Objective To investigate the clinical effect of tranexamic acid combined with hydroquinone cream in the treatment of chloasma. Methods A total of 60 patients with chloasma admitted to the Dermatology Clinic of Guanyun County Center for Disease Control and Prevention from January 2018 to December 2021 were selected as the research objects. They were divided into control group and observation group by random number table, with 30 patients in each group. The control group was treated with hydroquinone cream, and the observation group was treated with tranexamic acid combined with hydroquinone cream. The symptom score, Melasma Area and Severity Index (MASI), clinical efficacy, recurrence rate and adverse reactions were compared between the two groups. Results After treatment, the symptom score and MASI score of the observation group were lower than those of the control group (P <0.05). The manifest efficiency of the observation group was higher than that of the control group, and the effective rate and ineffective rate were lower than those of the control group (P <0.05). The recurrence rate of the observation group was 6.67%, which was lower than 30.00% of the control group (P <0.05). The incidence of adverse reactions in the observation group was 10.00%, which was slightly higher than 6.67% in the control group, but the difference was not statistically significant (P >0.05). Conclusion Tranexamic acid combined with hydroquinone cream is effective in the treatment of chloasma, which can improve the skin condition of patients, relieve clinical symptoms, reduce the recurrence rate, and will not increase the incidence of adverse reactions, with high safety.