Increased pigmentation is the main characteristic of melasma. Melasma lesions have greater vascularization , solar
elastosis and an increased number of fibroblasts and mast cells compared with perilesional normal skin, suggesting that
altered dermal structures play an important role in the development of melasma. The aim of the present study was to compare
the efficacy and safety of topically applied tranexamic acid in combination with Fractional Co2 laser verus Fractional Co2
only in the treatment of melasma. This study was conducted on 20 patients suffering from melasma. Patients were recruited
from Dermatology outpatient clinic in Benha University. Written informed consents were obtained from all participants. The
patients were divided into two groups .Group A in whom the whole face was treated with fractional CO2 laser followed by
topical application of tanexamic acid solution, while group B were treated with fractional CO2 laser only. 50% of the cases
were in group A and 50% were in group B. There is no significant difference between the studied groups as regard baseline
data. Regarding the treatment efficacy, the results in both treatment groups were comparable. This table shows that there is
no significant difference between the two studied groups as regard patient satisfaction. All patients [100%] reported very
mild burning pain after the sessions that lasted for few hours. Mild erythema was experienced by patients for 3-5 days
following treatment sessions. Addition of topical tranexamic acid following fractional CO2 laser did not add to its efficacy.