Comparative efficacy and safety of Oral Tranexamic acid with 35 percent Glycolic acid peels and Oral Tranexamic acid with low Fluence Q Switched ND-YAG Laser in treatment of Melasma.

Melasma a chronic acquired hypermelanosis affecting mainly the face (malar regains,chin,forehead ,upper lips) mainly triggered by uv radiations ,hormones and by genetically influence ,in which  pathogenesis includes triggering of melanocytes, interaction between keratinocytes, mast cells, gene regulation abnormalities,neovascularization,disruption of basement membrane and hormones .Many treatment options are available with unsatisfactory results ,so combination methods like Oral tranexamic acid with 35 percent glycolic acids peels to randomly selected 100 patents with 2 weeks interval gap ,total 6 sessions for 3 months durations and oral tranexamic acid with low fluence q switched nd- yag laser to randomly selected 100 patients with 2 weeks interval gap ,total 6 sessions for 3 months duration.clinical examination for decreased pigmentation is done by using mMASI(Melasma area severity index) after the end of procedure.