Q-Switched 1064 nm Fractional Laser with Intradermal Tranexamic Acid for Melasma: A Retrospective Propensity Score-Matched Study.

Purpose: To evaluate the efficacy and safety of Q-switched 1064 nm fractional laser combined with intradermal tranexamic acid (TXA) injection in the treatment of melasma. Patients and Methods: This retrospective study initially reviewed 161 female patients with melasma who received laser therapy alone (group A), intradermal TXA injection alone (group B), and combination therapy (group C). After eligibility screening and 1:1:1 propensity score matching, 90 patients were included in the final matched analysis, with 30 patients in each group. Clinical outcomes were assessed using the Melasma Area and Severity Index (MASI), VISIA-derived ultraviolet and brown spot indices, and patient satisfaction. Adverse events and recurrence at 6 months were also evaluated. Results: All groups demonstrated significant improvements in MASI scores and VISIA parameters (all P < 0.001). The combination group achieved significantly greater reductions in MASI scores and pigmentation indices compared with the other groups (all P < 0.001), along with a higher likelihood of patient satisfaction (OR = 3.82, 95% CI: 1.15-12.69, P = 0.028). Recurrence rates at 6 months were not significantly different among groups (P = 0.31), although numerically lower in the combination group. All treatments were well tolerated, with only mild and transient adverse events. Conclusion: Q-switched 1064 nm fractional laser combined with intradermal TXA injection was associated with greater clinical improvement and higher patient satisfaction compared with monotherapies.