Clinical Research Directory

Inclusion Criteria: * Age 18 years or above, either sex * Clinically diagnosed facial melasma * Fitzpatrick skin type III, IV or V * Baseline mMASI of 4 or greater * Treatment-naive, or no topical or systemic melasma treatment for at least 2 weeks * Willing to take oral tranexamic acid and attend all follow-up visits * Written informed consent Exclusion Criteria: * Pregnancy, lactation or planned pregnancy during the study * History of deep venous thrombosis, pulmonary embolism, stroke, myocardial infarction or other significant thromboembolic disease * Known thrombophilia or coagulation disorder, or clinically relevant family history * Current oestrogen-containing contraceptive or other oestrogen-containing treatment * Current anticoagulant treatment * Renal impairment or serum creatinine above the reference range * Active malignancy, or major surgery within 3 months * Known hypersensitivity to tranexamic acid * Other facial pigmentary disorder that may interfere with assessment (exogenous ochronosis, lichen planus pigmentosus, acquired dermal macular hyperpigmentation, prominent post-inflammatory hyperpigmentation) * Active rosacea, facial eczema, inflammatory acne or other facial inflammatory dermatosis * Dermoscopic vascularity ungradable in two or more affected facial regions * Chemical peel, microneedling, laser or other procedural melasma treatment within 3 months * Any other contraindication to oral tranexamic acid