Resumen

Objectives: This Systematic review and meta-analysis aims to evaluate the efficacy of fractional erbium: YAG laser combined with tranexamic acid (TXA) delivery methods compared to TXA alone for melasma treatment. Introduction: Melasma is a chronic hyperpigmentary disorder characterized by light-brown to bluish-gray patches. No single treatment is universally effective, and combination approaches are increasingly favored to enhance therapeutic outcomes. The fractional Erbium:YAG laser has been explored for enhancing TXA delivery, yet its comparative benefits remain uncertain Materials / method: A search was done in PubMed, Google Scholar, and Web of Science, including RCTs, cohort studies, and case series on melasma. Studies with high bias, low quality, active infections, inflammatory or systemic diseases, keloid history, anticoagulant/steroid use, or protocol non-compliance were excluded. Outcomes included melasma improvement, adverse events, pigment reduction, or treatment duration/relapse. Bias was assessed by the Newcastle-Ottawa Scale. Meta-analysis used a random-effects model to address variability. Results: We included 13 studies with 585 participants, mostly 30–60 each. Subgroup analysis of the modified Melasma Area and Severity Index (mMASI) showed no overall effect (SMD = -0.0802, p=0.8685) with high heterogeneity (I²=92.5%, p<0.0001). A large positive effect occurred at 3 months (SMD=1.9802) and a negative effect at 6 months (SMD=-0.7190), both significant. Overall intervention effect on MASI was minimal (SMD=0.0039, p=0.9877) with moderate heterogeneity (I²=50.3%, p=0.1337). A small negative effect appeared at 6 months (SMD=-0.4234); no significant effects at 3 months. Conclusion: There is no consistent or significant long-term impact on melasma severity. Although some short-term improvements were seen, these effects often diminished over time, showing limited lasting benefit