Combination of Oral Tranexamic Acid and Glycolic Acid 50% Peel Vs. Oral Tranexamic Acid in the Treatment of Melasma

Background and Objectives: Melasma remains a challenging condition due to the limited efficacy of current treatments. This study aimed to compare the effectiveness and safety of combining oral Tranexamic acid (TXA) with a 50% Glycolic acid peel versus oral TXA alone. Methods: A comparative clinical trial was conducted in Sulaimani, Iraq, from January to July 2024, enrolling 40 melasma patients randomly assigned to two groups: Group A (oral TXA + 50% Glycolic acid peel) and Group B (oral TXA alone). Follow-up assessments, including modified Melasma Area and Severity Index (mMASI) scores, were performed every four weeks to evaluate treatment efficacy. Results: The average patient age was 35.97 ± 4.88 years (range: 25–45), with 92.5% (n=37) female and 70.0% (n=28) having a family history of melasma. Fitzpatrick skin type IV was most common (55.0%, n=22), followed by III (22.5%, n=9), II (17.5%, n=7), and V (5.0%, n=2). Dermal melasma was dominant (57.5%, n=23), followed by mixed (30.0%, n=12) and epidermal (12.5%, n=5). Group A (TXA + glycolic acid) showed a greater mMASI reduction (11.47 ± 5.37 to 4.43 ± 1.36, P<0.001) than TXA alone (11.19 ± 5.56 to 6.90 ± 1.94, P<0.001). Epidermal melasma responded best to combination therapy (mMASI=3.1 ± 0.99) vs. dermal (5.0 ± 1.21, P=0.05) and mixed (3.48 ± 1.07, P=0.026). Conclusion: The combination of TXA and glycolic acid peel significantly improved melasma treatment, with greater mMASI reduction than TXA alone, highlighting its enhanced efficacy.