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

Sridhar Venu, Sarath Chandran Balachandar, Kamalanathan Nallu, C. Lakshmanan


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.


Melasma, Trichloroacetic acid, Q-switched Nd:YAG laser, Post inflammatory hyperpigmentation

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Handel AC, Miot LDB, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014;89:771–82.

Melasma: a monography. 1st edition. New Delhi, Philadelphia: Jaypee Brothers Medical Publishers (P) Ltd; 2015: 86.

Rendon M, Berneburg M, Arellano I, Picardo M. Treatment of Melasma. J Am Acad Dermatol. 2006;545(2):272-81.

Barlow RJ, Hruza GJ. Lasers and light tissue interactions. In: Goldberg DJ, Dover JS, Alam M (eds). Procedures in cosmetic dermatology: lasers and Lights. 1st edition. Volume 1. Philadelphia: Elsevier; 2005: 1-11.

Pandya A, Berneburg M, Ortonne JP, Picardo M. Guidelines for clinical trials in melasma. Br J Dermatol. 2007;156(S1):21–8.

Kimbrough-Green CK, Griffiths CE, Finkel LJ, Hamilton TA, Bulengo-Ransby SM, Ellis CN. Topical retinoic acid (tretinoin) for melasma in black patients. A vehicle-controlled clinical trial. Arch Dermatol. 1994;130:727-33.

Pandya AG, Hynan LS, Bhore R, Riley FC. Reliability assessment and validation of the Melasma Area and Severity Index (MASI) and a new modified MASI scoring method. J Am Acad Dermatol. 2011;64:78–83.

SPSS. Statistical package for social science. Version 17. Standard version. Chicago, IL: SPSS Inc.; 2008.

Tsai T, Bowman P, Jee S, Maibach H. Effects of glycolic acid on light induced skin pigmentation in Asian and Caucasian subjects. J Am Acad Dermatol. 2000;43:238–43.

Rendon MI. Utilizing combination therapy to optimize melasma outcomes. J Drugs Dermatol. 2004;3:27.

Bansal C, Naik H, Kar HK, Chauhan A. A comparison of low fluence 1064nm Q switched Nd:Yag Laser with topical 20% azelaic acid cream and their combination in melasma in Indian patients. J Cutan Aesthet Surg. 2012;5:266-72.

Moubasher AE, Youssef EM, Abou-Taleb DA. Q-switched Nd: YAG laser versus trichloroacetic acid peeling in the treatment of melasma among Egyptian patients. American society of Dermatol Surg. 2014;40(8):874-82.

Houfbauer Parra CA, Careta MF, Valente NY, de Sanches Osorio NE, Torezan LA. Clinical and histopathologic assessment of facial melasmaafter low-fluence Q-switched Nd-YAG laser. Dermatol Surg. 2016;42:507-12.

Halachimi S, Haedersdal M, Lapidoth M. Melasma and Laser Treatment: An evidence based analysis. Lasers Med Sci. 2014;29:589-98.

Azzam OA, Leheta TM, Nagui NA, Shaarawy E. Different therapeutic modalities for treatment of melasma. J Cosmet Dermatol. 2009;8:275–81.

Dogra A, Gupta S, Gupta S. Comparative efficacy of 20% trichloroacetic acid and 50% glycolic acid peels in treatment of recalcitrant melasma. J Pak Assoc Derma. 2006:16:79–85.

Soliman MM, Ramadan SA, Bassiouny DA, Abdelmalek M. Combined trichloroacetic acid peel and topical ascorbic acid versus trichloroacetic acid peel alone in the treatment of melasma: a comparative study. J Cosmet Dermatol. 2007;6:89–94.

Safoury OS, Zaki NM, El Nabarawy EA, Farag EA. A study comparing chemical peeling using modified jessner’s solution and 15% trichloroacetic acid versus 15% trichloroacetic acid in the treatment of melasma. Indian J Dermatol. 2009;54:41–5.