Effects Of Q-switched Laser Combined With Tranexamic Acid On Melasma And Its Effect On Serum Estradiol

Objective:To observe the clinical efficacy of Q-switched Nd:YAG 1064 nm laser,oral tranexamic acid alone,laser combined with tranexamic acid in the treatment of melasma,and study the changes of estradiol levels before and after treatment of melasma,explore a treatment with high efficacy and less side effects and the role of estradiol in the treatment of melasma.Method:From January 2017 to December 2017,45 patients aged 25-47 years who were diagnosed as having melasma by plastic surgery at the Jiangxi Provincial People's Hospital were selected.Randomly divided into three groups,namely the laser group,the drug group,the joint group,each group with 15 people.The laser group only received Q-switched Nd:YAG 1064 nm laser treatment,2 weeks/time,for a total of 8treatments,with 16 weeks as a course of treatment.The drug group received only oral tranexamic acid tablets,250 mg for each time,twice daily,for 16 weeks.The combination group was treated with laser and oral tranexamic acid tablets at the same treatment for 16 weeks.After 4 weeks of treatment,follow-up photos were taken before and during each visit.Two non-participating specialists were used to compare the modified melasma area and severity index(mMASI)score before and after treatment for the three groups of patients.The serum estradiol(E2)levels in the follicular phase were measured before treatment in the three groups of patients.The mMASI and E2 levels before and after treatment in the three groups were statistically analyzed.All adverse reactions that occurred during the entire course of treatment and follow-up were recorded in the three groups of patients.Results:Of the 45 patients enrolled,44 completed treatment and follow-up.After 4weeks of treatment,the difference of mMASI score in the laser group,the drug group,and the combined group was 1.82±2.7,2.06±0.79,and 4.27±1.82,respectively;the differences in the m MASI scores between the combined group and the laser group and the drug group were statistically significant(P<c0.05);Before and after treatment,the E2 levels in the laser group,the drug group,and the combination group decreased by 9.86±19.01,21.6±26.07,and 43.53±31.38,respectively;and the E2 decreased level before and after the treatment in the combined group was significantly different from that in the laser group(P<0.05).There was no significant difference between the drug group and the combination group(P>0.05).There were no significant adverse reactions in the three groups.Conclusion:1.Q-switched Nd:YAG1 064 nm laser or oral tranexamic acid tablets can effectively treat melasma2.Q-switched Nd:YAG 1064 nm laser combined with tranexamic acid tablets is superior to laser or tranexamic acid alone in the treatment of melasma,and has fewer adverse reactions.3.Tranexamic acid tablets can reduce estradiol levels in the treatment of melasma,which suggested that Q-switch laser combined with tranexamic acid may further improve efficacy by reducing estradiol levels.4.There is no linear correlation between the reduction of estradiol levels and the efficacy of melasma.The relationship between estradiol changes and the efficacy of melasma remains to be further studied.