Rahimnia Amirhossein, Hosnian Motahareh, Ehsani Amir Houshang, Nourmohammadpour Pedram, Shadlou Zahra, Koohian Mohammadabadi Mina, Ehsani Ala
Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
J Cosmet Dermatol. 2025 Aug;24(8):e70384. doi: 10.1111/jocd.70384.
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.
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.
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).
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.
非剥脱性铒玻璃激光（NAFL）1540nm联合外用氨甲环酸（TXA）是治疗黄褐斑的一种新方法。然而，这种联合治疗的疗效和安全性仍存在争议。本研究旨在评估NAFL联合TXA治疗黄褐斑的有效性和安全性。
对27例对称性黄褐斑患者进行了一项采用半脸设计的随机对照试验。所有参与者每天两次在全脸外用5%TXA。面部一侧每隔4周接受3次NAFL联合TXA治疗，而另一侧仅用TXA治疗作为对照。在治疗结束时、最后一次激光治疗后1个月和3个月，使用改良的黄褐斑面积和严重程度指数（m-MASI）、医生整体评估（PGA）以及参与者满意度来评估结果。
治疗结束时，面部两侧的m-MASI评分均有显著改善（p<0.001）；然而，两组在随访期间均出现了显著复发。治疗结束时，NAFL加TXA组的m-MASI评分降低幅度显著大于单用TXA组（p=0.029）。然而，在1个月和3个月随访时，两组之间未观察到显著差异（分别为p=0.33和0.31）。NAFL加TXA在第12周时导致显著更好的PGA评分（p<0.001），但这种改善在随访期间未持续（分别为p=0.06和0.07）。NAFL加TXA组的参与者满意度一直较高（p=0.001）。
NAFL与外用TXA联合在治疗黄褐斑方面提供了显著的短期临床益处，可能是通过增强TXA渗透到靶组织并改善色素清除。然而，由于黄褐斑不可避免的复发，其疗效会随着时间而降低，需要进一步研究长期维持策略。
