Oral tranexamic acid combined with low fluence 1064 nm Q-switched Nd: YAG laser is an effective and safe melasma treatment, with outcomes that are better than oral tranexamic acid alone, according to a study published January 7, 2020 in the Journal of Dermatological Treatment.
Studies suggest that tranexamic acid, a trans-4-(aminomethyl) cyclohexane carboxylic acid, modulates melasma’s vascular component and inhibits melanin synthesis. The high-intensity beam and short pulses from the Q-switched Nd: YAG 1064 nm laser target melanin in melanocytes, keratinocytes or dermal melanophages, removing brown dyschromia and red vascularity, according to the authors.
“Though there are many lines of melasma treatment, in the absence of any ‘gold standard,’ it still remains a challenge for dermatologists,” the authors write.
To compare tranexamic acid oral monotherapy with oral tranexamic acid and laser treatment for melasma, researchers in Greece and Egypt studied 60 female melasma patients. Thirty women (group A) received 250 mg daily of oral tranexamic acid for three months, while 30 women (group B) received the oral treatment along with Q-switched Nd: YAG 1064 nm laser treatments every two weeks for three months, unless they improved before three months. Researchers kept the energy level for laser treatment to a minimum of 2 J/cm2 to avoid side effects.
The researchers found that Modified Melasma Area and Severity Index (mMASI) improved significantly compared to baseline in both groups, but group B’s response was notably higher than that of group A. Eighteen, or 60%, of the patients in group B achieved melasma clearance before completing three months of laser treatments.
The authors report no conflicts of interest.
Agamia N, Apalla Z, Salem W, Abdallah W. A comparative study between oral tranexamic acid versus oral tranexamic acid and Q-switched Nd-YAG laser in melasma treatment: a clinical and dermoscopic evaluation. J Dermatolog Treat. 2020 Jan 7:1-8. doi: 10.1080/09546634.2019.1708847.