Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2024;14(3):e2024182 1 Successful Management of Post-Laser Hyperpigmented Scar with Intralesional Tranexamic Acid Injections Hanane Rachadi1, Fouzia Hali1, Fatima Zahra Elfatoiki1, Soumiya Chiheb1 1 Dermatology and Venerology Department, Ibn Rochd University Hospital, Hassan II University, Casablanca, Morocco Citation: Rachadi H, Hali F, Elfatoiki FZ, Chiheb S. Successful Management of Post-Laser Hyperpigmented Scar with Intralesional Tranexamic Acid Injections. Dermatol Pract Concept. 2024;14(3):e2024182. DOI: https://doi.org/10.5826/dpc.1403a182 Accepted: January 28, 2024; Published: July 2024 Copyright: ©2024 Rachadi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Hanane Rachadi, Dermatologist, Professor assistant in Ibn Rochd hospital university, Dermatology and venerology department. Ibn Rochd University hospital. Hassan II University. Casablanca, Morocco Casablanca, Morocco. Email: hananerachadi@ gmail.com Case Presentation A fifty-two-year-old woman, Fitzpatrick skin type IV, pre- sented with a hyperpigmented scar on the face. The patient had a history of a linear depressed scar on the left cheek, previously treated with the fractional CO2 laser, which was complicated by post-treatment hyperpigmentation. The aes- thetic appearance of the hyperpigmented scar (Figure 1A) affected considerably the patient social life, more than her initial depressed scar. A dermatological examination revealed a hyperpigmented macular lesion in the area treated with laser therapy. A dermoscopic examination revealed an exag- gerated pigment network associated with some telangiecta- sia. The lesion was treated with two intradermal tranexamic acid injections, diluted to 10% (10 mg/mL), with an interval of three weeks. At each session, we injected a total of 1 ml of product. After the two sessions, we observed a consid- erable clinical improvement with the total disappearance of hyperpigmentation, achieving good patient satisfaction (Figure 1B). Teaching Point Hyperpigmentation is a possible complication of laser ther- apy, particularly in patients with Fitzpatrick skin types IV and V. The management of this complication is based on topical corticosteroids and depigmenting creams with vari- able effectiveness. The use of tranexamic acid to treat me- lasma, lichen planus pigmentosus, and post-inflammatory hyperpigmentation has shown encouraging results [1,2]. In our case, tranexamic acid was injected intradermally and was associated with a rapid and very satisfactory response. Therefore, further studies will clarify the role of intrader- mal tranexamic acid injections as a cheap and effective therapeutic alternative for the management of post-laser hyperpigmented scars. 2 Image Letter | Dermatol Pract Concept. 2024;14(3):e2024182 References 1. Lindgren AL, Austin AH, Welsh KM. The Use of Tranexamic Acid to Prevent and Treat Post-Inflammatory Hyperpigmenta- tion. J Drugs Dermatol. 2021;20(3):344-345. DOI:10.36849 /JDD.5622. PMID: 33683077. 2. Chabchoub I, Litaiem N, Gara S, Bacha T, Jones M, Zeglaoui F. Efficacité de l’acide tranexamique dans le traitement des cicatri- ces postopératoires hyperpigmentées. Annales de Dermatologie et de Vénéréologie - FMC. 2021;1(8, Supplement 1):A327-A328. DOI:10.1016/j.fander.2021.09.383. Figure 1. (A) Post-laser hyperpigmented scar on the cheek. (B) Clinical picture 3 weeks after the second intradermal injection of tranexamic acid, showing almost complete disap- pearance of the post-laser hyperpigmented scar.