title: Melasma: treatment evaluation.
abstract: BACKGROUND
  Melasma is a common disorder of facial hyperpigmentation that can be resistant to treatment. Our purpose is to evaluate the clinical efficacy of the different available modalities of treatment of melasma among Egyptian patients who have mostly skin types IV-V under a sunny climate.
  
  
  METHODS
  A total of 45 patients with moderate-to-severe melasma were subjected to topical application of hydroquinone 4% cream, chemical peeling with 30% trichloroacetic acid (TCA) and/or frequency-doubled Q-switched Nd:YAG laser therapy for an average of 6 months. Clinical evaluation and melasma severity were recorded using the melasma area and severity index (MASI) score.
  
  
  RESULTS
  The improvement score was significantly higher among the topically treated group compared with other lines of therapy (p<0.0001). No significant difference in improvement score was detected in the laser group compared with the peeling group. The epidermal type of melasma was also significantly improved compared with the dermal type (p<0.01).
  
  
  CONCLUSIONS
  Topical hydroquinone remains the most effective agent for the treatment of melasma in dark-skinned people with rare side effects.
authors.affiliation: Department of Dermatology and Venereology, Faculty of Medicine, Zagazig University, Egypt. aasalem@live.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: Salem
authors.forename: Hend
authors.initials: H
authors.lastname: Gamil
authors.forename: Ali
authors.initials: A
authors.lastname: Ramadan
authors.forename: Mona
authors.initials: M
authors.lastname: Harras
authors.forename: Amin
authors.initials: A
authors.lastname: Amer