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Further, it upregulates multiple growth receptors in the body and stimulates the production of fibroblasts, vital to the synthesis of collagen

Since then, several clinical studies have shown its safe and effective use - but the pharmacuetical companies have decided not to (yet) pursue FDA-Approval (likely because each new FDA-Approval costs several million dollars to go through the process, and because there are a good deal of drugs used off-label in the way tranexamic acid is for melasma, especially when the drug has a long history of safety and efficacy, as is in this case)

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This suggests a very good safety and tolerability profile indistinguishable from placebo in those trial settings