- Design
- Single-centre randomised comparative study, 1:1
- Population
- 50 Chinese women with epidermal melasma, Fitzpatrick III–IV (36 completed)
- Primary outcome
- Change in modified MASI at 6 months and 2 months after treatment
- Effect
- Adjusted mean difference 0.72 points (95% CI 0.46–0.98); 6-month mMASI 2.50 vs 3.39
A single-centre Chinese study randomised 50 women with epidermal melasma and Fitzpatrick III–IV skin to six monthly sessions of low-fluence Q-switched 1064-nm Nd:YAG laser with oral tranexamic acid 250 mg daily, with or without intradermal hyaluronic acid carrying glutathione.
Only 36 completed. After adjusting for baseline, the combination lowered the modified Melasma Area and Severity Index by 0.72 points more across visits (95% CI 0.46–0.98). At six months mMASI was 2.50 versus 3.39, and the gap persisted two months after treatment (2.06 vs 2.67). Satisfaction did not differ significantly. Side effects were transient erythema, swelling and bruising.
This is relevant to Indian practice, where glutathione is heavily promoted. The trial is small, lost over a quarter of participants, and follow-up was only two months — too short for a relapsing condition. The absolute gain is under one mMASI point. It does not support intravenous glutathione, which this study did not test.
- Keep sun and visible-light protection and topical therapy as the foundation of melasma care.
- Treat intradermal glutathione as an adjunct with early, small-trial support only.
- Do not extrapolate this to intravenous glutathione, which was not studied.
- Screen for contraindications to tranexamic acid, including thrombosis history and oestrogen use.
- Warn patients that melasma relapses and that two months' follow-up says little about durability.
Why it matters
It gives a measured answer on a treatment patients often ask for.
Don't overread it
With 36 completers and two months of follow-up, durability is unknown.
The statistics, in plain English
The 0.72-point difference is statistically clear but small against a baseline mMASI of about 5.6. Losing 14 of 50 participants can bias results if those who left differed from those who stayed.
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