{
  "abstract": "Melasma is a chronic, acquired facial hyperpigmentation disorder with multifactorial pathogenesis and frequent relapse. Low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) (LQSNY) laser with oral tranexamic acid (TA) is widely used, but responses are often incomplete and short-lived. glutathione (GSH), an antioxidant that inhibits melanogenesis, may improve outcomes when delivered intradermally with a hyaluronic acid (HA) carrier. We assessed whether adding an HA-based GSH skin booster (HA-GSH) to this regimen enhances efficacy and durability. Fifty Chinese women with epidermal melasma (Fitzpatrick III-IV) were randomized 1:1 to 6 monthly LQSNY sessions plus oral TA (250 mg daily), with (Group A) or without (Group B) intradermal HA-GSH. The primary outcome was change in modified melasma area and severity index (mMASI) at 6 months and at 2-month posttreatment follow-up. Secondary outcomes were patient satisfaction (short assessment of patient satisfaction) and safety. Sample size was determined a priori. mMASI was analyzed using a linear mixed-effects model with baseline mMASI as a covariate and Benjamini-Hochberg adjustment for visit-level comparisons. Thirty-six patients completed the study (18 per group); baseline mMASI was comparable (5.61 ± 1.29 vs 5.56 ± 1.20; P = .89). Fourteen participants withdrew (seven per group), none due to adverse events. Group A showed significantly greater mMASI reduction from the third session onward. Adjusted for baseline, the mean difference across all post-baseline visits was 0.72 points (95% confidence interval 0.46-0.98; P < .001) favoring Group A, evident at the first posttreatment assessment. At 6 months, mean mMASI was lower in Group A (2.50 ± 0.62 vs 3.39 ± 0.70; P < .001), an advantage maintained at follow-up (2.06 ± 0.54 vs 2.67 ± 0.59; P = .003). More Group A patients were \"very satisfied\" (28% vs 11%), though not significantly (P = .31). Both regimens were well tolerated; only transient erythema, mild swelling, and bruising occurred, with no serious or pigmentary adverse events. Adding intradermal HA-GSH to LQSNY laser and oral TA produced earlier, greater, and more durable melasma improvement with high satisfaction and a favorable safety profile, supporting HA-GSH as a promising adjuvant pending confirmation in larger, longer trials.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Aesthetic Medicine, 3201 Hospital, 783 Tianhan Avenue, Hantai District, Hanzhong, Shaanxi, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 1,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Jie Ling Bai"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/f3pfy8njppbsq.bib",
  "cited_by": 0,
  "doi": "10.1097/md.0000000000051212",
  "fulltext_url": "https://europepmc.org/articles/PMC13681162",
  "id": "f3pfy8njppbsq",
  "issns": [
    "0304-5412",
    "1536-5964"
  ],
  "landing_url": "https://europepmc.org/article/MED/42888572",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2708|Dermatologic Treatments and Research"
    ]
  ],
  "openalex": "W7222757150",
  "pdf_url": "https://europepmc.org/articles/PMC13681162?pdf=render",
  "pmcid": "PMC13681162",
  "pmid": "42888572",
  "published": "2026-10-01",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/f3pfy8njppbsq.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:16Z",
      "native_id": "MED:42888572",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42888572"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2708|Dermatologic Treatments and Research",
      "subfield": "general"
    }
  ],
  "title": "Hyaluronic acid-based skin booster with glutathione combined with 1064-nm Nd:YAG laser and oral tranexamic acid for melasma: A prospective comparative study.",
  "title_text": "Hyaluronic acid-based skin booster with glutathione combined with 1064-nm Nd:YAG laser and oral tranexamic acid for melasma: A prospective comparative study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:16Z",
  "url": "https://research.draconitic.com/paper/f3pfy8njppbsq",
  "venue": "Medicine",
  "versions": []
}