Melasma is a chronic hyperpigmentation disorder that presents significant therapeutic challenges due to its multifactorial etiology and high recurrence rates. Current treatments, including topical agents, oral medications, and lasers, often provide variable results and may be accompanied by adverse effects or limited long-term efficacy. Tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a novel intervention for melasma, particularly in its intradermal injectable form.<br/><br/>Tranexamic acid works by inhibiting melanogenesis through the suppression of the UV-induced plasminogen-plasmin pathway, which reduces the release of inflammatory mediators and the activation of melanocytes. Additionally, TXA affects vascular factors involved in melasma, addressing both the pigmentary and vascular components of the disorder.<br/><br/>Recent clinical trials and case studies have shown that intradermal TXA injections can provide significant improvement, particularly for recalcitrant and dermal types of melasma. This lecture will review the mechanism of action of tranexamic acid in treating melasma, along with optimized dosing regimens, techniques, and injection protocols to achieve consistent results. Comparative outcomes with other established treatments will be discussed, highlighting reduced side effects such as post-inflammatory hyperpigmentation and minimal downtime.<br/><br/>We will also explore patient selection criteria, focusing on individuals with hormonal and vascular triggers of melasma, who are most likely to benefit from this treatment. Safety and potential side effects will be covered to ensure clinicians are fully informed when offering this modality.<br/><br/>Intradermal tranexamic acid injections offer a promising addition to the therapeutic options for melasma. It is a safe, minimally invasive procedure that provides effective, long-lasting improvement, making it a valuable option for patients who have failed or cannot tolerate conventional therapies.

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Abstract:<br/>Melasma is a persistent and complex condition, particularly in individuals with darker skin types,<br/>where hyperpigmentation can be more pronounced. Traditional treatments such as topical agents,<br/>chemical peels, and oral medications effectively reduce pigmentation but often fail to address<br/>the broader signs of ageing, such as fine lines, wrinkles, and skin laxity. Evidence suggests that by<br/>treating signs of ageing, we can also reduce melasma symptoms and its recurrence, highlighting<br/>the need for a more comprehensive approach.<br/>To achieve this, incorporating energy-based devices (EBDs) into melasma treatment is essential.<br/>EBDs, such as fractional lasers, radiofrequency microneedling, and picosecond lasers, not only target<br/>pigmentation but also improve skin texture and overall rejuvenation. However, special care is<br/>required when treating darker skin types, as the risk of post-inflammatory hyperpigmentation (PIH)<br/>is significantly higher.<br/>This presentation will discuss the selection of EBDs for melasma treatment, focusing on their<br/>mechanisms of action—whether through breaking down excess pigmentation or stimulating collagen<br/>for anti-ageing benefits. The advantages include a dual effect on pigmentation and ageing, with<br/>the potential for longer-lasting results and reduced recurrence. On the other hand, the<br/>disadvantages include the higher risk of PIH and the need for precise, customized protocols to avoid<br/>complications. By understanding the balance of these factors, clinicians can offer safer and more<br/>effective treatments for melasma in darker skin types.<br/><br/>Keywords: melasma, darker skin, energy-based devices

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