Low-Fluence Q-Switch Laser and Tranexamic Acid Can Quickly Treat Postinflammatory Hyperpigmentation

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Combining low-fluence Q-switch 1064 nm laser with oral tranexamic acid can quickly treat post-inflammatory hyperpigmentation induced by lasers, according to new research.¹ This study highlights a safe and reliable protocol with minimal complications that will manage this type of hyperpigmentation, especially on darker skin.

The retrospective cohort study took place across 2 years (2021 to 2023). Nearly all of the 20 patients were female. Participants were between the ages of 29 and 58 and had Fitzpatrick skin types of III or V. Each had post-inflammatory hyperpigmentation for less than 3 months, which was caused by picosecond laser (n = 7), fractional laser (n = 7), or intense pulsed light treatment (n = 6).

To begin the combination treatment, 250 mg of oral tranexamic acid was taken twice a day for a month. Then, 3 to 5 passes of the laser were applied in monthly intervals. The range of treatment sessions was between 3 and 6 but the average patient utilized 4 sessions.

Pigment color and patient satisfaction were evaluated before and after treatment via the Melasma Area and Severity Index (MASI) score. Standard VISIA-CR photographs on the cheeks were taken at baseline, before each treatment, and 2 months after the last session.

The MASI score decreased from 9.325 to 5.97. Just after the first treatment alone, the MASI score decreased by 40%. Two months after the final treatment, the MASI score decreased to 0.93, which was a 90% change from baseline (p < 0.05). At the 6-month follow-up, none of the patients said that their post-inflammatory hyperpigmentation had returned.

Nearly all of the participants achieved more than 75% improvement after the last treatment with 45% reaching 100% improvement. In terms of specific changes, it was found that pigment color decreased first, followed by improved pigment uniformity, and smaller pigment area.

Almost all patients (95%) were highly or strongly satisfied with the results, specifically the very fast decrease in color and intensity of post-inflammatory hyperpigmentation. This improved patients’ quality of life and reduced any feelings of anxiety or poor self-image. Furthermore, no participant had a poor response.

Hypomenorrhea was observed in 9 patients after the tranexamic acid treatment, but these adverse effects disappeared after discontinuation. Another patient also experienced mild nausea. After the first day of laser treatment, 2 patients reported itching and rash, but this was resolved with the use of mometasone furoate cream. Pigmentation did not worsen in any of the participants.

Tranexamic acid reduces tyrosinase protein expression in keratinocytes and is commonly used to treat melasma.² The investigators chose to combine this drug with the low-fluence Q-switch 1064 nm laser, as it is the most commonly used laser to treat post-inflammatory hyperpigmentation on darker skin. 

Laser-induced post-inflammatory hyperpigmentation may cause more direct damage to the deeper layers of the skin, especially when compared to Ultraviolet B- or drug-induced post-inflammatory hyperpigmentation.³ 

“Compared with UVB- and drug-induced PIH, the heat produced by inflammatory processes caused by laser treatment is more involved in the regulation of processes in fibroblasts, keratinocytes, and melanocytes,” the authors said.

This clinical study does have some limitations regarding the small sample size, non-randomized trial design, and lack of a control group.

“Larger, randomized controlled trials that investigate therapies for each skin type are warranted to optimize treatment strategies, and that is what we are going to do,” the researchers confirmed.

References

1. Feng W, Yang L. Low-Fluence Q-Switch 1064 Nm Laser Combined With Oral Tranexamic Acid: A Quicker Treatment for Laser-Induced Postinflammatory Hyperpigmentation. J Cosmet Dermatol. 2025;24(2):e70018. doi:10.1111/jocd.70018

2. Alsharif SH, Alghamdi AS, Alwayel ZA, Alaklabi SN, Alyamani NA, Sabsabee MA, Bu izran DAA, Alajlan AM. Efficacy and Best Mode of Delivery for Tranexamic Acid in Post-Inflammatory Hyperpigmentation: A Systematic Review. Clin Cosmet Investig Dermatol. 2022;15:2873-2882. https://doi.org/10.2147/CCID.S394889

3. Vachiramon V, Sakpuwadol N, Yongpisarn T, Anuntrangsee T, Palakornkitti P. Efficacy of isobutylamido thiazolyl resorcinol for prevention of laser-induced post-inflammatory hyperpigmentation: A randomized, controlled trial. J Cosmet Dermatol. 2024;23(7):2450-2457. doi:10.1111/jocd.16287