Sarcouncil Journal of Medical Series

Abstract: Perioral hyperpigmentation remains a challenging clinical condition, often necessitating advanced dermatological interventions to target underlying melanogenesis. (Bhatt, S. et al., 2022) While ablative modalities such as fractional CO2 laser effectively address pigment through epidermal resurfacing, the concurrent application of Nd:YAG laser with tranexamic acid offers a non-ablative pathway that specifically inhibits melanocyte activity and dermal vascular components. (Pour Mohammad, A. et al., 2025) A total of 24 female participants enrolled in this study having hyperpigmentation around the mouth with multiple etiology , divided into 2 equal group , group A had 2 sessions of CO2 fractional laser with topical tranexamic acid while group B had Q-switch Nd:YAG laser of multiple session with low fluence with topical tranexamic acid for 12 weeks. Visual analog scale (VAS) and physician global assessment (PGA) are used to assessing the effect of these laser on the disease. The findings in the current study reveal a significant reduction in the mean of VAS and PGA score following combination treatment (from 5.80 to 2.40 for VAS and from 6.10 to 2.7 for the PGA) at the end of 12 weeks in group A while the group B has less reduction of the mean of VAS and PGA score (from 5.90 to 3.42 for VAS and from 5.88 to 3.22 for the PGA). In conclusion the comparative study indicates that fractional CO2 offers superior dermal remodeling, the Nd: YAG laser paired with tranexamic acid provides a more sustainable, low-risk approach for the complex management of perioral hyperpigmentation.