A randomized comparative study of the efficacy of Q-switched neodymium-doped yttrium aluminium garnet laser versus 4% hydroquinone in the treatment of melasma

Objectives: The objective of the study is to compare the therapeutic efficacy and side effects of Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser versus topical 4% hydroquinone cream in the treatment of melasma. Material and Methods: Eighty patients with clinically diagnosed melasma were randomly assigned to two groups: Group A received three sessions of Q-switched Nd:YAG laser 4 weeks apart, while Group B applied 4% hydroquinone cream once daily for 12 weeks. Efficacy was assessed using modified melasma area and severity index (mMASI) scores; investigator’s global assessment (IGA); and patient global assessment (PGA) at weeks 4, 8, and 12. Results: In our study, the mean age was 34.48 ± 6.7 years, with a male-to-female ratio of 1:4. Both groups showed statistically significant reductions in mMASI scores over 12 weeks, with Group B consistently demonstrating lower mMASI scores (Week 12: Group A 3.97 ± 2.59 vs. Group B 2.98 ± 1.93; p = 0.023). Patient and IGA scores also improved in both groups, with Group B showing significantly better patient-reported outcomes at week 12 ( p = 0.043). The mean percentage reduction in mMASI increased progressively over time in both treatment arms. Although Group B showed numerically greater percentage reduction at all visits, the inter-group differences were not statistically significant at any time point. Side effects were mild and comparable; erythema was more common in Group B (17.50% vs. 5%). Conclusion: Both treatments produced significant improvement in melasma over 12 weeks. Although hydroquinone achieved lower absolute mMASI scores and greater patient-reported improvement at week 12, the percentage reduction in mMASI between the groups was comparable, suggesting that both modalities are effective treatment options.