The study investigates the efficacy of oral tranexamic acid (TA) in combination with ketotifen for treating facial melasma and/or prevents TA posttreatment relapse, over a 90-day period, revealing no addnl. benefit with ketotifen when combined with TA.Evaluation of the reduction in the modified Melasma Area and Severity Index (mMASI), Global Aesthetic Improvement Scale (GAIS), and quality of life in participants receiving TA or TA plus placebo, showing a reduction in mMASI and MELASQol with no significant differences between groups.Discussion on the safety and effectiveness of the combination of oral TA with ketotifen in treating melasma, reaffirming the efficacy of TA in melasma treatment.Exploration of the potential of ketotifen in preventing UV-induced wrinkle formation by stabilizing mast cells, suggesting its use in photoaging treatment.The effect of ketotifen may have been concealed by the strength of melasma lightening promoted by TA. Furthermore, as pigmentation follows mast cell degranulation, ketotifen should be investigated to prevent relapse after treatment. However, this can be used to prospectively investigate the addnl. effect of ketotifen in combination with TA.