Tranexamic Acid for Rosacea: What the Research Says

Key Takeaways

Tranexamic acid is an antifibrinolytic medication originally used to control bleeding, now being studied for rosacea
Preclinical research shows it works through multiple pathways: reducing inflammation, inhibiting excess blood vessel formation, and improving skin barrier function
A review of six clinical studies found tranexamic acid effective for rosacea, with no severe adverse effects reported across any of them
A 70-patient randomized controlled trial found that adding oral tranexamic acid to standard rosacea treatment significantly improved clinical erythema, skin hydration, and skin barrier function
Tranexamic acid is available in oral, topical, and injectable forms, each with different effectiveness and side effect profiles

Over the past few years, tranexamic acid has been increasingly featured in skin care products and medical research, initially for treating severe bleeding associated with heavy menstrual blood loss, but more recently for skin redness and inflammation. While it has been widely used for years in surgical and emergency medicine for its antifibrinolytic properties (i.e., it helps stop excessive bleeding), in dermatology, tranexamic acid may offer hope for one of the most challenging skin concerns of all, rosacea (1, 2).

If you’ve been struggling with persistent facial redness, visible blood vessels, and inflammation that aren’t responding to your usual treatments, you may want to learn more about tranexamic acid. Here, we’ll review what it is, how it works, the research behind it for rosacea, and what you need to know about its safety.

What Is Tranexamic Acid?

Tranexamic acid is a synthetic derivative of the amino acid lysine. It was first used as an antifibrinolytic agent, which means that it’s approved by the FDA to prevent blood clots from dissolving too quickly. This has made it an important tool in surgeries and emergency situations to prevent excessive bleeding, and it is listed on the World Health Organization’s List of Essential Medicines (4).

But in dermatology, tranexamic acid first began to attract attention for its effects on skin pigmentation, in particular for treating melasma. Researchers soon realized, however, that its anti-inflammatory and anti-angiogenic effects (i.e., its ability to reduce inflammation and formation of new blood vessels) might make it effective against rosacea as well. In recent years there has been a significant amount of research investigating the use of tranexamic acid for reducing redness, flushing, and skin barrier disruption in rosacea (1, 2).

Tranexamic acid can be used orally, topically, or via injection. Each method of use has different efficacy and safety considerations, which we’ll discuss below.

How Does Tranexamic Acid Work for Rosacea?

One of the reasons researchers suspect that tranexamic acid may be useful against rosacea is that it appears to targets the condition through several interconnected pathways. Here is what the research has found so far (1, 2):

Reducing inflammation: Rosacea is an inflammatory disease, and much of the damage it causes to skin comes from the inflammation that it triggers. In one mouse study examining rosacea, researchers found that tranexamic acid decreased production of several different pro-inflammatory chemicals (IL-6 and TNF-alpha), as well as an enzyme (MMP9) that contributes to inflammation. They also found that tranexamic acid regulated the presence of immune cells (T cells), as well as the expression of several immune-related genes (including TLR2 and KLK5) in rosacea-like lesions. In simpler terms, it can help get rid of some of those extra blood vessels that lead to chronic facial redness (1).

Improving skin barrier function: Rosacea prone skin often has a weakened barrier, which means increased sensitivity, dryness, and transepithelial water loss. One RCT involving 70 patients found that oral tranexamic acid enhanced skin barrier function, increased skin hydration, and reduced transepithelial water loss compared to the control group, which received conventional treatment. The researchers noted that patients with dry-type rosacea saw even greater improvements in skin barrier function (3).

What Does the Research Say About Tranexamic Acid for Rosacea?

The research on tranexamic acid 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).

