Melasma is a chronic, relapsing hyperpigmentation disorder with significant psychosocial impact, especially in darker skin types. Low-fluence Q-switched Nd:YAG laser (LFQSNY) is widely used, and oral tranexamic acid (TA) has been proposed as a useful adjunct. This case describes a 49-year-old Chinese woman (Fitzpatrick IV) with a 10-year history of centrofacial melasma treated with LFQSNY (Spectra XT™, 1064 nm, 8 mm spot, 10 Hz, fluence 0.55–0.90 J/cm²; three passes/session) for 18 sessions. Oral TA 250 mg OD was added after the eighth session due to a sun-induced flare. Clinical changes were assessed using the modified Melasma Area and Severity Index (mMASI). The baseline score of 13.8 increased to 15.3 following sunburn. After initiating TA, progressive improvement was observed, with mMASI decreasing to 8.7 at session 15 and 5.8 at session 18. No adverse effects occurred during or after six months of TA therapy. The combination of LFQSNY and oral TA resulted in greater and more sustained improvement compared with LFQSNY alone. This case highlights the therapeutic potential of integrating oral TA into laser-based treatment for chronic, relapsing melasma. Larger randomized controlled trials are needed to confirm efficacy, safety, and generalizability across different melasma subtypes and skin types.

Dr. Loo Shi Jin (MD, MAC, Prof Diploma in Dermatology (RCPI)) is a medical doctor trained at Universiti Sains Malaysia. She currently practices at UR Klinik, Malaysia, a skin pigmentation center, where her work focuses on pigmentation management. Dr. Loo is committed to evidence-based aesthetic practice and patient-centered care. Her interest in pigmentary conditions drives her continuous learning and research involvement to improve treatment outcomes in pigmentary disorder.