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Tranexamic Acid for Rosacea: What the Research Says
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What Does the Research Say About Tranexamic Acid for Rosacea?
The research on TXA for rosacea is still in its infancy, but the data looks promising so far.
A comprehensive review published in 2024 included six clinical trials on the use of tranexamic acid for rosacea that were conducted between 2012 and 2023. The studies collectively looked at 64 patients, 28 of whom had erythematotelangiectatic rosacea (redness and broken blood vessels) and 36 of whom had papulopustular rosacea (acne-like bumps). All six studies concluded the treatment was effective, and none of the studies reported any serious side effects. The methods of application varied from oral tablets to topical solutions to intradermal injections, which means different methods might be effective in different situations. (2)
The largest clinical trial on the topic to date is a randomized controlled trial of 70 patients with papulopustular rosacea. The patients were split into two groups, one of which received conventional treatment for rosacea plus oral tranexamic acid and the other of which received conventional treatment only, for eight weeks, followed by a four-week follow-up period. The tranexamic acid group saw significantly greater improvement in clinical erythema assessment, investigator’s global assessment, patient self-assessment, and rosacea-specific quality of life scores. No adverse events were reported. (3)
One comparative trial of 45 female patients with erythematotelangiectatic rosacea looked at topical 10% tranexamic acid with and without microneedling. One side of each patient’s face received tranexamic acid alone, and the other received tranexamic acid and microneedling. Both sides of the face responded to the treatment, but the combination of microneedling and tranexamic acid saw significantly better results. In terms of telangiectasia, so-called “spider veins,” 66.6% of patients had good to excellent results on the microneedling + TXA side of the face, while 0% of patients on the TXA-alone side had good to excellent results. No adverse effects were reported on the side of the face treated with topical tranexamic acid alone. (5)
These findings are promising, but keep in mind that tranexamic acid is not yet a go-to treatment for rosacea. The sample sizes are small, and more large-scale randomized controlled trials need to be conducted before it’s a standard suggestion. That being said, if you’ve tried other treatments for rosacea without success, TXA is a research-backed approach you might consider talking to a provider about.
Oral vs. Topical Tranexamic Acid: What Are the Differences?
One of the most common questions about tranexamic acid is whether the oral or topical form works better.
Oral tranexamic acid is absorbed throughout the body, meaning it can address inflammation and vascular changes throughout the skin layers rather than just at a surface level. The 70-patient randomized trial using oral tranexamic acid added to standard therapy found significant improvements in both clinical rosacea severity and skin barrier function over eight weeks. (3) However, because oral TXA enters your bloodstream, it comes with potential side effects including gastrointestinal discomfort and, in rare cases, an increased risk of blood clots, which we cover in the safety section below.
Topical tranexamic acid is available in solutions and creams, typically at concentrations between 5% and 10%. It is gentler than oral TXA and carries virtually no systemic risk, making it a good option for people who prefer a more conservative approach. In the split-face study, the side treated with topical TXA alone still showed statistically significant improvement in erythema, though the results were less dramatic than the microneedling combination. (5) Across the studies reviewed, no adverse effects were reported with topical tranexamic acid alone. (2)
What Are the Side Effects and Safety Considerations?
TXA is considered generally safe, and none of the rosacea clinical studies we reviewed reported any serious adverse effects. (2, 3)
Topical TXA’s side effects are minimal. Across many clinical studies, no adverse effects were reported in patients who received topical TXA alone. (2, 5) In the split-face study, all the reported side effects (pain, exfoliation, erythema, bruises) occurred on the side of the face that also underwent microneedling, not the side that only received TXA. (5)
Oral side effects are more substantial. The most common side effects are gastrointestinal issues like nausea or bloating, and there is a risk of blood clots. In the 70-patient randomized trial, no significant side effects were associated with oral TXA when added to standard therapy for eight weeks. (3)
Blood clot risk is the most discussed safety concern with oral tranexamic acid. Since the drug works by helping your blood form clots, there’s a potential risk of venous thromboembolism. A large population-based study of nearly 2 million Danish women followed for 13.8 million person-years found that the use of oral TXA was associated with a roughly fourfold increased relative risk of venous thromboembolism compared to nonuse. However, the absolute risk was still low. With a five-day treatment course, the math showed that 78,549 women would need to be treated with oral TXA in order for 1 to experience a blood clot. (6) Nevertheless, your practitioner should assess your risk factors before prescribing oral TXA, particularly if you have a history of blood clots or other cardiovascular risk factors. It’s important to keep your provider up-to-date on your health history, so they can determine which medications are safe options for your individual situation.
FAQs
How long does it take to see results from tranexamic acid for rosacea?
In a 70-patient trial, patients saw significant improvement after 8 weeks of oral tranexamic acid added to standard treatment. They also saw improvement in their quality of life. (3) Some studies of topical TXA found improvement as early as 2-6 weeks, though the degree of that improvement varied. (2)
Can you use tranexamic acid with other rosacea treatments?