A split-face comparative trial of 45 female patients with erythematotelangiectatic rosacea looked at topical 10% tranexamic acid with and without microneedling. Both sides of the face responded well to the treatment, but microneedling plus tranexamic acid saw significantly better results. In terms of telangiectasia specifically, 66.6 percent of patients had good to excellent results on the microneedling-plus-TXA side of the face, while 82.2 percent of patients saw poor to no response on the TXA side. 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, it’s 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 systemically, meaning it can address inflammation and vascular changes throughout the skin rather than just at the surface. The 70-patient randomized trial used oral tranexamic acid added to standard therapy and found significant improvements in both clinical severity and skin barrier function over eight weeks (3). However, because it 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 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 TXA alone (2).

Intradermal injections are a third option, where tranexamic acid is injected directly into the affected skin by a provider. One study of six patients with erythematotelangiectatic rosacea using monthly intradermal microinjections of 5% tranexamic acid found significant reduction in clinical severity scores, with improvements maintained for at least three months after treatment ended. Only transient erythema and swelling were reported in three of the six patients (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 side effects are negligible. 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 microneedling side of the face, not the TXA-only side (5).

Oral side effects are more substantial. The most common side effects are gastrointestinal issues like nausea or bloating. 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: The number needed to harm per five days of treatment was 78,549 women, which means that the absolute risk of experiencing a blood clot is still extremely low for healthy women (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.

FAQs

How long does it take to see results from tranexamic acid for rosacea?

The 70-patient randomized trial found that after 8 weeks of receiving oral tranexamic acid in addition to standard treatment, patients had significant improvements in clinical erythema, skin hydration, and quality of life (3). Some of the topical studies found improvement as early as 2-6 weeks, though the degree of improvement ranged (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 with improvement and no notable drug interactions (3). Topical tranexamic acid is typically safe to layer with most skin care ingredients. As always, it’s always best to consult your provider to check for potential drug interactions with any medications you are taking.

Is tranexamic acid safe to use long term?

Topical tranexamic acid: No side effects have been reported in the clinical studies to date (2). Oral tranexamic acid: The longest studies have been 8 weeks with a follow-up period, and no side effects were reported (3). However, long-term 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 or ocular rosacea. Your provider can help you decide whether tranexamic acid might be a good fit for your particular 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 doxycycline at this point. 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. Head-to-head comparison studies will be needed (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/

Key Takeaways

Tranexamic acid is an antifibrinolytic medication originally used to control bleeding, now being studied for rosacea
Preclinical research shows it works through multiple pathways: reducing inflammation, inhibiting excess blood vessel formation, and improving skin barrier function
A review of six clinical studies found tranexamic acid effective for rosacea, with no severe adverse effects reported across any of them
A 70-patient randomized controlled trial found that adding oral tranexamic acid to standard rosacea treatment significantly improved clinical erythema, skin hydration, and skin barrier function
Tranexamic acid is available in oral, topical, and injectable forms, each with different effectiveness and side effect profiles

Over the past few years, tranexamic acid has been increasingly featured in skin care products and medical research, initially for treating severe bleeding associated with heavy menstrual blood loss, but more recently for skin redness and inflammation. While it has been widely used for years in surgical and emergency medicine for its antifibrinolytic properties (i.e., it helps stop excessive bleeding), in dermatology, tranexamic acid may offer hope for one of the most challenging skin concerns of all, rosacea (1, 2).

If you’ve been struggling with persistent facial redness, visible blood vessels, and inflammation that aren’t responding to your usual treatments, you may want to learn more about tranexamic acid. Here, we’ll review what it is, how it works, the research behind it for rosacea, and what you need to know about its safety.

What Is Tranexamic Acid?

Tranexamic acid is a synthetic derivative of the amino acid lysine. It was first used as an antifibrinolytic agent, which means that it’s approved by the FDA to prevent blood clots from dissolving too quickly. This has made it an important tool in surgeries and emergency situations to prevent excessive bleeding, and it is listed on the World Health Organization’s List of Essential Medicines (4).

But in dermatology, tranexamic acid first began to attract attention for its effects on skin pigmentation, in particular for treating melasma. Researchers soon realized, however, that its anti-inflammatory and anti-angiogenic effects (i.e., its ability to reduce inflammation and formation of new blood vessels) might make it effective against rosacea as well. In recent years there has been a significant amount of research investigating the use of tranexamic acid for reducing redness, flushing, and skin barrier disruption in rosacea (1, 2).

