Q-Switched 1064 nm Fractional Laser with Intradermal Tranexamic Acid for Melasma: A Retrospective Propensity Score–Matched Study

Purpose: To evaluate the efficacy and safety of Q-switched 1064 nm fractional laser combined with intradermal tranexamic acid (TXA) injection in the treatment of melasma. Patients and Methods: This retrospective study initially reviewed 161 female patients with melasma who received laser therapy alone (group A), intradermal TXA injection alone (group B), and combination therapy (group C). After eligibility screening and 1:1:1 propensity score matching, 90 patients were included in the final matched analysis, with 30 patients in each group. Clinical outcomes were assessed using the Melasma Area and Severity Index (MASI), VISIA-derived ultraviolet and brown spot indices, and patient satisfaction. Adverse events and recurrence at 6 months were also evaluated. Results: All groups demonstrated significant improvements in MASI scores and VISIA parameters (all P < 0.001). The combination group achieved significantly greater reductions in MASI scores and pigmentation indices compared with the other groups (all P < 0.001), along with a higher likelihood of patient satisfaction (OR = 3.82, 95% CI: 1.15– 12.69, P = 0.028). Recurrence rates at 6 months were not significantly different among groups (P = 0.31), although numerically lower in the combination group. All treatments were well tolerated, with only mild and transient adverse events. Conclusion: Q-switched 1064 nm fractional laser combined with intradermal TXA injection was associated with greater clinical improvement and higher patient satisfaction compared with monotherapies. Plain Language Summary: Melasma is a common skin condition that causes dark patches on the face. It can be difficult to treat, and the condition often returns after therapy. Many patients do not achieve satisfactory results with a single treatment, so better approaches are needed. In this study, we examined whether combining two treatments could improve outcomes. We reviewed the records of 161 women with melasma who received one of three treatments: laser therapy, small injections of tranexamic acid (a medication that reduces pigment formation), or a combination of both. After eligibility screening and statistical matching, 90 women were included in the final analysis. We assessed changes in skin pigmentation using clinical scoring, imaging analysis, and patient-reported satisfaction. All treatments led to visible improvement. However, the combination treatment produced greater reductions in pigmentation and higher patient satisfaction than either treatment alone. The treatments were well tolerated, with only mild and temporary side effects. While melasma can recur, we did not observe a significant difference in recurrence rates between groups over six months, although the combination group showed a trend toward lower recurrence. These results suggest that combining laser therapy with tranexamic acid injections may provide a more effective option for managing melasma, with good safety and improved patient outcomes.