Laser‐assisted delivery of tranexamic acid for melasma: Pilot study using a novel 1927 nm fractional thulium fiber laser

Abstract Background Melasma can be associated with immense psychosocial stress, which can impact quality of life. One theory suggests that ultraviolet light can increase plasmin activity in keratinocytes, which has led to the investigation of tranexamic acid for treating melasma, since it possesses anti‐plasmin properties. The use of laser‐assisted drug delivery can also increase the uptake of topical medications. Aims A prospective pilot study was performed to assess the utility of combination treatment with low‐energy, low‐density 1927 nm fractional thulium fiber laser and topical tranexamic acid for melasma. Patients/Methods A total of 10 subjects were enrolled. Each received 5 treatments to the full face with a low‐energy, low‐density 1927 nm fractional thulium fiber laser. Immediately following treatment, topical tranexamic acid was applied, and subjects were instructed to apply it twice daily for 7 days. Clinical measures, quality of life, and patient satisfaction were assessed. Results Mean improvements in Melasma Area and Severity Index (MASI) scores were 1.1 ( P = .0899), 3.5 ( P = .0395), and 2.5 ( P = .2429) at 30‐, 90‐, and 180‐day follow‐up, respectively. Maximum improvement occurred at 90‐day follow‐up. The mean improvement of Melasma Quality of Life Scale (MELASQOL) score was 9.6 ( P = .0024) at 30‐day follow‐up. In addition to changes in pigmentation, subjects also believed their skin felt better, looked more radiant, and had improvements in skin texture and tone. Conclusion Combination of low‐energy, low‐density 1927 nm fractional thulium fiber laser and topical tranexamic acid improved clinical outcomes and quality of life associated with melasma. This combination treatment was safe, well‐tolerated, and well‐liked by subjects.