title: A comparative study on efficacy of high and low fluence Q-switched Nd:YAG laser and glycolic acid peel in melasma.
abstract: BACKGROUND
  Melasma is acquired symmetric hypermelanosis characterized by light-to-deep brown pigmentation over cheeks, forehead, upper lip, and nose. Treatment of this condition is difficult and associated with high recurrence rates. With the advent of newer therapies, there is interest in the use of glycolic acid peels and Q-switched Nd:YAG laser (QSNYL) in high and low fluence for this disorder.
  
  
  OBJECTIVE
  To compare the therapeutic efficacy of low fluence QSNYL, high fluence QSNYL, and glycolic acid peel in melasma in three study groups of 25 patients each.
  
  
  METHODS
  Seventy-five Indian patients diagnosed as melasma were included. These patients were randomly divided in three groups (Group A = 25 patients of melasma treated with low-fluence QSNYL at weekly intervals, Group B = 25 patients of melasma treated with glycolic acid peel at 2 weeks intervals, Group C = 25 patients of melasma treated with high-fluence QSNYL at 2 weeks intervals). Study period and follow-up period was of 12 weeks each. Out of the 75 patients included, 21 patients in Group A, 19 patients in Group B, and 20 patients in Group C completed the study. Response to treatment was assessed using melasma area and severity index score.
  
  
  RESULTS
  Significant improvement was recorded in all the three groups. The improvement was statistically highly significant in Group A as compared to Group C (P<0.005), significant in Group A as compared to Group B (P<0.05), and also in Group B when compared to Group C (P<0.05). Low-fluence QSNYL was associated with least side effects.
  
  
  CONCLUSIONS
  This study shows the efficacy of low-fluence QSNYL and glycolic acid peel in melasma. These could be an effective treatment options compared to conventional methods for the treatment of melasma.
authors.affiliation: Department of Dermatology, STD and Leprosy, Dr. RML Hospital and PGIMER, Baba Kharak Singh Marg, New Delhi, India. hkkar_2000@yahoomail.com
authors.forename: Hemanta Kumar
authors.initials: HK
authors.lastname: Kar
authors.forename: Lipy
authors.initials: L
authors.lastname: Gupta
authors.forename: Amrita
authors.initials: A
authors.lastname: Chauhan
mesh_terms: D000328:Adult; D002615:Chemexfoliation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006016:Glycolates / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007641:Keratolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D028022:Low-Level Light Therapy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008548:Melanosis / Q000628:therapy*; D008875:Middle Aged; D017060:Patient Satisfaction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006016:Glycolates; D007641:Keratolytic Agents; C031149:glycolic acid