Objective: to assess the efficacy and safety of tranexamic acid cataplasm combined with large spot low energy Q switch Nd :YAG laser for melasma. Methods: Selected 180 patients with facial melasma as the research object, according to different treatment methods, the included patients were divided into group A and group B, with 90 cases each. Group A was treated by large spot low energy Q switch Nd :YAG laser, and Group B was treated by tranexamic acid cataplasm combined with large spot low energy Q switch Nd :YAG laser. The total melasma score decline index, total effective rate, dermatology life quality index (DLQI), melasma quality of life scale(MELASQOL) and adverse reactions of chloasma were observed and compared between the two groups after treatment. The patients in the two groups were followed up for 6 months to observe and compare the recurrence of patients in the two groups. Results: ①There was no statistically significant difference in total chloasma score before treatment (P>0.05)between the two groups, and decreased after treatment (P<0.05), but the difference in total chloasma score and decline index between the two groups after treatment were statistically significant (P<0.05).②The total effective rate of group A was 61%(55/90), and that of group B was 80%(72/90). The total effective rate of group B was significantly higher than that of group A (P<0.05).③There was no statistical difference in DLQI and MELASQOL scores between the two groups before treatment (P>0.05), and DLQI and MELASQOL scores were significantly reduced after treatment in the two groups (P<0.05), but the improvement degree in group B was greater than that in group A (P<0.05).④No serious adverse reactions occurred in all patients during the treatment.There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).During the 6-month follow-up, the recurrence rate of group B (5.6%) was lower than that of group A (11.1%), and the difference was statistically significant (P<0.05). Conclusion The efficacy of tranexamic acid cataplasm combined with large spot low energy Q switch Nd :YAG laser for melasma is significant, has high patient satisfaction, low recurrence rate and mild adverse reactions, which is worthy of clinical application.