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Methods: A total of 256 patients with melasma were treated with low-dose oral tranexamic acid for a period of 6-15 months with a mean duration of 9.6 months. The clinical effects, the time of onset of treatment, the recurrence and Adverse reactions. Results The majority of patients (80.9%) developed different degrees of pigmentation. Most of them (65.0%) started to have pigmentation relief 2 months after taking the medicine. Some patients (35.0% Appear effect After six months of medication basic cure, significantly regressed and improved the proportion was 10.5%, 18.8% and 51.6%. The rate of relapse after discontinuation was approximately 8.2% (21/256). In addition to mild gastrointestinal reactions in 4.3% of patients and 3.5% of patients with decreased menstrual flow, no other significant adverse reactions were found. Conclusion Low doses of long-term oral tranexamic acid is a safe and effective melasma treatment.