Combination of Q-Switched Nd:YAG and Fractional Erbium:YAG Lasers in Treatment of Melasma: A Randomized Controlled Clinical Trial

Abstract Introduction: Ablative and nonablative lasers have been used to treat melasma. We aimed to assess and compare the combining Q-switched Nd:YAG laser (QSNYL) and fractional erbium:YAG laser (FEYL) with QSNYL alone in treatment of melasma.Methods: This randomized controlled clinical trial was performed in our Research Center during ۲۰۱۳-۲۰۱۴. Women with melasma and without a history of keloid formation, hypersensitivity to hydroquinone, or pigmentary changes due to laser therapy were randomly allocated to receive four sessions of either QSNYL-FEYL combination or QSNYL alone. All patients received topical treatment with Kligman’s formula. Before laser therapy and ۴ weeks after the last treatment session, patients’ skin was assessed for changes in skin color, melanin content, and erythema intensity of melasma lesions quantitatively.Results: Finally, ۲۱ patients in QSNYL-FEYL and ۲۰ in QSNYL group (mean age, ۳۸.۵۷ [۵.۶۰] and ۴۲.۶۰ [۸.۴۴] years, respectively) completed study. The skin color had become lighter in both groups (mean [SD] percentage change of ۵۶.۹۵ [۴۰.۲۹] and ۲۹.۲۵ [۱۳.۲۰] in QSNYL-FEYL and QSNYL groups, respectively) with significantly better results in QSNYL-FEYL group (P = ۰.۰۰۶). Percentage of decrease of melanin content was significantly higher in QSNYL-FEYL group (۲۲.۰۱ [۱۰.۶۷] vs. ۷.۶۹ [۴.۷۵]; P < ۰.۰۰۱). After adjustment for baseline values, the post treatment intensity of erythema was significantly lower in QSNYL-FEYL group (P < ۰.۰۰۱). The patients reported no adverse events.Conclusion: QSNYL-FEYL was significantly more effective in decreasing melanin content of lesions than QSNYL and led to a lighter skin. Keywords: Melasma Melanosis Lasers Solid-State Erbium-Doped Yttrium Aluminum Garnet Lasers Neodymium Doped Yttrium Aluminum Garnet Lasers