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 8weeks 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 4weeks 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.