Topical 3% tranexamic acid enhances the efficacy of 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser in the treatment of melasma

Background: A QS-NdYAG laser (QSNYL) and topical tranexamic acid (TA) have been widely used. However, no study has yet reported the efficacy of using both QSNYL and TA as a combined treatment for melasma. Objectives: To evaluate the efficacy and adverse effects of topical 3% TA combined with 1064-nm QSNYL as a treatment for melasma. Methods: A randomized, prospective, split-face, controlled trial was conducted. A 1064-nm QSNYL was performed on the entire face at baseline and 4 weeks later. The participants were randomly selected for application of topical 3% TA on one side of the face and the vehicle treatment on the other side of the face for 8 weeks. Clinical responses were determined by mMASI scores, Mexameter™, and participants’ evaluation. Results: Twenty-five participants completed the study. At the end of the study, the mMASI score significantly decreased in the combination treatment (p < 0.05), while no significant changes were observed in the laser-alone treatment. More than 80% of the participants noticed a >50% improvement on the side with combination therapy at every follow-up visit. No serious adverse events were reported. Conclusion: Topical TA as an adjuvant demonstrated trends of better outcomes than QSNYL alone for the treatment of melasma.