Oral tranexamic acid, hydroquinone 4% and low-fluence 1064 nm Q-switched Nd:YAG laser for mixed melasma: Clinical and dermoscopic evaluation.

Abstract

Tranexamic acid (TA) can prevent melanocyte activation by various stimuli. Combining TA with either hydroquinone 4% or Q-switched Nd:YAG laser may be associated with greater improvement of melasma. We aimed to evaluate the efficacy and safety of oral TA alone and combined with either topical hydroquinone 4% or low-fluence 1064nm Q-switched Nd:YAG laser in treatment of mixed melasma. Patients were randomly divided into three groups of 20 patients each. Group A were treated with oral TA 250mg twice daily for three months; group B were treated with TA similarly combined with topical hydroquinone 4% cream; group C were treated with TA combined with two sessions of 1064nm low-fluence Q-switched ND:YAG laser (850-1200mJ/cm2 , 4-5Hz,spot size 4mm) spaced 4weeks apart. Patients were followed monthly for 9months. After cessation of therapy, the mean mMASI score was lowest in group B (2.34±2.37) followed by groups A (6.38±4.04) and C (7.24±4.95).Mean percentage of mMASI score improvement was 35.91±24.13, 77.47±19.07, and 24.94±27.79 in groups A, B, and C (p<0.001). There was a significant reduction of telangiectasia in the three groups. Reported side effects were itching & irritation, post-inflammatory hyperpigmentation, and gastritis. Oral TA is a tolerable effective treatment modality for melasma. Combining hydroquinone 4% with oral TA is associated with a relatively earlier and better cosmetic outcome.