〔Abstract〕 Objective To analyze the effect of microneedle repair and tranexamic acid tablets in the treatment of chloasma. Methods A total of 92 patients with melasma who were admitted to Taijiang Strait Aesthetic Hospital from June 2019 to September 2020 were selected and divided into a control group and an observation group according to the principle of random allocation, with 46 cases in each group. The control group was treated with tranexamic acid tablets, and the observation group was treated with microneedle repair combined with tranexamic acid tablets, the therapeutic effects of the two groups were observed and compared. Results The total effective rate of treatment of patients in the observation group was higher than that of the control group, and the difference was statistically significant (P < 0.05); The skin lesion area score, skin color score and total score of the observation group after treatment were lower than those of the control group. The differences were statistically significant (P < 0.05); The chloasma lesion area and severity index score system (MASI) scores of the observation group after treatment were lower than those of the control group, and the differences were statistically significant (P < 0.05); After treatment, the scores of the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) of the patients in the observation group were lower than those in control group, and the differences were statistically significant (P < 0.05). Conclusion The clinical effect of microneedle repair combined with tranexamic acid tablets in the treatment of melasma is ideal, which can significantly improve the symptoms of skin lesions, help the recovery of skin lesions, and eliminate the patient's bad mood to a certain extent.