The efficacy of tranexamic acid in prevention and treatment of post-inflammatory hyperpigmentation: a pilot study

Post-inflammatory hyperpigmentation (PIH) is a common complication following trauma or cutaneous inflammation, particularly affecting individuals with skin of color. Tranexamic acid (TXA) is a lysine analogue with antifibrinolytic properties and has been used as an off-label agent for melasma and procedural PIH. This pilot study evaluated the efficacy of oral TXA in the prevention and treatment of PIH using a validated in-vivo model. A baseline site was treated with 30% trichloroacetic acid (TCA) to induce PIH (control). After PIH developed, another site was induced and patients started oral TXA 650mg for 4 weeks. Both sites were assessed for pigmentation changes at day 56 using standardized photography, Investigator Global Assessment (IGA), colorimetry, and digital reflectance spectroscopy. While trends toward reduced pigmentation were observed in the TXA-prevention group, none reached statistical significance. Oral TXA may play a role in preventing PIH, but did not significantly reduce pigmentation in established PIH lesions.