Objective To investigate the clinical effect of Q-switched laser combined with nanocrystalline microneedle introduction of tranexamic acid in the treatment of chloasma. Methods A total of 70 patients with chloasma admitted to the People's Hospital of Chongzuo from January 2023 to January 2024 were randomly divided into control group and observation group, with 35 patients in each group. The control group was treated with Q-switched laser. On this basis, the observation group was treated with nanocrystalline microneedle introduction of tranexamic acid. The clinical efficacy, chloasma improvement and incidence of adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group was 77.14%, which was higher than 51.43% in the control group, and the difference was statistically significant (P <0.05). After treatment, the MASI score of the observation group was (6.31±1.05) scores, which was lower than (8.24±2.19) scores of the control group, and the difference was statistically significant (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion Q-switched laser combined with nanocrystal microneedle introduction of tranexamic acid in the treatment of chloasma has a good clinical effect, which can improve the facial skin lesions, and has good safety, which is worthy of clinical application.