Low-Fluence Q-Switched Neodymium-Doped Yttrium Aluminum Garnet (1,064 nm) Laser for the Treatment of Facial Melasma in Asians

BACKGROUND Pigment lasers have been used in melasma with unsatisfactory results. OBJECTIVE To determine the effectiveness and safety of 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS-Nd:YAG) laser treatment of melasma in Asians. MATERIALS AND METHODS Split-face randomized study comparing combination QS-Nd:YAG laser and 2% hydroquinone with topical treatment in dermal or mixed-type melasma. Twenty-two patients were treated with 1,064-nm QS-Nd:YAG laser, 6-mm spot size, 3.0- to 3.8-J/cm2 fluence for five sessions at 1-week intervals. Pigmentation was objectively recorded using a colorimeter (lightness index score), and subjective assessments were evaluated using the modified Melasma Area and Severity Index (mMASI) score. RESULTS After five laser treatments, statistically significant improvement of melasma from baseline was observed in colorimeter (p <.001) and mMASI score (p <.001) on the laser side. The laser side achieved an average 92.5% improvement in relative lightness index and 75.9% improvement in mMASI, compared with 19.7% and 24%, respectively, on the control side (p <.001). Mottled hypopigmentation developed in three patients. During follow-up, four of 22 patients developed rebound hyperpigmentation, and all patients had recurrence of melasma. CONCLUSION QS-Nd:YAG laser treatment for melasma in Asians produced only temporary improvement and had side effects. Common complications were hypopigmentation, melasma recurrence, and rebound hyperpigmentation. The authors have indicated no significant interest with commercial supporters.