Objective To explore the clinical effect of skin needle tapping combined with local injection of tranexamic acid in the treatment of chloasma. Methods A total of 60 patients with chloasma admitted to Department of Dermatology, Pizhou Hospital of Traditional Chinese Medicine from January to December 2023 were selected as the research objects, and they were divided into control group and experimental group according to random number table method, with 30 patients in each group. The control group was treated with skin needle tapping, and the experimental group was treated with skin needle tapping combined with local injection of tranexamic acid. The improvement of chloasma, clinical efficacy, patient satisfaction, adverse reactions and recurrence were compared between the two groups. Results After treatment, the MASI score of the experimental group was lower than that of the control group (P <0.05). The total effective rate of the experimental group was 96.67%, which was higher than 76.67% of the control group (P <0.05). The satisfaction rate of the experimental group was 100.00%, which was higher than 80.00% of the control group (P <0.05). The incidence of adverse reactions in the experimental group was 3.33%, which was lower than 6.67% in the control group, but the difference was not statistically significant (P >0.05). The recurrence rate of the experimental group was 0, which was lower than 13.33% of the control group (P <0.05). Conclusion Skin needle tapping combined with local injection of tranexamic acid is effective and safe in the treatment of chloasma, which can improve the clinical symptoms of patients and is worthy of clinical application.