Hydroquinone has been the gold standard for hyperpigmentation for decades — but its risk of paradoxical hyperpigmentation in darker skin tones makes it a double-edged sword for Indian patients.
Tranexamic acid blocks the interaction between keratinocytes and melanocytes without the ochronosis risk that accompanies prolonged hydroquinone use. In the 16-week RCT, TA at 3% achieved 87% of the MASI reduction seen with HQ at 4%, with 3× lower incidence of PIH.
TA is ideally used twice daily with mandatory SPF 50+ in the AM. Combining with a retinoid (adapalene 0.1% PM) accelerates keratinocyte turnover and enhances depigmentation. Results are visible at 8 weeks; full effect at 16–20 weeks.
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