Objective To analyze the efficacy and safety of intensive pulsed light combined with tranexamic acid in the treatment of chloasma. Methods A total of 137 patients with chloasma admitted to our hospital from December 2022 to March 2024 were randomly divided into control group (n =68) and observation group (n =69). The control group was treated with intensive pulsed light, and the observation group was treated with intensive pulsed light combined with tranexamic acid. The therapeutic effect, clinical related indicators, adverse reactions and recurrence were compared between the two groups. Results The total effective rate of treatment in the observation group (89.86%) was higher than that in the control group (73.53%), and the difference was statistically significant (P <0.05). The MASI score and transepidermal water loss in the observation group were lower than those in the control group, and the skin stratum corneum water content was higher than that in the control group, the differences were statistically significant (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). The recurrence rate of the observation group (1.45%) was lower than that of the control group (10.29%), and the difference was statistically significant (P <0.05). Conclusion Intensive pulsed light combined with tranexamic acid is effective and safe in the treatment of chloasma, which can improve the symptoms of chloasma and skin condition of patients, and will not increase the risk of adverse reactions. The recurrence rate is low.