Melasma is a tan or dark skin discoloration of face. Melasma is thought to be caused by sun exposure, genetic predisposition, hormone changes, and skin irritation. Although it can affect anyone, it is particularly common in women, especially pregnant women and those who are taking contraceptives or hormone replacement therapy medications.

Melasma cannot be resolved with laser treatment for a certain period of time, as it is a disease in which pigment is continuously produced. Tranxenemic acid helps to improve to reduce the pigmentation.

In some countries (e.g. Japan, Korea), oral tranexamic acid is available over the counter and is effective. The melasma cream with tranexamic acid and azelaic acid may be partially helpful.
Hydroquinone may be used topically for the treatment of hyperpigmentation, but the FDA halted the OTC products containing hydroquinone as of 2020.
#Tranexamic acid [TRANSINO]

#Laser toning technique (low fluence QS1064 laser)
  • It is a common condition observed in Asian women in their early 40s. The circled lesion in the photo is closer to lentigo rather than melasma.
    References Efficacy and Safety of Tranexamic Acid in Melasma: A Meta-analysis and Systematic Review 28374042
    Tranexamic acid is a new option for treating melasma. When only tranexamic acid was used, there was an average decrease of 1.60 in the Melasma Area and Severity Index (MASI) after treatment. Adding tranexamic acid to regular treatments resulted in a further decrease of 0.94 in MASI. These findings support that tranexamic acid is effective and safe, either on its own or alongside regular treatments for melasma.
     The Low-Fluence Q-Switched Nd:YAG Laser Treatment for Melasma: A Systematic Review 35888655 
    Recently, the low-fluence Q-switched Nd:YAG laser (LFQSNY) has been widely used for treating melasma, especially in Asia. It was hard to summarize the heterogenous studies, but LFQSNY appeared to be a generally effective and safe treatment for melasma considering the results of previous conventional therapies. However, mottled hypopigmentation has been occasionally reported to develop and persist as an adverse event of LFQSNY, which may be associated with the high accumulated laser energy. When used aggressively, even LFQSNY can induce hyperpigmentation via unwanted inflammation, especially in darker skin.
     Pigmentation Disorders: Diagnosis and Management 29431372
    Pigmentation problems are often found in primary care. Common types of hyperpigmentation disorders include post-inflammatory hyperpigmentation, melasma, sunspots, freckles, café au lait spots.