Tranexamic acid can be used orally, topically, or via injection. Each method of use has different efficacy and safety considerations, which we’ll discuss below.

How Does Tranexamic Acid Work for Rosacea?

One of the reasons researchers suspect that tranexamic acid may be useful against rosacea is that it appears to targets the condition through several interconnected pathways. Here is what the research has found so far (1, 2):

Reducing inflammation: Rosacea is an inflammatory disease, and much of the damage it causes to skin comes from the inflammation that it triggers. In one mouse study examining rosacea, researchers found that tranexamic acid decreased production of several different pro-inflammatory chemicals (IL-6 and TNF-alpha), as well as an enzyme (MMP9) that contributes to inflammation. They also found that tranexamic acid regulated the presence of immune cells (T cells), as well as the expression of several immune-related genes (including TLR2 and KLK5) in rosacea-like lesions. In simpler terms, it can help get rid of some of those extra blood vessels that lead to chronic facial redness (1).

Improving skin barrier function: Rosacea prone skin often has a weakened barrier, which means increased sensitivity, dryness, and transepithelial water loss. One RCT involving 70 patients found that oral tranexamic acid enhanced skin barrier function, increased skin hydration, and reduced transepithelial water loss compared to the control group, which received conventional treatment. The researchers noted that patients with dry-type rosacea saw even greater improvements in skin barrier function (3).

What Does the Research Say About Tranexamic Acid for Rosacea?

The research on tranexamic acid 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).

A split-face comparative trial of 45 female patients with erythematotelangiectatic rosacea looked at topical 10% tranexamic acid with and without microneedling. Both sides of the face responded well to the treatment, but microneedling plus tranexamic acid saw significantly better results. In terms of telangiectasia specifically, 66.6 percent of patients had good to excellent results on the microneedling-plus-TXA side of the face, while 82.2 percent of patients saw poor to no response on the TXA side. 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, it’s 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 systemically, meaning it can address inflammation and vascular changes throughout the skin rather than just at the surface. The 70-patient randomized trial used oral tranexamic acid added to standard therapy and found significant improvements in both clinical severity and skin barrier function over eight weeks (3). However, because it 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 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 TXA alone (2).

Intradermal injections are a third option, where tranexamic acid is injected directly into the affected skin by a provider. One study of six patients with erythematotelangiectatic rosacea using monthly intradermal microinjections of 5% tranexamic acid found significant reduction in clinical severity scores, with improvements maintained for at least three months after treatment ended. Only transient erythema and swelling were reported in three of the six patients (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 side effects are negligible. 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 microneedling side of the face, not the TXA-only side (5).

Oral side effects are more substantial. The most common side effects are gastrointestinal issues like nausea or bloating. 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: The number needed to harm per five days of treatment was 78,549 women, which means that the absolute risk of experiencing a blood clot is still extremely low for healthy women (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.

FAQs

How long does it take to see results from tranexamic acid for rosacea?

The 70-patient randomized trial found that after 8 weeks of receiving oral tranexamic acid in addition to standard treatment, patients had significant improvements in clinical erythema, skin hydration, and quality of life (3). Some of the topical studies found improvement as early as 2-6 weeks, though the degree of improvement ranged (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 with improvement and no notable drug interactions (3). Topical tranexamic acid is typically safe to layer with most skin care ingredients. As always, it’s always best to consult your provider to check for potential drug interactions with any medications you are taking.

Is tranexamic acid safe to use long term?

Topical tranexamic acid: No side effects have been reported in the clinical studies to date (2). Oral tranexamic acid: The longest studies have been 8 weeks with a follow-up period, and no side effects were reported (3). However, long-term 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 or ocular rosacea. Your provider can help you decide whether tranexamic acid might be a good fit for your particular 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 doxycycline at this point. 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. Head-to-head comparison studies will be needed (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/