Efficacy and safety of fractional Q-switched 1064-nm neodymium-doped yttrium aluminum garnet laser in the treatment of melasma in Chinese patients.

Abstract

Melasma is an acquired disorder of symmetrical hyperpigmentation commonly seen in patients with Fitzpatrick skin types III and IV. Various novel therapeutic modalities have emerged to treat melasma. The large-spot low-fluence QS Nd:YAG laser has been widely used in Asia; however, the modality needs to be optimized because of the high recurrence rate. The objective of this study is to explore the clinical efficacy and safety of fractional-mode (Pixel) Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) 1064-nm laser for treatment of melasma in Chinese patients. Twenty-seven patients were enrolled and completed all the treatment sessions and the 12-week follow-up. All were treated using the fractional-mode Pixel QS Nd:YAG (1064nm) laser for eight sessions at a 2-3-week interval. Clinical photographs were taken using the Visia skin analysis imaging system. Two blinded assessors evaluated melasma area and severity index (MASI) scores before and 4weeks after the final session. Melanin index (MI) and erythema index (EI) was measured before each treatment visit and after the final treatment. The degree of pigmentation and erythema was assessed using a tristimulus color analyzer. Physicians' global assessment (PGA) and patients' self-assessment were taken as the subjective assessments. Wilcoxon signed-rank test was performed to evaluate clinical response. Recurrence rate were also evaluated. Mean MASI scores decreased from 12.84 ± 6.89 to 7.29 ± 4.15 after treatment (p = 0.000). Seventy percent of patients got moderate to good improvements after all the treatment. Mean MI decreased significantly from 56.52 ± 23.35 to 32.75 ± 12.91 (p = 0.000). L value increased from 59.21 ± 2.22 before treatment to 61.60 ± 2.40 (p = 0.000) after therapy. The mean score of PGA was 3.76 ± 0.71, indicating a "moderate" clearance of the lesion. In patients' self-evaluations, 70% of the patients rated the result as "good" to "remarkable." Partial recurrence was seen in 40% patients at the 3-month follow-up. No severe adverse events were observed during the study, and the treatment was well tolerated. The fractional mode (Pixel) QS Nd:YAG 1064-nm laser is an effective and safe treatment for melasma. The recurrence rate was relatively lower than that reported in studies treating with large-spot low-fluence QS Nd:YAG laser.