Effect of Hydroquinone Plus Neodymium-Doped Yttrium Aluminium Garnet Laser With and Without CO2 Fractional Laser on Resistant Dermal Melasma

Background The use of different types of lasers in the treatment of refractory melasma is still controversial. The present study was designed according to previous studies and used a combination of treatments. Objectives The purpose of this study was to compare Q-switched (QS) neodymium-doped yttrium aluminium garnet (Nd: YAG) laser and hydroquinone with or without CO2 fractional laser in refractory melasma. Patients and Methods Seventeen patients with refractory melasma, in a split-face randomized trial, received topical hydroquinone and Nd: YAG laser treatment on one half of their face and topical hydroquinone, Nd: YAG laser and CO2 fractional laser on the other half of their face. The patients were then assessed by Melasma area and severity index (MASI) over 12 weeks in three treatment sessions with an interval of three to four weeks. Results Seventeen patients with melasma (14 females and three males) with mean (± SD) age of 38.47 (± 6.29) years (range 29 - 53) were included in this study. The only side effect for the Nd: YAG treatment was erythema observed in two cases (11.8%). The mean MASI scores decreased significantly after six weeks for both therapies. Also, a significant reduction was observed in the mean MASI scores from week six till the end of the study. Controlling for the effect of “MASI score at baseline”, the mean MASI score was significantly lower on the side treated with Nd:YAG + CO2 fractional laser in comparison with the Nd: YAG laser. Conclusions Our study showed that the triple therapy of ND: YAG and ND: YAG + CO2 fractional and hydroquinone cream had high efficiency and low morbidity compared to twofold treatment with ND: YAG and ND: YAG + CO2 fractional