma include:¹⁵ 

  • Triple combination therapy (a blend of hydroquinone, a retinoid, and a topical steroid).

  • Ascorbic acid.

  • Glycolic acid.

  • Kojic acid.

Ensure that you consult with a dermatology provider for solutions catered to your specific skincare needs for optimal treatment.

Curology can help treat melasma

Navigating the landscape of skincare ingredients, particularly for conditions like melasma, can be a challenge. Hopefully, how tranexamic acid and azelaic acid work—two potent tools for fighting hyperpigmentation—will significantly illuminate your path to clearer skin. 

Both ingredients have unique benefits, demonstrating effectiveness individually and potentially showing even greater results when combined. This complex dance of skincare ingredients underlines the importance of personalization and expertise in treatment decisions. Each person’s journey with melasma is unique, which means a tailored approach can lead to optimal outcomes.

If you’re looking for more information on melasma or other types of hyperpigmentation or you want individualized recommendations for your skin, talk with a licensed dermatology provider, like those at Curology.

Get your personalized skincare routine with Curology

Get your personalized skincare routine with Curology

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We were founded by dermatologists who believe everyone should have access to skincare products that actually work. Our prescription skincare uses a combination of clinically researched ingredients to address specific skin concerns like acne, dark spots, or fine lines.

Getting started is easy!* Simply take a quick quiz and snap photos of your skin concerns. Then, one of our licensed medical providers will evaluate your skin. If Curology is right for you, your provider will prescribe a formula containing up to 3 active ingredients, such as tretinoin, azelaic acid, niacinamide, or tranexamic acid, based on your skin quiz and photos.

FAQs

Which is better, azelaic acid or tranexamic acid?

Both azelaic acid and tranexamic acid are proven-effective treatments for melasma.¹⁶ Direct comparison research is limited, but a small study showed that a combination of oral and topical tranexamic acid was significantly more effective than a blend of oral tranexamic acid and azelaic acid.¹⁷

Which acid is better for hyperpigmentation?

Both tranexamic acid (TXA) and azelaic acid (AA) can effectively treat hyperpigmentation, including dark spots and melasma. However, there isn’t enough direct comparison research to decisively determine which is superior. Often, a combination of treatments yields the best results.¹⁸ Other acids known to be effective for hyperpigmentation include ascorbic acid, glycolic acid, and kojic acid.¹⁹

Can I use tranexamic acid and azelaic acid at the same time?

Yes, you can generally use tranexamic acid and azelaic acid together, and there are several prescription and over-the-counter products that contain both. In fact, Curology offers personalized formulas with one or both of these proven ingredients.

• • •

P.S. We did the homework, so you don’t have to:

  1. Chauncey, J.M. and Wieters, J.S. Tranexamic Acid. StatPearls. (2022, July 25).

  2. González-Molina, V., et al. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. (May 2022).

  3. Wang, J.V., et al. Tranexamic Acid for Melasma: Evaluating the Various Formulations. J Clin Aesthet Dermatol. (August 2019).

  4. González-Molina, V., et al. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. Ibid.

  5. Hollinger, J.C., et al. Are Natural Ingredients Effective in the Management of Hyperpigmentation? A Systematic Review. J Clin Aesthet Dermatol. (February 2018).

  6. Hollinger, J.C., et al. Are Natural Ingredients Effective in the Management of Hyperpigmentation? A Systematic Review. J Clin Aesthet Dermatol. Ibid.

  7. González-Molina, V., et al. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. Ibid.

  8. González-Molina, V., et al. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. Ibid.

  9. González-Molina, V., et al. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. Ibid.

  10. Malik, F., et al. Combination of Oral Tranexamic Acid with Topical 3% Tranexamic Acid versus Oral Tranexamic Acid with Topical 20% Azelaic Acid in the Treatment of Melasma. J Coll Physicians Surg Pak. (June 2019).

  11. González-Molina, V., et al. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. Ibid.

  12. Plensdorf, S., et al. Pigmentation Disorders: Diagnosis and Management. Am Fam Physician. (2017, December 15).

  13. González-Molina, V., et al. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. Ibid.

  14. González-Molina, V., et al. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. Ibid.

  15. González-Molina, V., et al. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. Ibid.

  16. González-Molina, V., et al. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. Ibid.

  17. Malik, F., et al. Combination of Oral Tranexamic Acid with Topical 3% Tranexamic Acid versus Oral Tranexamic Acid with Topical 20% Azelaic Acid in the Treatment of Melasma. J Coll Physicians Surg Pak. Ibid.

  18. González-Molina, V., et al. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. Ibid.

  19. González-Molina, V., et al. Topical Treatments for Melasma and Their Mechanism of Action. J Clin Aesthet Dermatol. Ibid.

* Subject to consultation. Subscription is required. Results may vary. 

Laura Phelan is a board-certified Family Nurse Practitioner at Curology. She earned her Masters of Science in Nursing at Benedictine University and went on to get her post-master’s certificate as a Family Nurse Practitioner at the University of Cincinnati.

• • •
Our medical review process:We’re here to tell you what we know. That’s why our information is evidence-based and fact-checked by medical experts. Still, everyone’s skin is unique—the best way to get advice is to talk to your healthcare provider.
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Curology Team

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Laura Phelan, NP-C

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