Yes. In the 70-patient randomized trial, oral tranexamic acid was given in addition to standard rosacea therapy of oral doxycycline and topical hyaluronic acid with improvement and no notable drug interactions. (3) Topical tranexamic acid is typically safe to layer with most skin care ingredients. As always, consult your provider to check for potential drug interactions with any medications you are taking.
Is tranexamic acid safe to use long term?
We don’t know for sure. In studies with topical tranexamic acid, no side effects have been reported in the clinical studies to date. (2) With oral tranexamic acid, the longest studies were 8 weeks of treatment with a follow-up period, and no side effects were reported. (3) We don’t have data about safety of use beyond that study period. Oral use should be monitored by a healthcare provider to keep an eye out for any signs of thromboembolic complications.
Does tranexamic acid work for all types of rosacea?
So far, most of the clinical studies have been on erythematotelangiectatic rosacea (redness and visible vessels) and papulopustular rosacea (red bumps), and it has been found to be effective for both. There is no published clinical data on its use in phymatous (nodular and thickening) or ocular (eye) rosacea. Your provider can help you decide whether tranexamic acid might be a good fit for your particular type of rosacea. (2)
Is tranexamic acid better than other rosacea treatments?
Tranexamic acid is not a substitute for other established rosacea treatments such as topical metronidazole, azelaic acid, brimonidine, or oral doxycycline. It’s best viewed as an additional option for patients who have not responded fully to first line therapies or for those who want to target the vascular and barrier aspects of their rosacea with an additional medication. Head-to-head comparison studies will be needed to definitely say if it is an appropriate substitute or a better option. (2)
Check Your Eligibility
If you have been struggling with rosacea and want to explore whether tranexamic acid or other treatment options might be right for you, a healthcare provider on Mochi Health's telehealth platform can help you understand your options and determine the best course of action for your needs. Check your eligibility here.
Disclaimer: This article is for educational purposes only and should not be considered medical advice. The information provided does not constitute recommendations for treatment. Always consult with your healthcare provider about your specific situation, symptoms, and treatment options.
References
Li, Y., Xie, H., Deng, Z., Wang, B., Tang, Y., Zhao, Z., Yuan, X., Zuo, Z., Xu, S., Zhang, Y., & Li, J. (2019). Tranexamic acid ameliorates rosacea symptoms through regulating immune response and angiogenesis. International Immunopharmacology, 67, 326–334. https://pubmed.ncbi.nlm.nih.gov/30578968/
Zhang, J., Gu, D., Yan, Y., Pan, R., Zhong, H., Zhang, C., & Xu, Y. (2024). Potential role of tranexamic acid in rosacea treatment: conquering flushing beyond melasma. Clinical, Cosmetic and Investigational Dermatology, 17, 1405–1412. https://pmc.ncbi.nlm.nih.gov/articles/PMC11185165/
Xu, Z., Yu, B., Xu, B., Ye, S., Qing, Y., Zhao, B., Hong, S., Wu, N., & Wu, J. (2024). Oral tranexamic acid treats papulopustular rosacea by improving the skin barrier. Journal of Cosmetic Dermatology, 23(9), 2918–2926. https://pubmed.ncbi.nlm.nih.gov/38712728/
National Center for Biotechnology Information. (2024). Tranexamic acid. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532909/
Mohamed, R.R., Mohamed, L.G.M., Mansour, M., & Rageh, M.A. (2024). Topical 10% tranexamic acid with and without microneedling in the treatment of erythematotelangiectatic rosacea: A split-face comparative study. Journal of Clinical and Aesthetic Dermatology, 17(2), 47–51. https://pmc.ncbi.nlm.nih.gov/articles/PMC10911261/
Meaidi, A., Mørch, L., Torp-Pedersen, C., & Lidegaard, O. (2021). Oral tranexamic acid and thrombosis risk in women. eClinicalMedicine, 35, 100882. https://pubmed.ncbi.nlm.nih.gov/34124632/
Zhu, J. W., Ni, Y. J., Tong, X. Y., Guo, X., Wu, X. P., & Lu, Z. F. (2020). Tranexamic Acid Inhibits Angiogenesis and Melanogenesis in Vitro by Targeting VEGF Receptors. International journal of medical sciences, 17(7), 903–911. https://doi.org/10.7150/ijms.44188
Micali, G., Gerber, P. A., Lacarrubba, F., & Schäfer, G. (2016). Improving Treatment of Erythematotelangiectatic Rosacea with Laser and/or Topical Therapy Through Enhanced Discrimination of its Clinical Features. The Journal of clinical and aesthetic dermatology, 9(7), 30–39.
Barakji, Y. A., Rønnstad, A. T. M., Christensen, M. O., Zachariae, C., Wienholtz, N. K. F., Halling, A. S., Maul, J. T., Thomsen, S. F., Egeberg, A., & Thyssen, J. P. (2022). Assessment of Frequency of Rosacea Subtypes in Patients With Rosacea: A Systematic Review and Meta-analysis. JAMA dermatology, 158(6), 617–625. https://doi.org/10.1001/jamadermatol.2022.0526
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