Clinical Efficacy and Safety of Combination Therapy Using Pico Laser, Platelet-Rich Plasma (PRP), and Tranexamic Acid (TXA) in The Management of Resistant Melasma

Abstract

Background: Melasma is a chronic, acquired hyper melanosis predominantly affecting individuals with Fitzpatrick skin types III–IV. Its complex, multifactorial pathogenesis and high relapse rate following conventional therapies necessitate development of more effective and safer treatment strategies.

Objective: To evaluate the clinical efficacy and safety of Pico laser combined with Platelet-Rich Plasma (PRP) and Tranexamic Acid (TXA), with or without co-administration, in patients with refractory melasma.

Methods: A prospective clinical study enrolled 40 patients, of whom 35 constituted the primary analysis cohort and 33 completed the full six-session protocol. Treatment groups received either PRP plus TXA or Pico laser therapy. Outcomes were assessed using the Melasma Area and Severity Index (MASI) and modified MASI (mMASI) at baseline, after three sessions, after six sessions, and at final follow-up. Adverse events were systematically recorded.

Results: The majority of participants were female (71.4%) in the 34–40 years age group (40.0%), with Fitzpatrick Skin Types III (45.7%) and IV (54.3%) predominating. Monotherapy yielded 20–48% improvement; combination therapy achieved 54–73% overall improvement. Both MASI and mMASI scores decreased significantly over 20 weeks (p < 0.01), with no significant difference between TXA and PRP modalities (p > 0.05). Final percentage improvement ranged from 57% to 65%. All adverse effects were mild and transient, with no serious events.

Conclusion: The combination of Pico laser, PRP, and TXA is a safe and clinically effective strategy for resistant melasma. Both TXA and PRP demonstrated comparable therapeutic benefits. Larger prospective trials with extended follow-up are warranted.