Objective To explore the application effect of nanocrystalline microneedle introduction of tranexamic acid combined with dermoscopy in the treatment ofpatientswith chloasma. Methods A total of 70 patients with chloasma admitted to our hospital from June 2022 to June 2023 were randomly divided into control group and observation group, with 35 patients in each group. The control group was treated with oral tranexamic acid, and the observation group was treated with nanocrystal microneedle introduction of tranexamic acid combined with dermoscopy. The clinical efficacy, melasma severity index (MASI score), patient global assessment (PGA score), satisfaction and skin lesion score were compared between the two groups. Results The total effective rate of treatment in the observation group was 94.29%, which was higher than 77.14% in the control group (P <0.05). After treatment, the MASI score and PGA score of the observation group were lower than those of the control group (P <0.05). The satisfaction rate of the observation group was 97.14%, which was higher than 80.00% of the control group (P <0.05). After treatment, the total skin lesion score of the observation group was lower than that of the control group (P <0.05). Conclusion Nanocrystalline microneedle introduction of tranexamic acid combined with dermoscopy has a good effect in the treatment of chloasma, which can effectively improve the severity of chloasma, reduce the symptoms of skin lesions, promote recovery, and improve patient satisfaction.