Oral Tranexamic Acid Enhances the Efficacy of Low-Fluence 1064-Nm Quality-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser Treatment for Melasma in Koreans: A Randomized, Prospective Trial

BACKGROUND: Tranexamic acid (TA) has recently gained in popularity in the treatment of pigmentary disorders. OBJECTIVE: To evaluate the clinical efficacy and safety of oral TA combined with low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet (QSNY) laser for the treatment of melasma. MATERIALS AND METHODS: Forty-eight patients with melasma were enrolled in the study and subsequently divided into two groups: a combination group and a laser treatment group. All patients were treated with two sessions of low-fluence QSNY laser, and patients in the combination group took 8 weeks of oral TA. Two blinded dermatologists evaluated patients using the Modified Melasma Area and Severity Index (mMASI) and a clinical improvement scale. RESULTS: Mean mMASI score 4 weeks after the second treatment decreased significantly in both groups from base line. Based on overall clinical improvement, a greater number of patients scored as grade 3 and more in the combination group; no patients were scored as grade 4 in the laser-alone group. CONCLUSIONS: Oral TA may prove a safe and efficient treatment option for melasma in combination with low-fluence QSNY laser therapy.