Hyaluronic acid-based skin booster with glutathione combined with 1064-nm Nd:YAG laser and oral tranexamic acid for melasma: A prospective comparative study.
- 1Department of Aesthetic Medicine, 3201 Hospital, 783 Tianhan Avenue, Hantai District, Hanzhong, Shaanxi, China.
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.
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BibTeX
@article{bai2026hyaluronic,
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.}},
author = {Jie Ling Bai},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051212},
url = {https://europepmc.org/article/MED/42888572},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Hyaluronic acid-based skin booster with glutathione combined with 1064-nm Nd:YAG laser and oral tranexamic acid for melasma: A prospective comparative study.
AU - Jie Ling Bai
PY - 2026
DA - 2026/10/01
JO - Medicine
DO - 10.1097/md.0000000000051212
UR - https://europepmc.org/article/MED/42888572
AB - 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.
SN - 0304-5412
SN - 1536-5964
ER -