Background: Melasma is a chronic hypermelanosis requiring effective therapies. Methods: This prospective, randomized controlled trial evaluated intense pulsed light (IPL) and topical tranexamic acid (TXA) versus IPL with placebo. Thirty-three patients completed the 5-month study (group A: TXA + IPL, n = 17; group B: Placebo + IPL, n = 16). Outcome included VISIA analysis, modified Melasma Area and Severity Index (mMASI), skin melanin index (MI) and erythema index (EI) measurement. Results: At Month 5, both groups showed improved mMASI scores; however, group A demonstrated a significantly greater reduction than group B (−50.52% vs. −38.49%; mean difference −12.03%, 95% CI −23.74% to −0.32%; p < 0.05). Excellent improvement was achieved in 70.59% of Group A versus 25% of Group B. Furthermore, Group A exhibited a significant decrease in MI (−36.31%) compared to a negligible change in Group B (−1.28%), with a significant between-group difference (p = 0.02). VISIA analysis confirmed superior improvements in brown spots and texture for Group A (p < 0.05). No adverse events occurred. Conclusions: Combining topical TXA with IPL is a safe and significantly more effective treatment for melasma than IPL alone, offering superior pigment reduction without increased risks.