Whitening and Blood Clots: What is Tranexamic Acid?

Hopefully, you've read the previous post, because the build-up was kind of there.

Because I have more free time, I am now tasked with the traditional "sa bahay lang" housewife role and am now in charge of everything housekeeping and cooking. I cannot carry very heavy loads according to my doctor, so every other day, I go to the nearest grocery to pick up household items and ingredients for our meals. I always make it a point to make fun of some products sold in the beauty aisle or read product labels.

Anyway, I've noticed that my go-to grocery, and I'm betting many other groceries, sell much more variety of whitening soaps compared to that of normal soap. Whitening soap with different ingredients saturate the shelves while ironically, the sunscreen area is tucked in an obscure corner. The "canon" whitening products are still there: papaya, calamansi, glutathione, kojic acid. Then something catches my eye: kojic acid with tranexamic acid. 

I've never heard of tranexamic acid before, so I took a mental note of the spelling, went on with my routine and proceeded to read about it after all the housework. Wikipedia, basically says it is given by doctor to patients with the risk of heavy bleeding. Huh? How was this related to skincare? How this ingredient was discovered as a whitening ingredient is beyond my Googling powers, but at least I now have an idea and how people use it, so I can share it with everyone.

Tranexamic acid is not only a drug that helps prevent too much bleeding, but it is used also to treat melasma and may be administered orally, with a prescription of course. Shiseido introduced this ingredient in one of their whitening lines around 1990 to 2000. Topical products and drips are also being marketed, despite the obvious health risks and unwanted side effects. 

Does it work?

One study followed the progress of 74 Chinese women, all given two 250 mg/day tablets for 6 months. Most subjects had favorable results: out of the 74, 8 had excellent results, 40 had good ones, and 23 had fair results. However, around 10% of the subject got their melasma back after the study. No mention of control for the study was made, so the conclusion of its safety and efficacy remain disputable.

A randomized, blind study found the application of 5% tranexamic acid topically was basically insignificant and even caused redness on the skin. Another study, with combined topicals and orals, had similar unimpressive results with minor unwanted side effects. 

A preliminary clinical trial showed the effectivity of weekly injected tranexamic acid on localized melasma lesions. The study period lasted for three months with almost 85% of the respondents achieving 25-75% lightening. It was deemed safe, at a low dosage of 50 mL weekly. No controls were provided.

Drips have not been studied yet, but as with any other drips, this is discouraged by doctors for cosmetics use. 

tl;dr: Limited studies show tranexamic acid works as an injectable at controlled dosages. As for the oral and topicals, the results are mixed due to side effects and/or recurrence of dark spots.

Any side effects?

The minor side effects observed include gastrointestinal discomfort, extremely light menstrual flows, mild headaches, back, joint or muscle pain.  Tranexamic acid should not be used long term (beyong 6 months) due to its bigger side effects: blood clots and heart attacks. Its approved concentration ranges from 1.5%-3% depending on the country imposing the regulation (the Philippines has none).

It may not be used by people with known clotting problems, acquired defective color vision, and hypersensitivity to the acid, and pregnant women (it has the same category as kojic acid). 

So about the soap?

A hit or a miss. May cause hypersensitivity and redness and other unknown side effects (very limited studies exist). Not for the pregnant, people with heart, clotting and eye problems. Patch test prior to use and go crazy with sunblock.