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This drug is widely used as an antifibrinolytic agent and has been found to inhibit plasminogenkeratinocyte interaction leading to decrease in activity of tyrosinase, thereby resulting in decreased synthesis of melanin from the melanocytes.[] Human keratinocytes secrete the urokinase-type plasminogen activator, which increases the activity of melanocytes leading to increased synthesis of melanin and the blockade of this effect may be the mechanism behind therapeutic effect of TA for the treatment of melasma.[] Glutathione is an anti-oxidant tri-peptide, which is normally present in humans and has also been tried successfully as a treatment modality for melasma

Suryakumar Narayanasamy of the Childrens Hospital of Cincinnati who is an expert on gastric ultrasound to assist

Cao WB, Harnett KM, Chen Q, Jain MK, Behar J, Biancani P

He was instructed to have nothing by mouth for 8 hr