Balance

Azelaic acid

A topical acid approved on its own for acne and for the inflammatory lesions of rosacea.

Not for

• Anyone who has reacted to azelaic acid before.

Common effects

• Burning, stinging or tingling when applied.
• Dryness, scaling, itching and redness.

Serious effects

• Lightening of the skin, which may be more noticeable and less wanted on darker skin.
• Worsening of asthma has been reported.

Get medical help if

• Wheezing or shortness of breath.
• Swelling of the lips, tongue or face.

Tell your provider

• If you have asthma.
• If your skin lightens unevenly where you apply it.

Sources

1. Azelaic acid topical prescribing information. US Food and Drug Administration. FDA-approved labeling

Tranexamic acid

A drug approved orally for heavy menstrual bleeding. Its use for skin pigmentation, oral or topical, is off-label and not FDA-approved.

Tranexamic acid is not FDA-approved for melasma or any skin indication. Using it this way is off-label, which a provider may do and should explain.

Not for

• Anyone with active clotting disease, or a history of blood clots, without discussing it with the prescriber.

Common effects

• Irritation where applied.

Serious effects

• The oral drug's concern is clotting. Systemic absorption from a compounded topical has not been characterized.

Get medical help if

• Chest pain, shortness of breath, or pain and swelling in one leg.
• Sudden vision change.

Tell your provider

• Any personal or family history of blood clots.
• Any hormonal contraception you take, which also affects clotting risk.

Sources

1. Tranexamic acid prescribing information. US Food and Drug Administration. FDA-approved labeling