A Clinical Observation of 1064-nm Q-Switched Fractional Laser Combined With Oral Tranexamic Acid on Treating of Melasma.
Condition: Melasma
MeSH terms: Melanosis
Study type: Interventional

Summary: 
      1.Melasma is a common acquired condition of symmetric hyperpigmentation, typically occurring
      on the face, with higher prevalence in females and darker skin types. Treatments for melasma
      include topical, oral, procedural, and combination treatments.

      2.1064-nm Q-Switched laser is one of the most widely used lasers for pigmented diseases in
      recent years. This wavelength laser can be effectively absorbed by pigment, which leads to
      damage of pigment and melanocyte. Previous 1064-nm Q-Switched laser treatment of melasma
      requires the use of large flare and low energy scanning repeatedly in the lesion area, and
      the terminal reaction is reddish and skin lesion temperature increased by 2℃. So the course
      of treatment is even longer and is closely related to the treatment of the doctor's
      subjective judgment. Current 1064-nm Q-Switched fractional laser is designed with focusing
      lens and can be scanned only once for skin lesions during treatment. Further more, the
      treatment energy of a single point is higher and it has stronger ability to destroy melanin.
      Finally, 1064-nm Q-Switched fractional laser promotes the expulsion of melanin particles from
      the superficial dermis and basal epidermis.

      3.Tranexamic acid (TA) works by inhibiting the plasmin-plasminogen pathway. Increase in
      plasmin in keratinocytes leads to increase in production of arachidonic acid and
      alpha-melanocyte-stimulating hormone (alpha-MSH) production. Thus, by inhibiting the plasmin
      pathway, TA results in decreased melanogenesis. Studies support the use of oral TA as an
      adjuvant therapy for in refractory cases of melasma or as a second-line or third-line agent,
      and there is some early evidence supporting the utility of oral TA as monotherapy. Overall,
      randomized controlled trials have found that combination treatment regimens using oral TA as
      adjunct therapy results in greater reduction of melasma.
    


Intervention name(s): tranexamic acid; 1064-nm Q-Switched fractional laser; 1064-nm Q-Switched laser
Intervention type(s): Drug; Radiation; Radiation
Intervention description(s): Oral tranexamic acid group(menstrual period>2days) 250mg bid（exclude menstrual period ）; Device: 1064-nm Q-Switched fractional laser is used for melisma with the MASI ≥24 left side of cheek is selected to be treated with 1064-nm Q-Switched fractional laser therapy (8ms, 1.5±0.5J/cm2) once 4 weeks for a total of 5 times; Device: 1064-nm Q-Switched laser is used for melisma with the MASI ≥24 right side of cheek is selected to be treated with 1064-nm Q-Switched laser therapy (8ms, 1.5±0.5J/cm2) once 4 weeks for a total of 5 times
Intervention MeSH terms: Tranexamic Acid
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Melasma; 1064-nm Q-Switched Fractional Laser; Tranexamic acid (TA); Treatment