title: Better clinical results with long term benefits in melasma patients.
abstract: BACKGROUND
  Low fluence Q-switched Nd:YAG laser has become popular in the treatment of melasma in Asian patients. However, it needs a lot of treatment sessions for substantial results and repetitive laser exposures may end up with unwanted depigmentation.
  
  
  OBJECTIVE
  We evaluated clinical effects and safety of combinational treatment using intense pulsed light and low fluence Q-switched Nd:YAG laser over laser treatment alone.
  
  
  METHODS
  Retrospective case series of 35 female patients with mixed type melasma were analyzed. Group A were treated with combination methods and group B with laser alone. At each visit, digital photographs were taken. Erythema index (EI) and melanin index (MI) were measured on the highest point on cheekbones. Modified melasma area and severity index (MASI) scores were marked using photographs by two blinded investigators.
  
  
  RESULTS
  The mean values of MI and EI decreased significantly in both groups. Modified MASI score reduction were 59.35% and 45.66% in groups A and B, respectively. In group A, 12 out of 20 patients were followed up (mean 5.9 months) without any further treatments and no clinical aggravations were observed. All patients in group B required at least five more treatment sessions for satisfactory results.
  
  
  CONCLUSIONS
  Combination treatment may provide more rapid clinical resolution in mixed type melasma with possible long term clinical benefits.
authors.affiliation: Department of Dermatology, Seoul National University Boramae Hospital, Seoul, Korea.
authors.forename: Se Young
authors.initials: SY
authors.lastname: Na
authors.forename: Soyun
authors.initials: S
authors.lastname: Cho
authors.forename: Jong Hee
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D004890:Erythema / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D062325:Intense Pulsed Light Therapy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008543:Melanins / Q000378:metabolism; D008548:Melanosis / Q000378:metabolism / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D008543:Melanins