title: Q-switched Nd: YAG laser versus trichloroacetic acid peeling in the treatment of melasma among Egyptian patients.
abstract: BACKGROUND
  Melasma is a common disorder of facial hyperpigmentation that is often resistant to treatment.
  
  
  OBJECTIVE
  To evaluate the efficacy of trichloroacetic acid (TCA) peeling in comparison with double frequency Q-switched neodymium-doped:yttrium aluminum garnet (QS-Nd:YAG) laser in the treatment of melasma.
  
  
  METHODS
  Sixty-five adult Egyptian female patients with melasma were enrolled in this study. Wood light was used for determination of the histological type of melasma. The patients were divided into 4 groups according to treatment modalities: peeling with different concentrations of TCA and double frequency QS-Nd:YAG laser. Trichloroacetic acid peeling was performed every 2 weeks up to 8 sessions, whereas laser treatment was performed every month up to 6 sessions. Melasma area and severity index (MASI) score was used before and after treatment for evaluation.
  
  
  RESULTS
  Improvement percentage of MASI score was significantly higher among patients treated with TCA 25% (p < .001). Epidermal type of melasma was significantly improved compared with the dermal type (p = .0029). Q-switched neodymium-doped:yttrium aluminum garnet laser showed the highest incidence of postinflammatory hyperpigmentation (53.3%).
  
  
  CONCLUSIONS
  Trichloroacetic acid peeling is effective in the treatment of melasma, TCA 25% was the most effective concentration. Q-switched neodymium-doped:yttrium aluminum garnet laser is not recommended in the treatment of melasma because it was associated with the highest incidence of complications.
authors: *All the authors are affiliated with the Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors: Alaa E A
authors: AE
authors: Moubasher
authors: Eman M K
authors: EM
authors: Youssef
authors: Doaa A E
authors: DA
authors: Abou-Taleb
mesh_terms: D000328:Adult; D002615:Chemexfoliation / Q000009:adverse effects; D003877:Dermatitis, Contact / Q000209:etiology; D004534:Egypt; D005145:Face; D005260:Female; D006801:Humans; D007641:Keratolytic Agents / Q000008:administration & dosage*; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D008548:Melanosis / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D017060:Patient Satisfaction; D012720:Severity of Illness Index; D014238:Trichloroacetic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D007641:Keratolytic Agents; D014238:Trichloroacetic Acid