Journal of Asia Pacific Aesthetic Sciences

Abstract: Melasma is a chronic, relapsing hyperpigmentation disorder with significant psychosocial impact, particularly in individuals with darker skin types. Low-fluence Q-switched Nd:YAG laser (LFQSNY) is a widely used treatment option. The adjunctive use of oral tranexamic acid (TA) has been proposed to improve outcomes. This is a case of 49-year-old Chinese woman (Fitzpatrick skin type IV) with a 10-year history of centrofacial melasma. Treatment commenced with LFQSNY (Spectra XT™, 1064 nm, 8 mm spot size, 10 Hz, fluence 0.55–0.90 J/cm², three passes per session) with a total of 18 sessions. Oral TA 250 mg OD was initiated after the eighth session due to suboptimal response and a flare following sun exposure. Clinical improvement was assessed using the modified Melasma Area and Severity Index (mMASI). At baseline, the mMASI score was 13.8. The score increased to 15.3 by the eighth session after patient had a sunburnt. Following the introduction of oral TA, progressive reduction was observed, reaching 8.7 at session 15 and 5.8 at session 18. No adverse events were reported during or after six months of TA therapy. The combination regimen demonstrated enhanced and sustained improvement compared with LFQSNY monotherapy. This case highlights the potential benefit of combining LFQSNY with oral TA for chronic melasma, achieving significant improvement. Further randomized controlled trials are warranted to validate the efficacy and safety of this multimodal approach across different melasma subtypes and patient populations.