Treatment of Melasma Using Low-Fluence QS Nd: YAG (1064 nm) Laser: A Blind, Randomized, Placebo-Controlled Trial

BACKGROUND Despite evidence supporting efficacy of low-fluence Q-switched (QS) neodymium-doped yttrium aluminum garnet (Nd:YAG) 1,064-nm lasers, treatment protocols are not standardized and limited to mostly retrospective, observational, or inadequately controlled studies. OBJECTIVE To investigate the safety and efficacy of low-fluence QS Nd:YAG (1,064 nm) laser in the treatment of melasma. MATERIALS AND METHODS A prospective, blind, randomized, placebo-controlled split face trial was conducted. Patients with Fitzpatrick skin types I-IV, and melasma severity scores of at least 2 received 3 monthly treatments using mechanical exfoliation, low-fluence QS Nd:YAG laser, hydroquinone 4% twice daily, and sunscreen. RESULTS Both treatment and control sides of the face showed a comparable decrease in melanin index (MI), with a statistically significant difference only after treatment 2 ( p = .04). The Modified Melasma and Severity Index (mMASI) score for both the treatment and control decreased but without any significant difference (.18 < p < .57). The highest level of patient-reported improvement occurred at week 8; however, patient-reported improvement decreased by the 6-month follow-up. CONCLUSION Placebo and laser treatment groups showed an effective, safe, yet similar decrease in both MI and mMASI scores, indicating that low-fluence, QS Nd:YAG laser treatments did not add significant benefit beyond combination topical therapies.