Objective To explore the effect of dermal needle tapping on skin physiological parameters in patients with melasma. Methods A total of 68 patients with melasma admitted to Wuzhong District Xukou Town Health Center from February 2022 to January 2025 were selected as the research subjects, and they were divided into the control group and the study group by the random number table method, with 34 patients in each group. The control group was treated with local injection of tranexamic acid, and the study group was treated with dermal needle tapping. The skin condition, skin physiological parameters, clinical efficacy and adverse reaction rate were compared between the two groups. Results After treatment, the texture, pores, red areas, spots and wrinkles of the study group were better than those of the control group (P <0.05). The transepidermal water loss and pigment distribution concentration of the study group after treatment were lower than those of the control group, and the skin elasticity score was higher than that of the control group (P <0.05). The total effective rate of the study group (97.06%) was higher than that of the control group (79.41%) (P <0.05). The incidence of adverse reactions in the study group was lower than that in the control group (P <0.05). Conclusion Dermal needle tapping in the treatment of melasma can effectively improve skin condition and skin physiological parameters, with good clinical efficacy and high safety.