title: Low-power fractional CO₂ laser versus low-fluence Q-switch 1,064 nm Nd:YAG laser for treatment of melasma: a randomized, controlled, split-face study.
abstract: BACKGROUND
  Various laser treatments are currently available for melasma but their use remains challenging because of potential side effects.
  
  
  OBJECTIVE
  The aim of this randomized controlled study was to compare the efficacy and safety of low-fluence Q-switch 1,064 nm Nd:YAG and low-power fractional CO2 laser using a split-face design.
  
  
  METHODS
  A total of 40 female patients with symmetric melasma were enrolled to the study and each side of their face was randomly allocated to either low-fluence Q-switch 1,064 nm Nd:YAG or low-power fractional CO2 laser. They were treated every 3 weeks for five consecutive sessions and followed for 2 months after the last treatment session. Response to treatment was assessed using the Melanin Index (MI) score, modified Melasma Area and Severity Index (mMASI) score, and a subjective self-assessment method.
  
  
  RESULTS
  At the 2-month follow-up visit, both sides of the face had statistically significant reductions in the MI and mMASI scores compared with the first visit (p < 0.001). The differences between the mean MI and mMASI scores at baseline and at 2-month follow-up were compared between the two treatments and results showed that the reduction of MI and mMASI score in the fractional CO2 laser-treated side was significantly more than on the Q-switch 1,064 nm Nd:YAG laser-treated side (p < 0.001). There were no significant adverse effects with either of the laser treatments.
  
  
  CONCLUSIONS
  The present study shows that low-power fractional CO2 laser is safe and effective and can be considered as a valuable approach in the treatment of melasma.
authors.affiliation: Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tajrish Sq, PO Box 1989934148, Tehran, Iran.
authors.forename: Niloofar Y
authors.initials: NY
authors.lastname: Jalaly
authors.forename: Neda
authors.initials: N
authors.lastname: Valizadeh
authors.forename: Behrooz
authors.initials: B
authors.lastname: Barikbin
authors.forename: Maryam
authors.initials: M
authors.lastname: Yousefi
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054020:Lasers, Gas / 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*; D008548:Melanosis / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult