Efficacy of Non-Ablative Fractional Laser Combined With Tranexamic Acid in Melasma Treatment: A Randomized Split-Face Trial.

INTRODUCTION

The non-ablative fractionated erbium glass laser (NAFL) 1540 nm combined with topical tranexamic acid (TXA) is a novel therapeutic approach for melasma. However, the efficacy and safety of this combination remain controversial. This study aims to evaluate the effectiveness and safety of NAFL combined with TXA in treating melasma.

METHODS

A randomized controlled trial with a split-face design was conducted on 27 participants with symmetric melasma. All participants applied 5% TXA topically twice daily to their entire face. One side of the face underwent three NAFL sessions combined with TXA at 4-week intervals, while the opposite side, treated with TXA alone, served as the control. Outcomes were assessed using the modified melasma area and severity index (m-MASI), physician global assessment (PGA), and participant satisfaction at the end of treatment, and at one and 3 months after the final laser session.

RESULTS

Both facial sides showed significant m-MASI score improvement at the end of treatment (p < 0.001); however, a significant recurrence was noted in both groups during follow-up. The reduction in m-MASI scores was significantly greater for the NAFL plus TXA group than for TXA alone at the end of treatment (p = 0.029). However, no significant difference was observed between the groups at the 1- and 3-month follow-ups (p = 0.33 and 0.31, respectively). NAFL plus TXA led to significantly better PGA scores at Week 12 (p < 0.001), but this improvement was not sustained during follow-up (p = 0.06 and 0.07, respectively). Participant satisfaction was consistently higher in the NAFL plus TXA group (p = 0.001).

CONCLUSIONS

The combination of NAFL and topical TXA provides significant short-term clinical benefits in treating melasma, likely by enhancing TXA penetration into target tissues and improving pigmentary clearance. However, its efficacy diminishes over time due to the inevitable recurrence of melasma, necessitating further investigation into long-term maintenance strategies.