title: Long-term results in low-fluence 1064-nm Q-Switched Nd:YAG laser for melasma: Is it effective?
abstract: OBJECTIVE
  This study assessed the safety and clinical efficacy of a low-fluence 1064-nm Q-switched neodymium-doped:yttrium aluminum garnet (QS-Nd:YAG) laser in the treatment of patients with melasma.
  
  
  METHODS
  The study evaluated 34 melasma patients treated at a single institution using a 1064-nm QS-Nd:YAG laser. The laser parameters were 6 mm spot size and 2.5 J/cm2fluence with multiple passes for 6-10 (median 8) sessions at 2-week intervals. Outcomes were evaluated using photography, the modified Melasma Area and Severity Index (mMASI) score, and patient satisfaction interviews after the last treatment and 1 year after the last treatment.
  
  
  RESULTS
  After the low-fluence 1064-nm QS-Nd:YAG laser treatments, the mean mMASI score decreased from 6.7 ± 3.3 to 3.2 ± 1.6 (P < 0.01). After treatment completion, 20 of 34 patients (58.8%) rated themselves as having at least a 50% reduction in melasma severity. One year after the last treatment, recurrence was observed in 20 patients (58.8%) and the mean mMASI score increased from 3.2 ± 1.6 to 5.8 ± 1.9 in all patients.
  
  
  CONCLUSIONS
  The recurrence of low-fluence 1064-nm QS-Nd:YAG laser rates in melasma was high when the long-term results were considered. This result may be attributed to certain patient and treatment-related factors.
authors.affiliation: Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey.
authors.forename: Hilal
authors.initials: H
authors.lastname: Gokalp
authors.affiliation: Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey.
authors.forename: Ayse Deniz
authors.initials: AD
authors.lastname: Akkaya
authors.affiliation: Department of Dermatology, Amerikan Hastanesi, Istanbul, Turkey.
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Oram
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D028022:Low-Level Light Therapy; D008297:Male; D008548:Melanosis / Q000532:radiotherapy*; D008875:Middle Aged; D017060:Patient Satisfaction; D010781:Photography; D012008:Recurrence; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Q-switched lasers; facial melasma; hyperpigmentation; laser treatment