Adding Oral Tranexamic Acid to Traditional Therapies Led to Rapid Improvements in Papulopustular Rosacea

The addition of oral tranexamic acid to traditional therapies led to marked and rapid improvements in patients with papulopustular rosacea, according to a study published in the Journal of Cosmetic Dermatology.¹

Furthermore, assessments and scores for factors such as erythema, dryness, aesthetic improvement, and patient quality of life, were significantly improved in individuals receiving tranexamic acid in combination with another therapy versus traditional therapy alone.

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Background and Methods

Researchers Xu et al noted that while doxycycline is the only antibiotic therapy approved by the US Food and Drug Administration for rosacea, its efficacy has been deemed unsatisfactory. They noted that rosacea development involves immune abnormalities, and the effects of tranexamic acid involve immune regulatory effects, indicative of its benefits and potential in this therapeutic area.²

The randomized, prospective, single-center, controlled study took place at a single study center from April to August 2023. Out of 158 screened volunteer patients with rosacea, 82 met the inclusion criteria and were enrolled.

Participants aged 18-60 with persistent erythema and papule/pustular rosacea per the 2021 Chinese Diagnostic Criteria, among other health and compliance requirements, were included for participation. Exclusion criteria included pregnancy, allergies to study drugs, serious systemic diseases, and poor compliance.

After 12 patients dropped out, 70 participants were randomized into 2 treatment groups: the tranexamic acid group (35 participants) received oral tranexamic acid 250 mg twice daily, doxycycline 50 mg once daily, and hyaluronic acid lotion for 8 weeks. The traditional treatment group (35 participants) received oral doxycycline 40 mg once daily and the same hyaluronic acid lotion regimen.

Baseline evaluations and follow-ups at weeks 0, 2, 4, 8, and 12 included clinical erythema assessment (CEA), investigator's global assessment (IGA), patient self-assessment (PSA) score, rosacea-specific quality of life (RQoL) score, and global aesthetic improvement score (GAIS), and clinical photographs. Participants were restricted from using other skin care products or treatments.

Findings

The tranexamic acid group demonstrated significantly greater and faster improvements in CEA and IGA scores compared to the traditional treatment group.

By weeks 8 and 12, significant proportions in the tranexamic acid group showed at least a 2-point decrease in CEA (85.29% and 79.41% respectively) and a 1-point decrease in IGA (76.47% and 70.59% respectively), compared to the traditional treatment group. Skin hydration and transepidermal water loss levels improved significantly in the tranexamic acid group after 2 weeks, reaching levels comparable to the traditional group by weeks 8 and 12.

At week 8, the tranexamic acid group showed significant reductions in dryness scores and improvements in PSA and GAIS. However, differences in itching and burning sensation scores were not statistically significant. By week 12, RQoL scores improved significantly in the tranexamic acid group.

Additionally, improvements in skin barrier function correlated strongly with reductions in CEA grade in the tranexamic acid group, and treatment was more effective for patients with dry skin compared to those with oily skin.

Conclusions

Potential limitations of the study, as noted by researchers, include its single-center design, open-label nature, and limited sample size, among others. In addition, focusing exclusively on East Asian patient populations may limit the representativeness of the study's findings.

"Despite the use of topical hyaluronic acid to strengthen the skin barrier, patients in the traditional treatment group still experienced high levels of dryness and itchiness, whereas the [tranexamic acid] TXA group showed significant improvements in the itchiness and dryness scores and improved skin barrier status, resulting in a better quality of life, without significant adverse reactions," according to Xu et al. "In addition, the global aesthetic scores at 8 and 12 weeks were lower in the TXA group than in the traditional treatment group. TXA can reduce melanin production by inhibiting tyrosinase, which may be in line with East Asian aesthetics, which general favor fair skin."

Furthermore, they noted that these findings are suggestive of tranexamic acid's potential to have more targeted effects in the mechanisms of dry skin rosacea. These results are indicative of the need for different, more tailored treatment approaches for varying types of rosacea.

References

1. Xu Z, Yu B, Xu B, et al. Oral tranexamic acid treats papulopustular rosacea by improving the skin barrier. J Cosmet Dermatol. May 7, 2024. doi:10.1111/jocd.16339
2. Li Y, Xie H, Deng Z, et al. Tranexamic acid ameliorates rosacea symptoms through regulating immune response and angiogenesis. Int Immunopharmacol. 2019; 67: 326-334.