What proportion of patients may improve with oral tranexamic acid according to the speaker?

Shereene IdrissBoard Certified Derm, Founder and Chief Nerd

Best and Worst Treatments for Melasma #shorts

19 Aug 2025 · 1 min

Watch on YouTube

1:01

A short monologue by a board-certified dermatologist (who also has melasma) outlining evidence-based treatment and maintenance strategies for melasma: prescription hydroquinone as the topical gold standard (not for long-term use), the importance of a daily over-the-counter skincare routine for maintenance, oral tranexamic acid (effective in up to 70% of patients) and intralesional tranexamic acid for stubborn patches, adjuncts like microneedling and light chemical peels, and explicit avoidance of heat-based lasers (Fraxel, IPL, CO2) and high-heat/UV conditions.

Questions this video answers

Up to 70% of patients.

Chapters

Melasma. She sucks. But it doesn't mean you have to remain hopeless. You have hope. I'm a board certified dermatologist who also has melasma. And you can get clear skin too. It's just about being smart. Prescription is required and hydroquinone is the gold standard. But newsflash, you cannot be on hydroquinone long term. And that is why having a solid over the counter skincare routine is essential. Think of that routine as your daily steps and the prescription as your gym workout number two. Let's say you've tried it or you can't tolerate it. Oral tranexamic acid can take you from this to this in up to 70% of patients. And in some cases when it's really really stubborn, I will inject tranexamic acid into these patches to help give it a boost to clear it up. Last, you can microneedle and do very light chemical peels. Just don't do it when it's too hot or the UV index is high. And try to avoid any heat based devices like Fraxel, IPL or CO2 laser. But the most important tip, you can go to the gym, but if you don't have an active lifestyle, how useful is that? In order to maintain the results you need that over the counter skincare routine.