Comparative Efficacy of Fractional CO₂ Laser and Q-Switched Nd:YAG Laser in Combination Therapy with Tranexamic Acid in Refractory Melasma: Results of a Prospective Clinical Trial

Abstract

Melasma manifests as hyperpigmented macules and patches, usually affecting the face, neck, and rarely upper limbs. This study evaluated comparative efficacy of a fractional CO2 laser with a Q-Switched Nd:YAG laser in combination therapy with tranexamic acid in refractory melasma. A total of 30 patients with refractory melasma were included in this study. The fractional CO2 laser (power: 30 w, pulse energy: 30 mJ, tip type: 300, pulse rate: 100/cm2) was used on one side of the patients’ face and three passes of the Q-Switched Nd:YAG (QSNY) laser (Wavelength: 1064 nm, pulse energy: 750 mJ, fluence: 1.50 J/cm2, spot size: 4 mm × 4 mm, hand piece: fractional) were used on the opposite side of the same patient’s face for six sessions. During the course of laser therapy, all patients received oral tranexamic acid 250 mg twice daily. Melasma area and severity index (MASI) score and physician’s satisfaction and patient’s satisfaction were analyzed. Thirty patients (mean age 39.97) were included. Patient global assessment (PtGA) in the fractional CO2 laser group was significantly better than the Q-Switched Nd:YAG laser group at 4th, 8th and 12th weeks (p-value 2 laser group was significantly better than the Q-Switched Nd:YAG laser group (p-value 2 laser group decreased more than the Q-Switched Nd:YAG laser group over time (p 2 laser with oral tranexamic acid is an effective and well tolerated therapeutic method for the treatment of patients with refractory melasma.

Keywords

• comparative efficacy
• melasma
• fractional CO₂ laser
• tranexamic acid