Combining Low Power Fractional CO2 With QS-NdYAG Toning in the Treatment of Melasma Reduces the Incidence of Punctate Leukoderma.

BACKGROUND AND OBJECTIVES: Q-switched Nd:YAG (QS-Nd:YAG) toning (low fluence, large spot size, and high frequency) has been used successfully for the treatment of melasma, especially in dark skin phototypes. Punctate leukoderma was found to be a frequent complication that reduced the safety of this procedure. Combining low power fractional CO2 laser, which is another effective melasma laser therapy, might improve the efficacy and safety of this procedure. The aim of this study was to evaluate  the effect of combining low power fractional CO2 laser with QS-Nd:YAG toning in the treatment of melasma. STUDY DESIGN/MATERIALS AND METHODS: A randomized comparative split-face study included a total of 30 patients with bilateral, symmetrical melasma. All patients received QS-Nd:YAG toning on one randomly selected side of the face, while the other side randomly received either low power fractional CO2 alone (group A) or combined QS-Nd:YAG toning with low power fractional CO2 (group B). QS-Nd:YAG toning sessions were scheduled every two weeks for nine consecutive sessions, and low power fractional CO2 sessions were received every 4 weeks for three consecutive sessions. The assessment was done using the modified melasma area and severity index (mMASI) score, spectrophotometry (melanin index [MI] and erythema index [EI]), photography, blinded physician assessment, and patient satisfaction (at baseline, 1 week and 8-12 weeks after the last treatment sessions). RESULTS: A significant reduction in the mMASI score and MI was obtained with all treatment regimens. On comparing different modalities, group A reduction in mMASI and MI was significantly greater on the side receiving QS-ND:YAG toning (64.03% and 8.27%, respectively), than the side receiving low power fractional CO2 laser alone (36.02%. 2.64%, respectively). On the other hand, reduction of mMASI score and MI showed no statistical significance between the side receiving QS-Nd:YAG toning alone and the combined modality. Punctate leukoderma occurred in four cases (13%) on the side receiving QS-Nd:YAG toning. CONCLUSION: QS-Nd:YAG toning is significantly more effective than low power fractional CO2 in the treatment of melasma when used separately. Although combining low power fractional CO2 with QS-Nd:YAG toning does not increase its efficacy, it minimizes the incidence of the undesirable punctate leukoderma complication and achieves lower recurrence. This combination can thus be recommended as a safe and effective measure for the treatment of melasma. © 2021 Wiley Periodicals LLC.

Q-Switched Nd:YAG (532 nm) Laser Versus Intra-Dermal Tranexamic Acid for Treatment of Facial Ephelides: A Split Face, Randomized, Comparative Trial.

BACKGROUND AND OBJECTIVES: To compare the efficacy and safety of intradermal injection of tranexamic acid (TXA) versus Q switched (QS) KTP (532 nm) in the treatment of facial ephelides. STUDY DESIGN/MATERIALS AND METHODS: A randomized comparative split-face study included a total of 30 female patients with bilateral facial ephelides. One cheek was treated by intra-dermal TXA injections and the other was treated by QS-KTP (532 nm). Patient assessment was performed by photography, pigmentation area, severity index and spectrophotometry at baseline, 1 week after treatment, and 2 months after treatment. RESULTS: A significant difference was found between both sides regarding the percentage change of pigmentation area, severity score (PSI) and melanin index (MI) after treatment and during follow up, favoring laser (P = 0.001). PSI decreased after treatment by 66.5% and 15.4% (laser and TXA sides respectively), further decrease after follow-up was 69.4% with laser and 26.1% with TXA. MI improved by 3.7% after KTP laser to 7.7% after follow-up and by 2.4% after TXA injections to 6.5% after follow-up. Four patients developed post-inflammatory hyperpigmentation following QS-KTP. CONCLUSION: QS-KTP laser is superior to intradermal TXA injection in the treatment of facial ephelides. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Different therapeutic modalities for treatment of melasma.

BACKGROUND: Chemical peels and topical depigmenting agents have become a popular modality in the treatment of melasma. AIMS: To compare the clinical efficacy of trichloroacetic acid peel 20%vs. Jessner's solution peel vs. the topical mixture of hydroquinone 2% and kojic acid. PATIENTS AND METHODS: Forty five patients with melasma were randomly assigned into three groups of fifteen patients each. Group A received Jessner's solution peel, group B received trichloroacetic acid peel 20%, and group C received topical hydroquinone 2% and kojic acid. All patients were seen in follow-up period after 16 weeks; clinical evaluation using Melasma Area and Severity Index (MASI) score and photography were recorded before and after treatment and after 16 weeks. RESULTS: There was a decrease in MASI score in all three groups after treatment and after follow-up period but after treatment MASI score was statistically significantly lower in group A than group C (P = 0.01), and it was also statistically significantly lower in group B than group C (P < 0.001) but there was no statistically significant difference between groups A and B. After the follow-up period, MASI score was statistically significantly lower in group A than group C (P < 0.001), statistically significantly lower in group B than group C (P < 0.001), and statistically significantly lower in group B than group A (P = 0.035). The statistical analysis was done through one-way anova followed by least significant difference (LSD). CONCLUSION: Trichloroacetic acid 20% showed better results than Jessner's solution as peeling agent and hydroquinone 2% with kojic acid as a topical agent in the treatment of melasma.