A Pilot Study for Triple Combination Therapy with a Low-Fluence 1064 nm Q-Switched Nd:YAG Laser, Hydroquinone Cream, and Oral Tranexamic Acid for Recalcitrant Riehl’s Melanosis

This pilot study evaluated a novel combination therapy for recalcitrant Riehl’s melanosis using a low-fluence 1064 nm Q-switched Nd:YAG laser, hydroquinone cream, and oral tranexamic acid in 8 patients. The results showed that 3 patients achieved an "Almost clear" grade, while the remaining 5 experienced "Marked improvement." Significant decreases in mean Melanin and Erythema Indexes were observed, and histopathological examination confirmed a notable reduction in melanin content. No serious adverse events or post-treatment downtime were reported, suggesting this combination therapy could be a viable option for Asian patients at high risk of post-inflammatory hyperpigmentation.