Behrangi E, Shemshadi M, Ghassemi M, et al. - For Middle Eastern patients suffering melasma disorder, combining Nd-Yag fractional 1,064 with microinjection of tranexamic acid or with oral tranexamic acid affords a viable treatment option. Tranexamic acid seems to be an effective as well as safe choice for melasma, regardless of its route of administration. This drug not only can increase the permeability locally via non-invasive methods such as microneedling which is less painful vs microinjection but also can increase patient satisfaction.

• A prospective, randomized study of 40 patients with melasma, for comparing the efficacy of Nd-Yag fractional 1,064 plus microinjection of tranexamic acid vs Nd-Yag fractional 1,064 plus oral tranexamic acid in these patients.

• Analysis involved 21 patients treated with oral tranexamic acid, and 20 patients treated with microinjection of tranexamic acid.

• Over the study span, significant reduction in patients MASI score and ∆E was evident in both treatment arms.

• No significant difference in patient's MASI score and ∆E was observed between the two groups over the time.

• No significant difference in satisfaction and complication was found between two groups.

• Despite a greater tolerability of the oral method, it could induce systemic side effects, and its combination with Q-switch laser increases its impact irrespective of the type of prescription.

• Hence, it is advised to employ this drug topically (cream or lotion) via non-invasive methods like microneedling to decrease pain and laser treatment in future studies.