Melasma is an acquired refractory pigmentary disorder that predominantly affects females. This investigation aims to assess the efficacy of a low-power fractional CO₂ laser combined with tranexamic acid (TXA) for melasma topical treatment with MASI and dermoscopy.

 A randomized comparative split-face study was performed. Each treatment interval was 3 weeks with four times in total. At the same time, tranexamic acid solution was applied twice a day. Assessments were made by the MASI score of the melasma area severity index, and the dermoscopy performance was collected and analyzed.

After treatments, the patient melasma area severity index score was decreased significantly. When compared with the baseline, the MASI score was significantly lower than that of control group and the decrease ratio was higher than that of controls. Dermoscopy examination results verified that all lesions performed reticuloglobular pattern, granular, or punctate, with no structural pigmentation and obvious capillary dilation. After comprehensive treatments, the pigmentation area displayed lighter chroma, the follicle pore uniformity was completely improved, and the capillary dilation was significantly reduced.

It was observed that when Low-power fractional CO2 laser combined with topical tranexamic acid solution it is a comparatively effective and safe method for melasma treatment. As tranexamic acid could reduce the dilation of blood vessels.

Source: J Cosmet Dermatol, 2021 Apr;20(4):1110-1116.