Efficacy of Tranexamic Acid Injection Combined with 1064 nm Nd:YAG Picosecond Laser for Melasma

ZENG Jingxin; LI Dongni; WEN Ju; LI Yueming; WU Yiling; HE Shiqi; LIN Ling

doi:10.11786/sypfbxzz.1674-1293.202605

Abstract：Objective To evaluate the efficacy and safety of intralesional tranexamic acid injection combined with 1064 nm Nd:YAG picosecond laser in the treatment of melasma.Methods Between January and March 2025,92 patients with melasma at the Guangzhou Dermatology Hospital were randomized(random-number table)into two equal groups.The control group(n=46)received 1064 nm Nd:YAG picosecond laser treatment,while the combination group(n=46)received the same laser protocol plus intradermal tranexamic acid injections.Treatments were performed once every 4 weeks for four sessions.We compared the two groups on Melasma Area Severity Index(MASI)scores,absolute VISIA measurements for facial brown and ultraviolet(UV)spots,clinical effective rates,incidence of adverse events,and recurrence.Results Compared with baseline,the combination group showed significant reductions in MASI scores and absolute VISIA brown-spot and UV-spot values at weeks 4,8,12,and 16 after treatment(P<0.05).The control group showed significant reductions in these measures at weeks 8,12,and 16(P<0.05).Between-group comparisons demonstrated that at weeks 4,8,12,and 16,the combination group had lower MASI scores and lower absolute UVspot values than the control group(P<0.05).For brown-spot absolute values,the combination group was significantly lower than the control group at weeks 8,12,and 16(P<0.05).Clinical efficacy(total effective rate)in the combination group at weeks 4,8,12,and 16 was 43.48%,78.26%,93.48%,and 100.00%,respectively;the control group rates at the same time points were 10.87%,34.78%,73.91%,and 82.61%,respectively.The combination group's total effective rate was significantly higher than the control group's at each corresponding time point(P<0.05).During treatment,4 patients(8.70%)in the control group developed transient,mild hyperpigmentation;no cases of hyperpigmentation occurred in the combination group.At 3-month follow-up,3 patients(6.53%)in the control group experienced recurrence at the original sites,whereas no recurrences(0.00%)were observed in the combination group.Conclusion Intradermal tranexamic acid combined with 1064 nm Nd:YAG picosecond laser provides reliable and fast-acting therapeutic benefit for melasma,with a favorable safety profile and low recurrence.This combined approach is superior to treatment with 1064 nm Nd:YAG picosecond laser alone.