Journal Article

Safety and efficacy of a picosecond 755‐nm alexandrite laser combined with topical tranexamic acid in the treatment of melasma

Yi, Zhen, Zhou, Na, Tao, Jingjing, Yang, Bin, Liu, Zhenfeng, Wu, Linshan

2024

Overview

Background The picosecond 755‐nm alexandrite laser and topical tranexamic acid (TA) have shown promise in treating melasma. Aim This aim of this study was to evaluate the efficacy and safety of combining to a picosecond 755‐nm alexandrite laser combined with topical TA for melasma treatment. Patients and Methods Forty‐eight patients’ facial halves with bilateral symmetrical melasma were randomized to receive either topical TA and picosecond laser treatment or laser monotherapy. All patients received three consecutive picosecond laser treatment sessions at 4‐week intervals, and additional one side facial received topical TA treatment twice daily until 4 weeks after the third treatments. Efficacy was assessed using the Modified Melasma Area and Severity Index (mMASI) score, VISIA (Canfield, USA) red area feature counts, and average pore volume as measured by Antera 3D®. Patient satisfaction was evaluated through questionnaires. Results Thirty‐five patients completed the study. Post‐treatment, mMASI scores and VISIA red area feature counts were lower in combination therapy halves and laser monotherapy halves, and average melanin level was lower in the combination therapy halves (p < 0.05). Comparisons between the combination therapy halves and laser monotherapy halves after the third treatment revealed significant differences in mMASI scores, melanin levels, and VISIA red area feature counts (p < 0.05). After treatment, patient satisfaction rates in the combination therapy halves and monotherapy halves was 71.4% and 54.3%, respectively (p < 0.05). No obvious adverse effects were observed in the combination therapy halves; whereas, 10.42% (5/48) of participants in the laser monotherapy halves experienced temporary pigmentation, which resolved within 3 months. Conclusion The picosecond 755‐nm alexandrite laser, when used independently and in combination with topical TA, has been proven to be effective in the improvement of melasma. However, the combined treatment approach showed a more pronounced improvement in melasma symptoms, with higher patient satisfaction, and was associated with a lower incidence of adverse effects. These findings strongly support that integrating topical TA with picosecond laser therapy as a superior therapeutic strategy for melasma management. Clinical Trial Registration Chinese Clinical Trial Registry: ChiCTR2200057771.

• Subject: Administration, Cutaneous / Adult / Antifibrinolytic Agents - administration & dosage / Antifibrinolytic Agents - adverse effects / Antifibrinolytic Agents - therapeutic use / Combined Modality Therapy - adverse effects / Combined Modality Therapy - methods / Female / Humans / Lasers, Solid-State - adverse effects / Lasers, Solid-State - therapeutic use / Low-Level Light Therapy - adverse effects / Low-Level Light Therapy - instrumentation / Low-Level Light Therapy - methods / Male / melanin / Melanosis - drug therapy / Melanosis - therapy / melasma / Middle Aged / mMASI score / Patient Satisfaction / picosecond 755‐nm alexandrite laser / Severity of Illness Index / topical tranexamic acid / Tranexamic Acid - administration & dosage / Tranexamic Acid - adverse effects / Treatment Outcome