Despite numerous treatment options, treating melasma remains challenging. A study investigated the efficacy and safety of combined treatment with a quality (Q)-switched 1064-nm neodymium: yttrium-aluminium-garnet (Nd: YAG) laser and a topical mixture of tranexamic acid, niacinamide, and kojic acid, for melasma. 

It enrolled 25 patients with melasma, who were treated on one side of the face with low-fluence Q-switched 1064-nm Nd: YAG laser alone, and another side with a combination of laser treatment and a topical mixture of tranexamic acid, niacinamide, and kojic acid. 

Five sessions at 2-week intervals were given to the patients, who were then followed up for 4 weeks. The hemi Melasma Area and Severity Index (MASI) score were utilized to assess overall improvement. Images of the patients faces were recorded with a specialized imaging system which was evaluated by two independent evaluators at 2, 4, 6, 8, and 12 weeks using a five-point grading scale. 

The following observations were made-

• Clinical improvement was observed at both sides of the face.
• Combination treatment improved the mean hemi MASI score more than the laser treatment alone.
• The photographic evaluation showed a greater improvement in melasma at 12 weeks, with combination treatment. 

Thus, the combination of treatment with a low-fluence Q-switched 1064-nm Nd: YAG laser and a topical mixture of tranexamic acid, niacinamide, and kojic acid is a good alternative for melasma treatment. 

Source- Park SJ, Park JW, Seo SJ, Park KY. Evaluating the Tolerance and Efficacy of Laser-Assisted Delivery of Tranexamic Acid, Niacinamide, and Kojic Acid for Melasma: A Single Center, Prospective, Split-face Trial. Dermatol Ther. 2021 Dec 27:e15287. doi: 10.1111/dth.15287. Epub ahead of print. PMID: 34962047.