Abstract：
Purpose: This study aimed to evaluate the efficacy of tranexamic acid (TXA) in treating melasma through a meta-analysis and systematic review of randomized controlled trials (RCTs). The study focused on identifying associated adverse effects and comparing TXA\'s effectiveness with other melasma treatments.Materials and methods: Following PROSPERO and PRISMA guidelines, an extensive electronic search was conducted across four databases for RCTs on TXA use in melasma. Inclusion criteria encompassed full-text English articles with specific outcome measures, while studies with high bias risk or non-English publications were excluded. Data were extracted from 22 relevant studies and analyzed using the RevMan software, with heterogeneity identified using I² statistics and forest plots.Results: A total of 22 studies with 1280 patients were included. TXA was administered orally, topically, or via injection, with treatment durations ranging from 8 weeks to nearly 2 years. TXA significantly reduced melasma severity, evidenced by reductions in MASI, mMASI, MI, and hemi-MASI scores. Oral TXA showed the most substantial decrease in MASI scores, followed by injections and topical applications. However, studies exhibited high heterogeneity, particularly in combined treatments. Adverse effects included gastrointestinal discomfort, skin irritation, and menstrual irregularities.Conclusions: TXA is effective in treating melasma, either alone or combined with other treatments. Despite significant reductions in melasma severity, further research is necessary to standardize TXA administration methods and address long-term effects. The high heterogeneity observed suggests a need for more consistent treatment protocols.
摘要：
目的：本研究旨在通过荟萃分析和系统评价随机对照试验（RCTs）评估氨甲环酸（TXA）治疗黄褐斑的疗效。该研究的重点是确定相关的不良反应，并比较TXA与其他黄褐斑治疗的有效性。材料和方法：遵循PROSPERO和PRISMA指南，在四个数据库中进行了广泛的电子搜索，以了解黄褐斑中TXA的使用情况。纳入标准包括带有具体结果衡量标准的全文英文文章，而具有高偏倚风险或非英语出版物的研究被排除。从22项相关研究中提取数据，并使用RevMan软件进行分析，具有使用I²统计数据和森林地块识别的异质性。结果：共纳入22项研究，共1280例患者。TXA口服给药，局部，或者通过注射，治疗持续时间从8周到近2年不等。TXA显着降低黄褐斑的严重程度，MASI的减少证明了这一点，mMASI,MI,和hemi-MASI得分.口腔TXA显示MASI评分下降幅度最大，其次是注射和局部应用。然而,研究表现出高度异质性，特别是在联合治疗中。副作用包括胃肠道不适，皮肤刺激,月经不调。结论:TXA治疗黄褐斑疗效确切,单独或与其他治疗相结合。尽管黄褐斑严重程度显著降低，需要进一步的研究来规范TXA给药方法并解决长期效应。观察到的高度异质性表明需要更一致的治疗方案。
