Publication:

A comparative study of low-fluence Q-switched neodymium-doped: yttrium aluminum garnet laser versus 15% trichloroacetic acid peel in the treatment of melasma

Background Melasma is an acquired, circumscribed, pigmentary disorder. It is characterized by more or less symmetrically distributed, dark brown macules with well-defined geographic borders and is often resistant to treatment. The aim of our study is to compare the therapeutic efficacy of low-fluence Q-switched neodymium-doped: yttrium aluminum garnet (Qs-Nd:YAG) laser versus 15% trichloroacetic acid (TCA) peel in the treatment of melasma.

Methods Our study was an open, prospective, comparative study that included 50 melasma patients. They were then randomized into group 1 (n=25) and group 2 (n=25) by means of sequentially numbered list. Patients in group 1 were treated with 15% TCA. The procedure was repeated every two weeks for 6 times. Group 2 patients were treated with low influence Q-switched Nd:YAG laser. The treatment was given for four sittings at a gap of 3 weeks. Melasma area and severity index (MASI) was used to assess the response of therapy. Patients were followed up for 12 weeks after completing the study.

Results The total percentage of reduction in mean MASI was 41.92% in group 1 and 27.88% in group 2 which was statistically significant (p=0.007). Post inflammatory hyper- pigmentation was the most common side effect in patients treated with Nd-YAG laser, particularly Fitzpatrick skin type V.

Conclusions 15% TCA was better than Q switched Nd:YAG laser for the treatment of melasma. Qs-Nd:YAG laser is not an effective treatment option due to higher incidence of adverse effects.